502 COMPLETE COSMETIC RHINOPLASTY - OPEN TECHNIQUE

          May use Porex implant or harvest septal cartilage graft.

          Note differences if using endonasal approach or limited tip rhinoplasty.

          Usually GENERAL ANESTHESIA. Note if using local anesthesia.


Page 1/3 updated March 26, 2016

 

OPERATIVE TIME: 3½ hours

ANESTHESIA: usually GENERAL on regular OR table

ICD9 CODE: V50.1 ELECTIVE COSMETIC, 748.1 CONGENITAL NASAL DEFORMITY

CPT CODE: 30410 RHINOPLASTY COMPLETE

 

ANESTHESIA NOTES

GENERAL: ETT OR RAE [ask], straight connecter,

accordion extender or circuit extender for turning

Usually general, sometimes local (e.g. limited tip rhino only)

PATIENT POSITION | SETUP

GENERAL: on OR table - do not change head

*IF LOCAL: Usually on Stryker stretcher but may use OR table. Moisten lips with Aquaphor

Use round gel pillow, tuck arms, pillow under knees

TABLE and PATIENT POSITION

Will be turning bed 180° counterclockwise (to patient’s right)

Place Bovie machine and Baer hugger by anesthesia machine.

Pillow under legs; extra pillow after case.

HEAD SUPPORT: Terrycloth shoulder roll, large round head gel; blue chux, 2 blankets

ROOM SETUP

Headlight to be on right side of patient (after turning).

Warm bed with Baer hugger and warm room to 70-72 degrees to start, then lower to 68-70.

 

EQUIPMENT

Headlight w/ [1] light source on right side of patient

*IF LOCAL: Eye stretcher, NO Baer hugger NO sequentials

SPECIALS

Sometimes uses Porex ( DrC will bring)

PREP

PCMX prep, cotton tip applicators inside nostrils.

2 metal cups w/ 4x4's

DRAPING

Split sheet, head sheet with 2 towels, 1000 drape,

[2] towels, White towels for Mayo stands

CAUTERY

● Colorado tip - N103A

● Megadyne 0018 needle tip [HOLD]

● Bovie set for 8/8, w/ [2] holsters- E2400

SUCTION

[2] suctions: 7 fr. Frazier (non-disposable) and mini-Yankauer

 

SOLUTIONS | IRRIGATION

Saline irrigation

Antibiotic irrigation: Kefzol 500mg in 500cc NS

      Use 30cc syringe 20g angiocath for general irrigation

Water in bowl for clearing suction

NEEDLES | SYRINGES

NEEDLES: [2] each: ½" 30g, 1½ " 27g

ANGIOCATH: 20g angiocath, 20cc syringe for irrigation

SYRINGES: [2] each: 3cc, 5cc, 10cc, 20cc

LOCAL ANESTHETIC

on separate Mayo stand

Keep all locals separated

do not mix

Fill and label plastic specimen containers with:

● 2% lidocaine w/epi , [2] vials 20cc

● 0.5% marcaine w/epi , [1] vial 30cc

● 1% topical Neosynephrine - I vial

● 8cc 4% cocaine

● 4% cocaine 8cc, [2] vials of 4cc ea.

Dr. Cuadros will mix

MEDICATIONS

● methylene blue, draw up and put in blue cup for tattooing.

● Bacitracin ointment for dressing at end

*IF LOCAL: [3] Versed, [3] Fentanyl, [1] Zofran, [1] Kefzol

502 COMPLETE COSMETIC RHINOPLASTY - OPEN TECHNIQUE

 page 2/3

 

SETS TO OPEN

[2] sets: Dr. C fine facial/bleph set and Dr.C rhino set

[3] Mayo stands: one for locals/dressing, two for instruments

INSTRUMENTS USED (ON 3 MAYO STANDS)

     FORCEPS

Bayonet, 05 fine Adsons, 03 Adsons, smooth Adsons,

.5 and .3 CV eyelid, angled Debakey, Cushing, packing

     SCISSORS

Iris curved and straight, Stevens, Gradle, papa mama baby bears, serrated black iris, Joseph, Wescott

     NEEDLE HOLDERS

[4] fine smooth Websters, [2] Castro Viejos, [2] super-fines

     RETRACTORS | SKIN HOOKS

Fomon double ball, Tebbetts alar, Converse, Kasdan blue, Senn, Ragnell, finger self retainer, 2mm 5mm 7mm 10mm double hooks

KNIFE | BLADES

[1] 30° super blade [save container], [2] No. 15 BP

         ELEVATORS

Tebbetts, Key, Joseph, Freer, McCullough elevators

     OTHER

[2] Nasal speculums - Short and medium

[2] Osteotomes - 2mm and 4mm, with nylon mallet

Rasp - 3/4

Carmalt clamp

Calipers

small rongeur

sterile safety pin w/ vessel loop

 

STERILE SUPPLIES

● [10 pack] ½" x 3" Neuro cottonoid patties

● [2] ValleyLab white accessory holster - E2400

● 2" Kling for throat pack

● sterile safety pin

● [2] fine marking pens

● [2] ½" steristrips

● [1] ¼" steristrips

● [2] short cotton tip applicators

● mag pad

● [2] Mayo stand covers 89601

● red Vessel loops 011011PBX

● [2] Protegrity latex gloves 7½

● soap-less scrub brush

SPONGES

[2] packs Raytec 4x4

[1] pack of 10, ½" x 3" cottonoid Neuro patties - cut strings

 

 

No

Type

SN

status

SUTURES

note: in endonasal approach or for limited tip rhino will be using fewer sutures – therefore do not open as many

[2]

5-0 Chromic P3

687

open

 

[2]

6-0 Chromic G1

796 single

open

 

[1]

6-0 Prolene P1

8697

 

hold

[1]

7-0 Prolene P6

8648

 

hold

[2]

5-0 Monocryl TF

Y433

open

 

[4]

6-0 Monocryl P1

Y489

open 2

hold 2

 

DRESSINGS AND SPLINT

set up on Mayo stand

● Mastisol

● Large Telfa

● ½" steristrips

● ¼" steristrips

● smooth packing forceps

● straight cutting scissors

● Thermasplint - 1529010

● hot water in thermos jar

● crushed ice w/ water in jar

● nasal drip pad from mask

● 4x4 gauze

● bacitracin ointment

 

POSTOPERATIVE

crushed ice pack to eyes, nasal drip pad, pillow under knees

 

DATES MODIFIED:

May 2007, Nov 2007, Apr 2008. Jul 2008, Jul 2009, Jun 2010, Dec 2010,

Jan 2011, Dec 2011, Aug 2012, Aug 2013, Jun 2014, Sep 2014, Jun 2015,

Nov 2015, Mar 2016


RHINO MAYO STAND SETUP PAGE 3/3

1st MAYO – Local infiltration: syringes and needles, then dressings

                   > > > Dr. Cuadros will draw up and mix < < <

 

[4] Plastic Specimen Cups:

   2% Lidocaine w/epi

   0.5% Marcaine w/epi

   4% cocaine

   1% neosynephrine topical

Syringes:

   [2] 10cc syringes

   [2] 3cc syringes

   [1] 5cc syringe

Needles:

   [2] 27g 1" needles,

   [2] 30g ½ in needles

Instruments:

   bayonet forceps

   Vienna & Killian nasal speculum

   packing forceps

   Smooth Adson

Supplies

   2" Kling throat pack

   Raytec sponges

   marking pen

   cottonoids (cut strings)

Note: after local infiltration, change mayo stand to splint and dressings (see above)

2nd MAYO – Opening and fine dissection; then closure

 

Knives

   [1] super blade

   [2] round knife handles w/ #15 blade

Scissors

   Gradles

   baby, mamma, papa bears

   black serrated iris

   Stevens tenotomies

   Iris, straight and curved iris

   long baby bears

   Wescott

Tissue forceps

   Castro-Viejo forceps .5 & .3

   Sontec fine silver 0.5 CV

   05 Adsons

   Long 0.5 micro eyelid

Needle holders

    Smooth Webster

    [2] super-fines

    [3] Castro-Viejos

Retractors

   Converse nasal

   Casdan blue retractor

   safety pin retractor

   double ball

   4-prong

   2mm 5mm 7mm dbl skin

   Ragnell

   Bunnell

   self retaining retractor

Other

    Mini Yankauer sucker

    7fr Frazier sucker

    Marking Pens

    Raytecs folded 4 x 8

    Cutting board, w/ silastic sheet

    Blue and Yellow silastic prep cups

3rd MAYO – rasps, osteotomes, rongeurs, etc.

 

Elevators

   Joseph

   Key

   Tebetts

   Freer

   Mccullough

   Aufricht

Bone

   3/4 rasp

   2mm & 4mm osteotomes

   mallet

Other

   swivel knife

   rongeur

   Takahashi rongeur

   Boies elevator

   Carmalt clamp