Question

Assign an external cause to indicate how the injury occurred.

LOCATION: Outpatient, Hospital
PATIENT: Leann Heathchilds
ATTENDING PHYSICIAN: Jeff King, MD
SURGEON: Jeff King, MD

PREOPERATIVE DIAGNOSES
     1. Nasal fracture.
     2. Septal deviation.
     3. Nasal obstruction.

POSTOPERATIVE DIAGNOSES
     1. Nasal fracture.
     2. Septal deviation.
     3. Nasal obstruction.

PROCEDURES PERFORMED
     1. Septoplasty.
     2. Closed treatment of nasal bone fracture with stabilization. ANESTHESIA: General endotracheal.

INDICATIONS: A 24-year-old female who sustained nasal trauma after being hit by a batted ball while playing softball. This resulted in a nasal bone fracture and significant septal deviation with associated nasal obstruction. The patient presents now for surgical treatment.

PROCEDURE: After consent was obtained, the patient was taken to the operating room and placed on the operating room table in the supine position. After an adequate level of general endotracheal anesthesia was obtained and the patient was draped in appropriate manner for nasal surgery, the patient’s nose was packed with cotton pledgets soaked with 4% cocaine. After several minutes, 1% Xylocaine with 1:100,000 units of epinephrine was infiltrated into the septum bilaterally as well as into the nasal dorsum area. Nasal hairs were trimmed. Then using a right hemitransfixation incision, mucoperichondrium and mucoperiosteal flaps were elevated. The deviation portion of the cartilaginous bone was removed. After achieving hemostasis, the flaps were returned to normal position. Subsequent reinspection showed no residual deformity. Attention was then focused on the nasal bones. The right nasal bone was depressed, and the left nasal bone was deviated laterally. As such, using the Sayer elevator, the depressed nasal bone was pushed out, and then with lateral pressure on the left nasal bone, the nasal pyramid was brought to the midline. Subsequently, the hemitransfixation incision was closed with interrupted 4–0 chromic suture. A quilting suture of 4–0 plain gut was then performed. Silastic splints were then placed on both sides of the nasal septum and secured with nylon suture. The nose was then packed bilaterally. The packs consisted of a Merocel sponge covered with a gloved finger coated with Bacitracin ointment. This was infiltrated with local solution. An exterior nasal splint was then applied. Nasal dressing was applied. The patient tolerated the procedure well, and there was no break in technique. The patient was extubated and taken to the postanesthesia care unit in good condition.

FLUIDS ADMINISTERED: 1500 cc of RL. ESTIMATED BLOOD LOSS: Less than 25 cc.

PREOPERATIVE MEDICATIONS: 1 gram of Ancef and 8 mg of Decadron IV.

CPT Code(s): __________________________
ICD-10-CM Code(s):_____________________

Abstracting Questions:
1. Was the nasal fracture repair accomplished by means of open or closed manipulation?
2. Was the fracture externally stabilized?
3. What was the open procedure that was performed?

Answer 1

ANSWERS:-

1) The nasal fracture repair was done by closed manipulation: using the sayer elevator, the depressed right nasal bone was pushed out and and with lateral pressure on the left nasal bone the nasal pyramid was brought to the normal.

2)Yes, The fracture was externally stabilized by applying an exterior nasal splint.

3) The open procedure that performed was septoplasty (repair of the deviated nasal septum) by using a right hemifixation incision and elevating mucoperichondrial and mucoperiosteal flaps the deviated portion of the cartilaginous bone was removed.