The patient was greeted in the preoperative area. All the risks and benefits of the procedure were once again explained and the risks of sinus communication as well as lower chin and lip numbness were explained in detail all questions were answered. Consent had already been signed. Care was then handed back to the anesthesia team.
The patient was brought into the operating room by the anesthesia team and the patient was placed in a supine position where the patient remained for the rest of the case. Anesthesia was able to establish an orotracheal intubation without any complications. Care was then handed back to the OMFS team.
Patient was draped in sterile manner timeout was performed in which the patient was correctly identified by name medical record number as well as a site of the procedure be performed. Patient had received preoperative IV ampicillin Antibiotics. Once a timeout was completed oral cavity was thoroughly suctioned with the Yankauer suction the moist vaginal packing was used it as a throat pack. Patient was given local anesthesia with 1% lidocaine with 1-100,000 epinephrine as local anesthesia extraorally then intraorally via local blocks and infiltration for OMFS procedures.
Attention was drawn extraorally in the *** submandibular region where a skin incision was made approximately 2 finger breadths below the inferior border of the mandible in skin and subcutaneous tissue. Curved stats were then introduced for blunt dissection through platysma carying the stats superiorly to the inferior border of the mandible to enter the submandibular space. The stats were withdrawn. Copious *** drainage was expressed. Cultures were then collected and passed off the field. The stats were then reintroduced staying along the bony mandible to enter the sublingual space while performing bimanual palpation intraorally. The stats were then carried superiorly while staying along the bony mandible to enter the lateral pharyngeal space while performing bimanual palpation intraorally. The stats were withdrawn. *** drainage noted. The stats were then reintroduced staying along the bony mandible going superiorly and laterally along the ramus to enter the masticator space. Scant drainage noted. The stats were withdrawn. A single 1/4″ penrose drain was then placed within the submandibular and sublingual spaces, and secured to the skin with 3-0 prolene suture. The incision was then irrigated.
Attention was directed toward the submental space where a skin incision was made approximately 2 finger breadths below the inferior border of the mandible in skin and subcutaneous tissue. Curved stats were then introduced for blunt dissection through genioglossus muscle carying the stats superiorly into the space of the floor of the mouth. *** drainage was expressed. The stats were withdrawn. A 1/4″ pennrose drain was then introduced and secured with 3-0 prolene suture.
Attention was then drawn intraorally where a full thickness mucoperiosteal flap was designed within the gingival sulcus to separate the gingiva from the teeth. The subperiosteal space was entered. ***Drainage was expressed. Blunt dissection with stats were used to enter through the buccinator muscle to the buccal space. *** drainage was expressed. The stats were withdrawn. The stats were then reintroduced intraorally under the flap along the lateral ramus of the mandible posteriorly to access the masticator space intraorally. *** drainage was expressed. The stats were then withdrawn. The stats were then re-introduced along the lingual aspect of the ramus of the mandible staying along the bony mandible to enter the sublingual and submandibular spaces intraorally. *** drainage was expressed. The stats were then withdrawn. A 1/4″ penrose drain was the placed intraorally within the submandibular, pterygomandibular, and buccal spaces and secured with 3-0 vicryl suture.
Attention was then drawn intraorally where a periosteal elevator was used to separate the gingiva from the teeth. Full thickness mucoperiosteal flaps elevated at all extraction sites. Periosteal elevator to remove minimal crestal bone. Universal forceps were used to extract teeth #*** without any complications. Surgical sites were thoroughly curetted, bone filed, and irrigated with sterile saline. Closure with 3-0 chromic gut sutures. All surgical sites were reevaluated found to be hemostatic. Next the oral cavity was thoroughly irrigated with sterile saline and suctioned with the Yankauer suction. The moist vaginal packing was removed and the oropharynx was suctioned.
Care was then handed back to anesthesia team where the patient was extubated in the operating room without any complications and then transferred to the postanesthesia care unit.
