Rhinoplasty

Surgical cosmetic procedure involving the reshaping or repositioning of the nose to enhance improve facial harmony. 

01 - Patient Setup

Pre-op Meds: Ancef or Clindamycin, Decadron 8 mg, Tranexamic acid

Anesthesia:  General, ETT off ;pt's left side about 2cm from commisure

Patient position: Supine

Bed position: 90° (R side of patient facing surgeon, L side facing anesthesia)

DVT ppx:  Compression boots on - working BEFORE induction of anesthesia

Side Table: Prep table includes 10 mL 1% lidocaine, 1/100 K epinephrine, 27 gauge needle, speculum, packing forceps, 6 nasal pledges soaked in Afrin, scissors

Lights: Surgical headlamp for surgeon

Bovie Settings: 10-10, Colorado Tip

Preinjection: See "Side Table"

Prep:  Ophthalmic Betadine

Drapes:  4 towels w/ split sheet

Instrument sets:   Tebbets rhinoplasty set, septoplasty set

03 - Case Details 

02 - Instrument Sets

Rhinoplasty Set

Special Instruments:  carving block, carving grid, graft templates, and  dorsal nasal sizers

Special Instruments: Carving block + grid, graft templates, dorsal nasal sizers.

Devices/Implants: None

Meds on field: Afrin (20cc) and 10cc syringe with 16 angiocath tip

Hypodermic needles:  27 gauge

Syringes:    10 mL w/ 1% lidocaine, 1/100 K epinephrine

Drains: none

Suture: 5-0 PDS undid cutting small needle, 6-0 praline taper, 4-0 plain gut straight needle, 5-0 chromic RB-1

Anesthesia on field: 10 cc 1% lidocaine 1-100 K epinephrine

Dressing:  benzoin + 0.5 in Steri-Strips cut by surgeon

04 - Post-Op Information

Admission status: SDS

Estimated time: 2 hrs

Coding:  ICD-9 478.19, 470.0, 905.0. CPT ask surgeon

Post-op wound care:  Minimize nose bleeding, knees w/ open mouth, drip pads for bleeding.

Post-op activity restrictions:  No vigorous activity for 2 wks

Follow up:  1 wk