return to: Reconstructive Procedures Protocols

Owen

• Clinic: Try to anticipate what might be needed. For post-op rhinoplasty patients, have the suction and a speculum ready. If packs or sutures are being removed, get the appropriate supplies from the MA/nurse. Ask for a flexible scope in the room for all new rhinoplasty patients. If no history of sinus/mucosal disease then OK to spray patient before he sees them.
• Post op rhinoplasty patients have .phrases for global care note. (.orhinonew, .orhinopostop1wk, .orhinopostop8wk)
• Inform MA or Nurse assisting in clinic of need for photos - any pre-op/post-op rhinoplasty patients and facial paralysis patients will require photos
• Residents may see facial paralysis patients initially, if clinic running on time.  Familiarize yourself with the .phrases used for facial paralysis clinic. (.ofacialparalysis)
• Botox: please have the nurse get:
  • 1 vial of Botox
  • 1 vial of saline
  • 1 each: 30 g needle, 18 g needle, 5 cc syringe, 1 cc syringe
  • cold pack/Ice
  • several 4 x 4s
  • Mixture is 2 cc of saline into vial of botox to give 5u of botox/0.1 cc

OPERATING ROOM PREFERENCES

• Prefers to papoose over tuck - greater access at patient's side, especially for rhino/septoplasties
• Gel round for head
• Half sheet under head, pillowcase turban - put this on after the prep
• Oral RAE in midline, tape only to lower lip. Gauze or scratch pad on chin so tube does not move around
• 180 degrees most cases
• Please print the patient photos the night prior to the OR. You may hang the photos on the wall, please be cognizant of the order (usually 1. Pt laying supine, lateral view with pt looking up, 2. Anterior- Front on view; just the face, 3. Lateral Left, 4. Base view, 5. Right oblique, 6. Left oblique, 7. Full H and N profile- front on, 8. Full H and N profile- lateral.)
• Nasal cases: Use the nasal prep tray to cut nasal hairs and apply lacrilube to the inferior fornix. Prefers 4% cocaine on pledgets-2 into each nostril. Place these first to get vasoconstriction effect before injecting. If patient has cardiac history, then use afrin pledgets. 1/2 size small Tegaderms are applied to eyes on the sterile field. May inject 1% lidocaine with 1:100,000 epi into septum with 25 g needle. Ask before injecting external nose to see if any markings need to be done before injection. Face prep with 5% ocular betadine. If using ear cartilage, prep and drape with Betadine.15C blade for hemi-transfixion and caudal cartilage cuts. Will use Doyle splints on all septoplasties unless in conjunction with a sinus procedure, then uses quilting stitch instead
  Nasal casting for any external rhinoplasty cases. (1/2" steristips, benzoin, casting). 
• Post-op rhino:
  • No humidified air (will cause cast to fall off) and no mask to face (pushes on nose)
  • Low salt diet to decrease swelling 
  • No contact sports or strenuous activity. 
  • Recommend button down shirts to avoid hitting nose. 
  • No nose blowing.  Sneeze with mouth open
  • Sleep with HOB up.
• Post-op septo:
  • No contact sports or stenuous activity, no lifting >10 lbs
  • No nose blowing, sneeze with mouth open
  • Sleep with head elevated
  • Nasal saline spray to nostril 4-6x/day
  • Bacitracin to nares BID
  • No CPAP for at least 1 month
  • Doyle splints will be removed in 1 week follow-up visit
• Septo/rhino discharge meds:
  • Cephalexin 500 mg QID x 5-7 days
  • Medrol dosepack
  • Lortab
  • Ocean spray NASL QID x 7 days