Location Inpatient Hospital Question & Answer Guide (With Explanation)

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Original Question

LOCATION: Inpatient, Hospital PATIENT: Delores Janus SURGEON: Gary Sanchez, MD PREOPERATIVE DIAGNOSIS: Right carotid body tumor POSTOPERATIVE DIAGNOSIS: Frozen section confirmed a right carotid body tumor with tortuous internal and external carotids that have been displaced by tumor mass with multiple blood vessels feeding this tumor mass, rising from the external carotid, all ligated individually. The tumor was highly vascularized. OPERATIVE PROCDURE: Excision of right carotid body tumor ANESTHESIA: General endotracheal with EEG (electroencephalogram) monitoring. The patient tolerated the procedure well. COMPLICATIONS: None NEEDLE AND SPONGE COUNTS: Needle and sponge counts appear correct. No adverse EEG changes were noted during the procedure. ESTIMATED BLOOD LOSS: 125 cc. No drains were placed. Incision was closed. INDICATION FOR PROCEDURE: The patient, on a workup for another problem, was dubiously noted to have what looked like a carotid body tumor on CT (computerized tomography) scan. Subsequently an angiogram was done to examine this further. This confirmed our suspicions and also showed that the blood supply was derived mostly from the external carotid. Consent was obtained for operative intervention. The procedure, indication, risks, benefits, and alternatives were discussed at length with the patient. She understood and wished to proceed. OPERATIVE TECHNIQUE: The patient was brought to the operating room and placed supine on the operating room table. General endotracheal anesthesia was administered under EEG monitoring. We then proceeded to prep the neck, lower face, and upper chest with Betadine and draped them off in a sterile fashion. We proceeded with proper placement of her neck, somewhat extended to provide adequate exposure. We proceeded with her incision anterior to the sternocleidomastoid. We extended this through skin and subcutaneous tissues and the platysma muscle down to the sternocleidomastoid and then subsequently retracted the sternocleidomastoid laterally and exposed the jugular vein, which was quite large and had many tributaries. These tributaries were doubly ligated on the large ones and also retracted laterally. The common carotid was identified, dissected down onto the common carotid, and a vessel loop placed around the common carotid dissection, subsequently carried distally. We identified the internal and external carotids and also placed vessel loops around this. On the external carotid, we identified the superior thyroid, placed a vessel loop around this, and followed this further. Another branch of the external carotid was noted to be feeding the tumor mass between external and internal carotid; multiple small feeding vessels were also identified and were individually ligated. We used bipolar cautery to dissect some of the tissue because this was very hypervascular. The tumor was well circumscribed, although it caused a lot of hypervascularity around it. We were able to dissect this off, identified and preserved the hypoglossal nerve, and identified and preserved the vagus nerve posteriorly. Also, after taking the mass out and sending it for frozen section, we had confirmation that this was a carotid body tumor. We will await permanent sections. Hemostasis was good. We then irrigated. Once we were satisfied with this procedure, we closed the platysma muscles with running 3-0 Vicryl sutures and closed the skin with 4-0 Vicryl subcuticular running sutures. We applied Steri-Strips and sterile dressings. The patient tolerated the procedure well without complications. On awakening in the operating room, she was able to move all extremities. She will be transferred to the surgical critical care unit for further observation and recovery. Pathology Report Later Indicated: See Report 10-22B. SERVICE CODE(S): ______________________________________ ICD-10-CM DX CODE(S): __________________________________

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