Surgeon(s): ***

‍Assistant Surgeon(s):  ***

‍Preoperative Diagnosis: ***

‍Postoperative Diagnosis: Same

‍Procedure(s): ***

‍Anesthesia: General

‍Implants: None

‍Specimen:***

‍Drains: None

‍Fluids: See anesthesia record

‍EBL: Minimal

‍Complications: None

‍Counts:  Correct x2

‍Indications: ​***

‍Findings: As expected

‍Procedure in Detail:

‍The patient was seen in the preoperative holding area with a H&P was updated, consents were verified, surgical site marked, and all questions and concerns related to the proposed procedure were discussed in detail.  The patient was transferred to the operating room by the anesthesia team.  The patient underwent general anesthesia with endotracheal intubation. Tegaderms were placed over the eyes. The patient was prepped and draped in the standard fashion for maxillofacial procedures.  A time-out was performed and the procedure began.

A pinch test was performed to assess the available skin to be included in flap design while leaving room for primary closure at the defect site. The incision was placed through the skin, subcutaneous tissue and platysma muscle at the inferior marking followed by raising the lower subplatysmal flap up to the clavicle. The upper incision was placed below the mandible and upper subplatysmal flap raised up to the lower border of the mandible. A tacking suture was placed to avoid shearing injury to the skin perforator. The marginal mandibular nerve and facial vessels were carefully identified. The flap was raised from the contralateral side while including the ipsilateral belly of digastric muscle. The dissection was continued over Mylohyoid muscle till the intermediate tendon is identified and transected to release the flap further. At this stage, Submandibular gland was carefully dissected off the flap while preserving the facial artery and vein and clipping all the small glandular branches of the facial nerve. A tunnel was created through the floor of mouth and flap inset was done in the oral cavity followed by suturing of the flap to the adjacent mucosa. Drain was placed in the neck and closure done in layers. Throat pack removed and NG secured.

The patient's face was then cleaned and the posterior pharynx was suctioned. An OG tube was used to suction out the contents of the stomach. Tegaderms were removed from the eyes. Dressings were placed. The patient was then transferred back to the care of the anesthesia team for extubation and recovery.

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