The patient was brought into the operating room and placed in a supine position. After adequate endotracheal anesthesia was obtained, the skin was prepped and draped in the usual sterile fashion.
Lidocaine 1% with 100,000 epinephrine was injected into the region of the anterior portion of the nasal septum. Approximately 10 cc total was used. A number 15 blade and freer elevator were used to help make a standard hemitransfixion incision. The mucoperichondrial flap was carefully elevated in the junction with the bony septum and separated with the freer elevator.
The bony deflection was removed using Jansen-Middleton forceps. The cartilaginous deflection was created by freeing up the inferior attachments of the cartilaginous septum.
Attention then was directed towards the left side. Lidocaine 1% with 100,000 epinephrine was injected into the region of the anterior portion of the left middle turbinate and uncinate process in polyps. Approximately 10 cc total was used.
The polyps were removed using a microdebrider and sent for pathology. The uncinate process was removed systematically, superiorly to inferiorly, using backbiting forceps. Next, the maxillary antrostomy was identified and expanded with the backbiting forceps and showed polypoid accumulation, which was again sent for pathology. The sinus linings were edematous but did not have any polyps in the inferior, lateral, or superior aspect.
The anterior and posterior ethmoid air cells were entered primarily and dissected with a microdebrider, followed by the use of a 30-degree endoscope and up biting forceps for the superior and lateral dissection. Bright mucosal disease and small polyp accumulation were noted throughout the sinuses. The inferior turbinates had some polypoid changes on them, also showing marked mucosal irritation and hypertrophy. Any obvious bleeding points along the edge were controlled with suction bovie apparatus.
This concluded the surgical portion of the procedure, and the patient was turned back to the anesthesiologist without further incident.