Endoscopic removal of forehead mass

Considerations

Preparation

Procedure

• • text

Sample operative report

Findings:

*** forehead *** mm osteoma

Performed endoscopic excision of forehead osteoma

Procedure in Detail:

The procedure was reviewed with patient in the pre-operative holding area. The patient was transferred in the OR and positioned supine on the operating table. Time out was performed with all OR staff. GETA was administered. Bed turned 180.

The mass lesion was marked with a marking pen as well as a *** **** cm vertical linear incision line just posterior to the hairline. 10 ml of 1% Lidocaine with 1:100,000 Epinephrine was infiltrated around the incision line as well as around the mass itself.

Patient was prepped and draped in sterile fashion. 15 blade used to incise the marked incision line to bone. Curved periosteal elevator was inserted into the incision and used to elevate the periosteum off the calvarium to the mass and roughly 1 cm lateral and medial to it.

The 30 degree rigid endoscope was inserted into the incision site to visualize the mass. A 4 mm curved osteome was then used to separate the osteoma. The edges were smoothed with the osteotome until flush. The periosteum and frontalis muscle intact. Endoscopic forceps were then used to pick up the osteoma and remove it from the incision. The wound was then irrigated and examined via endoscopy revealing complete removal of the mass and hemostasis.

The incisions were approximated with simple running 4-0 Plain gut suture. Face, scalp, and hair cleansed. Ointment and compressive dressing applied.

The patient tolerated the procedure well, final count was correct, patient transferred to PACU in stable condition.

Post-op

• • CPT codes

    • 21026 - Excision of bone (eg, for osteomyelitis or bone abscess); facial bone(s)

    • 21499 - Unlisted musculoskeletal procedure, head

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