DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Metastatic squamous cell carcinoma to the neck.
2. Nasopharyngeal mass.
POSTOPERATIVE DIAGNOSES:
1. Metastatic squamous cell carcinoma to the neck.
2. Nasopharyngeal mass, squamous cell carcinoma by frozen section.
PROCEDURE PERFORMED: Nasal endoscopy and nasopharyngoscopy with fine-needle aspiration, left nasopharynx, and biopsy of left nasopharynx.
ANESTHESIA:
1. Local 1% Xylocaine with 1:100,000 epinephrine, less than 1 mL employed.
2. Topical 4% lidocaine, less than 2 mL.
SPECIMENS REMOVED:
1. Fine needle aspirate, left nasopharyngeal mass, primarily respiratory mucosa.
2. Biopsy, 2, left nasopharyngeal mass, consistent with squamous cell carcinoma by frozen section.
ESTIMATED BLOOD LOSS: Less than 3 mL. Hemostasis was obtained at the conclusion of the procedure with no active bleeding.
COMPLICATIONS: None.
DESCRIPTION OF PROCEDURE: After the patient was identified, he was taken from the preoperative holding area to the operating room suite and transferred onto the operating table for Nasal endoscopy and nasopharyngoscopy. Because of the patient’s weight, there was limitation in head elevation. The legs were lowered slightly, the back was raised slightly, and the patient was placed in mild reverse Trendelenburg position until comfortable. He was awake and alert throughout the procedure, and we conversed with him on the degree of discomfort.
Neo-Synephrine-impregnated cottonoids were placed in the nasal cavity after the nasal cannula was removed and placed in the mouth for O2 supplementation. Topical 4% lidocaine was applied using cottonoids as well, and after the application of Neo-Synephrine, a 0-degree endoscope with Xenon lighting and video head was passed bilaterally. Photo documentation was taken.
There were no masses, lesions or polyps noted in the nasal cavity on the right or the nasopharynx on the right. Anterior to the choana, on the left, there was no involvement, including masses, tumors or lesions. However, the nasopharynx has an exophytic lesion in the perimeter of the eustachian tube torus. Local was infiltrated in miniscule amounts in the perimeter of the lesion, including the anticipated branch from the sphenopalatine. This was allowed to take effect. The patient tolerated this well. Fine-needle aspiration was completed with the findings as noted above.
Following this, bites were taken. Two separate bites, after entry to the mucosa, was completed and the posterolateral one-third of the left superior nasopharynx. Specimen was collected, and there was minimal bleeding afterwards. However, whatever bleeding was occurring was controlled with suction Bovie cautery with the setting of 10 watts with a few touches. The oozing was resolved fully. We awaited the verbal confirmation of squamous cell carcinoma by frozen section as being adequate for diagnosis.
Photo documentation was taken. Scope was removed. The table was nearly flattened. He was transferred to the cart and then taken through PACU to Day Surgery. The patient tolerated the procedure well. The instrument and sponge counts were all reported to be correct.
