419 Excision Buccal Fat Pads (intra-oral approach)

In this operation, buccal fat pads are removed through an intra-oral incision.

Usually under Local Anesthesia;

Can be done alone, but often done in conjunction with facelift

updated January 20, 2017 page 1

 

OPERATIVE TIME: 1½ - 2 hours

 

 

ANESTHESIA NOTES



Note: for general anesthesia use ENT position

Local Anesthesia: patient receives preop Valium, Demerol, and Clonidine. Moderate sedation protocol. Nasal O2 cannula with CO2 monitor

General Anesthesia: SCD’s, Foley catheter,

✔ regular OR table in ENT position - rotate clockwise after induction

✔ Dr. C to sew in tube with 0-Vicryl CT1, needle holder, scissors

✔ Accordion extension, ✔ straight connector, ✔ long circuit , ✔ regular ET tube

PATIENT POSITION | SETUP

Holding Area: On Stryker eye bed. Start IV on right side. Baer hugger.

   Apply warm Bovie pad, EKG pads, wrist restraints, etc. in holding.

   Give IV Kefzol, Zofran, Decadron and ½ to 1 mg Versed.

   Warm blankets, kisses and hugs.

In OR: Position patient bed flat, pillow under knees, terry cloth towel, gel pad, towels for headrest. [2[ blue Chux under head, blankets to tuck arms.

Rotate clockwise 135O. Nasal prongs with CO2 monitor.

- Aquaphor to lips. - Kerlix roll wrist restraints.

- Hair ties, comb and shaver box - extra pillow in room for end of case

ROOM SETUP

Warm room to 70O, then lower to 68O after patient. draped

Warm up Bovie grounding pad and EKG leads in warmer [for local]

[2] ring stands for dirty sponges; [1] Double ring stand for ice bath

[3] Mayo stands, [1] large back table

Bovie machine at foot of bed; bipolar foot pedal taped to floor

 

EQUIPMENT

Headlight and extension box, [2] light sources, [2] stools

PREP

Chlorxylenol (PCMX), 4x4 sponge box - do not add water.

DRAPING

Head sheet, 1000 drape, split sheet, 4 towels,

[2] rigid bovie holsters, [2] packs green towels

Custom ENT pack #315360

CAUTERY

Megadyne needle tip (0118A), [2] holsters

✔ Safe-t-Vac, ✔ [2] holsters, ✔ Bovie 20/20 pure

SUCTION

[2] blue 3/16" suction tubing for Saf-T-Vac & Yankauer

 

SOLUTIONS | IRRIGATION

[1] liters NS irrigation, [1] saline bowl - NO ICE unless doing FACELIFT

NEEDLES | SYRINGES

[2] 27g 1" needle on [2] 10cc syringe

[2] 16g angiocath [2] 30cc syringes ➤ for Gwen irrigation

LOCAL ANESTHETIC

Solution E1

     1% lidocaine w/ epi - 1 vial, buffered 1:10 with HCO3

MEDICATIONS

[4] Versed; [4] Fentanyl; [1] Zofran; [1] Kefzol

 

STERILE SUPPLIES

1000 drape, needle box, magnetic pad

NO scalpel blades - will use cautery for intraoral incision

SPONGES

[2] packs Raytec, 10ea.

NON-STERILE SUPPLIES

 

419 Excision Buccal Fat Pads (intra-oral approach)

 page 2

 

SETS TO OPEN

Dr. C Facelift Set, Special Plastic Set

INSTRUMENTS USED ON MAYO STAND

     FORCEPS

81 and 83 6" Adsons, smooth Adson, 7" Debakey, Dressing forceps, Cushings

     SCISSORS

str Metz, str Mayo, Reynolds

     NEEDLE HOLDERS

[2] Aesculup serr NH, [1] 6" Debakey NH

     RETRACTORS

Weitlaner self-retainer, sharp, medium

3/8" baby Deaver, L-shaped retractor, Weider cheek

     KNIFE | BLADES

NONE - will use needle cautery for intraoral incision

     OTHER

Weitlaner self-retainer, sharp, medium

 

SUTURES

No

Type

SN

status

 

 


4-0 Chromic PS-2


4-4-

 

 

 

[ 4 ]

4-0 Chromic PS-2

1637

open 2

hold 2

[ 2 ]

3-0 nylon PS-1

1663

open 1

 

 

 

 

 

 

 

 

 

 

 

 

DRESSINGS

none

POSTOPERATIVE

Remove head cushion, put 2nd pillow under head

DATES MODIFIED

Dec 2016, Jan 2017




NOTE DIFFERENCES:

 

Solution E-1 local

No scalpel, will use short needle tip electrocautery Megadyne (0118A)

Weitlaner self-retainer, sharp, medium

Tongue stitch using 3-0 nylon