603 OTOPLASTY - CHILD or ADULT

NOTE MODIFICATIONS if ADULT

usually cosmetic self-pay, may also be covered insurance procedure - ask for billing

unilateral or bilateral, limited or complete

updated December 21, 2018

 

OPERATIVE TIME: 2 ½ hours

USUAL LOCATION(S): Kaseman and Pres Main

FREQUENCY: 4-5/ year , especially summer

ASSISTANT: Gwen

ICD-10-CM Q17.5 Prominent ear

CPT CODE: 69300 OTOPLASTY

 

ANESTHESIA NOTES

long anesthesia circuit

Peds - General ETT, Kefzol 25mg/kg

   Tranexamic Acid, 10mg/kg up to 1 gram, repeat at 2 hours

   Tegaderm to eyes

Adult - usually LOCAL w/ intravenous sedation

   Kefzol 1 gm, TXA 1gm IV

PATIENT POSITION | SETUP

Regular OR table. If patient small, lower foot. Close head gap

● Shoulder roll

● Large round gel headrest, blankets

● Lower body Baer hugger

● 4" Coban if hair is long

TABLE POSITION

Will turn table 180 degrees

ROOM SETUP

Pre-warm bed and room 70 degrees

 

EQUIPMENT

Dr. C headlight with [2] light sources, [2] hydraulic pump-up stools

SPECIALS

Methylene blue - 1mL on field in blue prep cup for tattooing

[2] Glasscock ear cups

4" Coban - non sterile, off the field

PREP

PCMX to entire face and both ears

DRAPING

Head drape, 2 towels, 1000 drape, split sheet, basic pack

CAUTERY

Tips: Colorado tip [open],

         Valleylab silver coated flat E1450x [hold]

         Megadyne needle tip 0018 [hold]

Settings: 10/10 pure.

[2] Holsters

SUCTION

7 fr Frazier tip suction (NO Saf-T-Vac),

pedi Yankauer

 

SOLUTIONS | IRRIGATION

TXA/Kefzol irrigation: 200cc NS + 4gm TXA + 200 mg cefazolin

NEEDLES | SYRINGES

● [2] 3cc syringes w/ 30g needle - for injection

● [2] 10cc syringes - for injection

● [1] 20cc syringe w/ 20g angiocath - for irrigation

● [4] ½” 30g needles - for injection and tattooing

● [4] ½“ 25g needles in cup/gauze for tattooing

LOCAL ANESTHETIC

Peds mixture: 50/50 - in 3cc syringe with short 30g needle x 2

                                     and 10cc syringe with long 27g needle

    • 1% lidocaine w/ epi 1:100,000 and

    • 0.5% Ropivicaine plain

Adult mixture, use Marcaine 0.5% instead of Ropivicaine

MEDICATIONS

● Kefzol for irrigation

● TXA for IV and irrigation

● [2] tubes Bactroban (mupirocin) ointment

● Methylene blue - dispense 1 mL in blue cup on field

603 OTOPLASTY - CHILD or ADULT page 2

 

SETS TO OPEN

DrC Fine Set A & B - from Pres main OR

INSTRUMENTS USED - [3] Mayo stands: instruments, suture, dressing

     FORCEPS

08 05 03 Adsons, Smooth Adsons

     SCISSORS

Kaye, baby Kaye, mama bears, papa bears

Stevens cueves and straight

straight Iris, straight Mayo, straight Metz

     NEEDLE HOLDERS

[4] smooth and serrated Webster, [2] serrated Crile Wood

     RETRACTORS

Senn, 5mm, 7mm, and 10mm double skin hooks

     KNIFE | BLADES

[4] No 15 blades

     OTHER

[6] mosquito clamps, 7fr Frazier tip

 

 

STERILE SUPPLIES

● Long cotton tip applicators - put only [4] on field

● magnetic pad

● [4] marking pens

● blue silicone cup

● ½ “ steri strips for hair if long - [hold]

SPONGES

[2] Raytec

NON-STERILE SUPPLIES

Coban 4" for hair if long prior to prepping - [hold]

 

 

No

Type

SN

status

SUTURES


[ 2 ]

4-0 Black Nylon PS2

1667

open

 

[ 2 ]

5-0 Plain P3

686

open

 

 [ 2 ]

5-0 Chromic P3

687

 

hold

[ 2 ]

6-0 Chromic G1

796

 

hold

[6-8]

Gore-Tex CV-2, TH-26

2U02

 

hold

 

 

   48", same as SH, 0

[6-8]

Gore-Tex CV-4, TH-18

4U02

**order**

 

 

 

    48", same as RB-1, 3-0

[6-8]

Gore-Tex CV-5, TH-18

5N04

**order**

 

 

 

    36", same as RB-1, 3-0

 

DRAINS

none

DRESSINGS

● [1] bx 4x4 sponges

● [2] 4" Kling rolls

● [2] tubes Bactroban (mupirocin) ointment

● [1] Tongue blade

● [1] 3"x 18" Vaseline gauze

● straight Mayo scissors, Lister bandage scissors

● smooth Adson forceps

● 8" or 9" Spandage

● [2] Glasscock ear cups

 

POSTOPERATIVE

usually outpatient, may go home same day

NOTES

See also 608 Otoplasty Article

 

DATES MODIFIED

April 2006, August 2007, June 2009, Jan 2010, Apr 2010, Jun 2010,

August 2011, May 2013, Oct 2013, Dec 2015, Jun 2016, Dec 2018


***** NOTE: ORDER [1] box each Gore-Tex suture #4U02, #5N04 ****