Supraorbital Nerves Decompression for Frontal Migraine Headache

By Dr. Kevin Han

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GLOVES:  6.5 Micro Indicator/6.5 Micro

PREP:  BETADINE PAINT ONLY – INCLUDE TAPE, EYES, HAIR, ET TUBES, EARS TO CLAVICLE. PREP THE WHOLE FACE, IF ALLERGIC TO BETADINE, PCMX (CAREFUL AROUND EYES)

POSITION:  SUPINE, TURN BED 90 DEGREES.  PAD & TUCK ARMS (ABD Padded) 

DRAPE – HEAD DRAPE WITH 2 TOWELS AND ¾ SHEET.  DRAPES WITH 3 TOWELS, SPLIT SHEET, ¾ SHEET TO BLOCK OFF ANESTHESIA.

MEDICATIONS: 0.5% MARCAINE WITH EPI 1:200,000 (20ML) (INJECTS BEFORE PREP)

BSS (HOLD)

ERYTHROMYCIN EYE OINTMENT FOR TRANS BLEPH APPROACH

INSTRUMENTS: Curved/STRAIGHT IRIS SCISSORS, Small Tenotomy Scissors, Sens Retractor, Ragnell Retractor, DOUBLE SKIN HOOKS WIDE (2), #3 KNIFE HANDLES (2), STRAIGHT MAYO SCISSORS, CURVED MAYO SCISSORS, FRAZIER TIP SUCTION (MAKE SURE FRAZIER TIP HAS A HOLE), Fine MOSQUITOS (2), Desmarres Eyelid retractor, 2 or 3 mm (rhinoplasty ones)/Small Osteotomes and Small Rongeur

EQUIPMENT:  BOVIE, BIPOLAR FOOT PEDAL, SCD’S, BAIR HUGGER

SUPPLIES:  HEAD AND NECK PACK

  • MAGNETIC PAD (GREEN REUSABLE PAD)
  • BIPOLAR CORD
  • BSS (AVAILABLE)
  • Vessel Clips-YELLOW CLIP (2) (OPEN)
  • Vessel Clips-RED CLIP (1) (HOLD)
  • Or Small Automatic Vessel Clip Applier 
  • COLORADO TIP (OPEN)
  • SMALL TEGADERM (1) (OPEN BEFORE CASE, CUT IN HALF AND KEEP ON BACK TABLE)
  • EYE PADS (AVAILABLE FOR THE END OF THE CASE In Ice Water)
  • SKIN STAPLER (OPEN)
  • Cornea Shields (HOLD) 

SUTURES: 7-0 VICRYL P-1 FOR EYELIDS (2)

6-0 PLAIN PC-1 (2)

6-0 Prolene (2) 

DRESSINGS:  ERYTHROMYCIN EYE OINTMENT FOR EYELIDS (left-over for patient to take home)

EYE PATCHES (SOAKED IN COLD ICE WATER)

Mastisol, ¼ inch Steri Strips

NOTES: EYE LID (CUT 12/COAG 10 AND BLEND 3)

BIPOLAR (20)

TURN VOLUME OF BOVIE/BIPOLAR ALL THE WAY DOWN