507 Open Tip Rhinoplasty - Child

       Nasal Reconstruction for Cleft Deformity

Soft tissue only; no osteotomy. Usually done at ages 5-7 years in a child with a cleft.

May include ear cartilage graft

Updated March 26, 2016

 

OPERATIVE TIME: 2 hours

LOCATION: Pres Main or Day

FREQUENCY: 2-4/year

ASSISTANT: NO

ICD9 CODES: 749.21 CLP unilateral, 749.23 CLP bilateral, 748.1 CONGENITAL NASAL DEFORMITY

CPT CODES: 30460 RHINOPLASTY CLP DEF TIP ONLY

 

ANESTHESIA NOTES

regular ETT tube (not RAE), Dr. C to suture tube with 2-0 silk, Dr. C to start IV, IV pump in room, temp probe

PATIENT POSITION | SETUP

•Will turn bed

•Rolled terrycloth towel for shoulder roll.

•Large round gel doughnut

•Pedi or lower body Baer hugger depending on child size

TABLE POSITION

Lower foot, large round gel doughnut, place Baer after turning.

ROOM SETUP

Pre-warm room and bed, set thermostat to 72°, Baer to bed. MAKE LABEL FOR PHARYNGEAL PACK - GIVE TO ANEAS.

 

EQUIPMENT

Light source w/headlight on patients right, Baer hugger

SPECIALS

none. NO Coblater

PREP

PCMX with minimal water, cotton tip applicators to clean nose

DRAPING

Head sheet (two green towels and a ½ sheet), ½ sheet, magnetic pad, holster for bovie, towel clips,

½ in. steri-strip or Tegaderm for eyes,

1000 drape, 2" Kling for pharyngeal pack

4" Coban for long hair, if ear cartilage to be taken

CAUTERY

Bovie 8/8 pure, Colorado tip, 18A tip, holster, bovie pad

SUCTION

2 suctions, single with 7fr Frazier tip, baby Yankauer/peds suction, 10fr NG suction catheter at end

 

SOLUTIONS | IRRIGATION

Kefzol irrigation 500mg/500cc NS,

30cc syringe with 20g angiocath, saline, water

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

in 3cc syringe with 30g needle:

     ● 1% lidocaine w/ epi 1:100,000

In 10cc syringe with 27g needle:

     ● Mixture 1% lidocaine w/ epi 1:100,000 0.5% Ropivicaine

MEDICATIONS

● methylene blue for tattooing

● 1% Neosynephrine (NO cocaine) for soaking packs

● Kefzol for irrigation

● Bacitracin ointment

 

507 Open Tip Rhinoplasty - Child

       Nasal Reconstruction for Cleft Deformity

Page 2

 

SETS TO OPEN Rhino set, Fine instrument set

INSTRUMENTS USED (ON MAYO STAND) - 3 mayo stands

     FORCEPS

Packing forceps, 05 Adson, .3 & .5 CV fine, bayonet forceps, angled Debakey

     SCISSORS

Gradle, fine, straight tenotomy, curved tenotomy, Iris, Stevens

     NEEDLE HOLDERS

[3] Castroviejos, [3] smooth Webster

     RETRACTORS

[2] ea: 2mm, 5mm, 10mm skin hooks,

nasal ball retractor, blue Kasdan, nasal tip, Ragnell, Demars, tip retractor

     KNIFE | BLADES

[1] 30° super sharp blades #7531, [2] 15 BP scalpel blades

     ELEVATORS

Hockey stick, Tebbetts, McCollough

     OTHER

calipers, measuring cup, med glasses, blue silicone cups, cutting board, nasal speculum

 

 

STERILE SUPPLIES

• [2] marking pens with ruler

• ½" x 3" Neuro patties

• bacitracin ointment

• non-disposable light handles

• methylene blue

• med glasses

• ½" steri-strips for eyes

• 10fr suction catheter

• Basin set

SPONGES

Raytec, 2" Kling for pharyngeal pack, cotton tip applicators, towel pack, ½" x 3" Neuro paddies

NON-STERILE SUPPLIES

Pedi or lower body Baer hugger,

 

 

No

Type

SN

status

SUTURES

[ 1 ]

2-0 Silk SH

K833

 

hold

[ 2 ]

5-0 Plain Gut P-3

686

 

hold

[ 2 ]

5-0 Chromic P-3

687

 

hold

[ 2 ]

6-0 Chromic G-1 single

796

open

 

[ 2 ]

6-0 Monocryl P-1

J489

open

 

[ 2 ]

5-0 Monocryl P-3

Y493

 

hold

[ 2 ]

6-0 Prolene P-1

8697

 

hold

[ 1 ]

7-0 PDS BV-1

2135

 

hold

[ 2 ]

7-0 Prolene P-6

8648

 

hold

 

DRAINS

none

DRESSINGS

bacitracin to wound, remember to remove pharyngeal pack and cut suture, 10fr or 14fr suction catheter to suction stomach.

Steristrips, telfa (NO Aquaplast NO hot water needed)

 

POSTOPERATIVE

Remember to remove nasal and pharyngeal packs

NOTES

 

 

COMMENTS

 

DATES MODIFIED

Nov 2007, Sept 2009, Jun 2013, Mar 2014, Mar 2016