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.

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The tumor was marked with a sterile pen making sure adequate safe oncological surgery margins. Simultaneously, the melo-labial advancement flap was designed to cover the defect  A #15 blade was used to place an incision around the tumor followed by excision using monopolar cautery set at 10W. Bipolar has been used to control small bleeders. The incisions placed at the marked medial and lateral borders of the flap and dissection proceeded by undermining and elevating in a subcutaneous plane while maintaining a pedicle of subcutaneous fat attached to ensure a robust blood supply. The dissection plane remains superficial to the facial muscles. All the bleeders need to be identified and cauterized before final closure. Once the flap is advanced in a tension free manner, the closure was done in layers using Vicryl 4-0 and Prolene 5-0.

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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