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, may be done as part of microtia reconstructionupdated June 5, 2016

 

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

Peds - General ETT, Kefzol 25mg/kg

If adult - GENERAL ETT or LOCAL w/ intravenous sedation

long anesthesia circuit

Kefzol 25mg/kg IV by anesthesia

PATIENT POSITION | SETUP

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

● Shoulder roll

● Large round gel headrest.

● 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 on field in blue prep cup for tattoing

[2] Glasscock ear cups

4" Coban

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

Saline

Kefzol irrigation, 500mg/500cc

NEEDLES | SYRINGES

● [4] 3cc syringes - for injection and tattooing

● [2] 10cc syringes - for injection

● [2] 20cc syringes - for irrigation

● [2] 20g 1¼" angiocaths (4056) - for irrigation

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

● [6] 1¼" 27g (305136) free needles in cup/gauze for tattooing

LOCAL ANESTHETIC

● 1% lidocaine with epi (in 3cc syringe with 30g needle)

● Pediatric mixture (in 10cc syringe with 1¼" 27g needle):

             mix 0.5% Ropivicaine with 1% lidocaine w/ epi

If adult, use Marcaine 0.5% instead of Ropivicaine

MEDICATIONS

● Kefzol for irrigation, 500mg/500cc

● Bacitracin ointment 2 oz

● Methylene blue in blue cup on field

603 OTOPLASTY - CHILD or ADULT page 2

 

SETS TO OPEN

Pres: DrC Fine Facial and Plastic sets

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

     FORCEPS

08 05 03 Adsons, Smooth Adsons

     SCISSORS

mama bears, papa bears, cvd and str Stevens, black Iris, straight Iris, str Mayo, str Metz.

     NEEDLE HOLDERS

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

     RETRACTORS

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

     KNIFE | BLADES

[4] No 15 blades

     OTHER

[4] mosquito clamps, 7fr Frazier tip, pedi Yankauer suction tip

 

 

STERILE SUPPLIES

● Long cotton tip applicators

● magnetic pad

● [4] marking pens

● blue silicone cup

● ½ “ steri strips

SPONGES

[2] Raytec

NON-STERILE SUPPLIES

 

 

 

No

Type

SN

status

SUTURES


[ 2 ]

4-0 Nylon PS2

1667

open

 

[ 4 ]

5-0 Plain P3

686

open

 

 [ 4 ]

5-0 Chromic P3

687

 

hold

[ 2 ]

6-0 Chromic G1

796

 

hold

[ 2 ]

4-0 Ethibond multipack

D-8366

open 1

hold 1

 

DRAINS

none

DRESSINGS

● [1] bx 4x4 sponges

● [2] 4" Kling rolls

● [1] tube Bactroban (Mupirocin) ointment

● [1] Tongue blade

● [1] 3"x 18" Vaseline gauze

● str Mayo scissors

● smooth forceps

● 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