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Posterior Vault Distraction
Preoperative Considerations
Consent:
Anesthesia/Positioning:
- Prone position with head elevated above heart
- Subcutaneous local anesthetic with epinephrine
- Eye Pads
- Trans nasal intubation preferred
- Two venous lines
Other:
Armamentarium:
- Bofa retractor
Technique
- 1. Patient intubated under general anesthesia in the prone position
- 2. Bircoronal weave incision marked
- 3. Supraperiosteal dissection to minimize bleeding
- 4. Periosteum incised at site of osteotomies and osteotomy line marked on bone
- 6. Ball drill used to make burr holes around the planned osteotomy
- 7. Dural dissectors utilized to separate calvarium and dura between burr holes
- 8. Craniotomy performed with craniotomy or piezotome and bone rongeurs
- 9. Two to four distractors placed in parallel direction
- 10. Skin closure
Postoperative Considerations
Immediate:
- Patient transported to PACU or ICU with extubation as soon as possible.
- Careful patient positioning to avoid pressure ulcers.
Follow Up:
- Two to four week activation period with lateral x-rays to monitor progression
- Distractor devices remain in place for one to six months post-activation for ossification period
Operative Note
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.
***
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.
Coding
Diagnosis Codes:
- Q75.00 Craniosynostosis unspecified
- Q75.01 Sagittal craniosynostosis
- Q75.02 Coronal craniosynostosis
- Q75.03 Metopic craniosynostosis
- Q75.04 Lamboid craniosynostosis
- Q75.04 Multi-suture craniosynostosis
- Q75.08 Other single-suture craniosynostosis
Procedure Code:
- 61550 Craniectomy for craniosynostosis, single cranial suture
- 61552 Craniectomy for craniosynostosis, multiple cranial sutures
