Flexible nasal endoscopy

• Verbal consent was obtained and the nose sprayed with topical anesthetic and vasoconstrictor. A flexible fiberoptic scope was then introduced into the patient's nose and the nose and examined.

Rigid nasal endoscopy

• Verbal consent was obtained and the nose sprayed with topical anesthetic and vasoconstrictor. The nose was examined using a 0-degree rigid telescope. 

Endoscopic nasal debridement

• Informed consent was obtained. Topical anesthetic was sprayed intranasally in both nostrils. A zero-degree telescope and straight suction were used to remove mucous and crust from each nasal vestibule. Forceps were used to remove a few bloody crusts from the middle meatus. The operative site was examined and noted to be healing. The patient tolerated the procedure well and there were no immediate complications.

Flexible laryngoscopy

• Informed consent was obtained and the nose sprayed with topical anesthetic and vasoconstrictor. Flexible fiberoptic scope was then introduced into the patient's nose and the nose, nasopharynx, oropharynx, larynx, and hypopharynx were then examined.

Endoscopic control of epistaxis

• Verbal consent was obtained nose was examined with the aid of a 0-degree telescope. Any blood, mucous and clot was cleared with suction. Pledgets soaked with 4% topical lidocaine and oxymetazoline were then placed into nasal passage. Following adequate anesthesia and vasoconstriction, the pledgets were removed and the telescope was used to determine the source of bleeding. A source of bleeding in the *** was identified. Hemostasis was obtained with a combination of silver nitrate and Surgicel. No further bleeding was noted. The oral cavity and oropharynx were then examined and noted to be free of blood. The patient tolerated the procedure well and without immediate complication.

Biopsy

• Written consent was obtained. The target site was identified and anesthetized with 1% lidocaine with 1:100,000 epinephrine.  A ***punch biopsy/scalpel was used to sample the tissue in question. Hemostasis was obtained with manual pressure and silver nitrate. Patient tolerated the procedure well and without complication.

Transnasal esophagoscopy +/- biopsy

• Informed consent was obtained. The patient's nose and pharynx were anesthetized with a topical anesthetic. A flexible fiberoptic scope was passed transnasally and guided into the esophagus via the pyriform sinus. Upon entering the proximal esophagus, the scope was guided into the stomach while keeping the esophageal lumen centered at all times. Once entry into the stomach was verified, the distal end of the scope was returned a neutral position and the esophageal mucosa examined as the scope was withdrawn. Suspicious areas were biopsied and locations noted using distance markers on the scope. The patient tolerated the procedure well and without immediate complication.

Vocal fold injection

• Informed consent was obtained. The patient's nose and pharynx were anesthetized with a topical anesthetic. A flexible fiberoptic scope was passed transnasally and used to examine the pharynx and larynx revealing a paretic right/left vocal fold. 4% lidocaine was applied to the vocal folds and allowed to take effect. Restylane was drawn up in a sclerotherapy needle and passed through the scope. A total of 0.{Numbers; 0-9:30091} mL was injected into {Right/left/bilateral:19034:s} thryroarytenoid muscle  at about 1/2 the distance from the anterior commissure to the vocal process. Examination of the larynx during patient vocalization demonstrated satisfactory apposition of the vocal folds. The patient tolerated the procedure well and without immediate complication.

Drainage of peritonsillar abscess

• Informed consent was obtained. The anterior tonsillar pillar and fossa was infiltrated with with 1% lidocaine with epinephrine 1:100,000. The enlarged area adjacent the tonsil was identified. An 18 gauge needle attached to a control top syringe was inserted into the center of the enlarged region. Pus {was/was not:18636} aspirated from the abscess. A 1cm incision was then made in the anterior pillar, lateral to the tonsil. A hemostat was then used to spread the pocket. Additional pus {was/was not:18636} expressed. Hemostasis was maintained throughout the procedure and the patient tolerated the procedure well and without immediate complication.

Incision and drainage of abscess

• Informed consent was obtained. Local anesthesia was administered and given time to take effect. After adequate anesthesia was ensured, an 18 gauge syringe was used aspirate the abscess. Pus {was/was not:18636} successfully aspirated. An 11-blade scalpel was then was used to make a {NUMBERS 0-10:28024} cm incision into the swelling. Pus {was/was not:18636} appreciated. The wound was then probed with a hemostat to break up loculations. A total of {NUMBERS 0-10:28024}ml of pus was expressed from the wound. The wound was then copiously irrigated with sterile saline until no more pus was appreciated. A drain {was/was not:18636} placed and the wound left to heal by secondary intention. Adequate hemostasis was confirmed and the patient tolerated the procedure well and without immediate complication.

Closure of laceration

• Informed consent was obtained. A *** laceration was noted on the ***. The wound was copiously irrigated with sterile saline and infiltrated with 1% lidocaine with 1:100,000 epinephrine. The wound was then prepped with chlorhexidine. A sterile field was created around the wound. After ensuring adequate anesthesia, hemostasis was obtained and wound closed in layers using sutures. The patient tolerated the procedure without complication.