21025 Excision of bone (eg, for osteomyelitis or bone abscess); mandible

Name of the Procedure:

Excision of bone (e.g., for osteomyelitis or bone abscess); mandible, also known as Mandibular Bone Excision.

Summary

This surgical procedure involves the removal of an infected or damaged portion of the mandible, or jawbone, to treat conditions like osteomyelitis or bone abscess.

Purpose

The procedure addresses severe infections or abscesses in the mandible that are not responsive to non-surgical treatments. The goal is to remove the diseased bone tissue, alleviate pain, prevent the spread of infection, and promote healing.

Indications

• Severe, persistent jaw pain
• Swelling or redness in the jaw area
• Fever or other systemic signs of infection
• Failure of antibiotics or other conservative treatments
• Presence of a bone abscess confirmed by imaging studies

Preparation

• Fasting for at least 6-8 hours before the procedure if general anesthesia is used.
• Stopping certain medications, as advised by the healthcare provider.
• Undergoing diagnostic tests such as X-rays, MRI, or CT scans.
• Completing blood tests to ensure fitness for surgery.

Procedure Description

1. Anesthesia: General anesthesia or local anesthesia with sedation is administered.
2. Incision: A small incision is made in the gum or through the skin over the affected area of the mandible.
3. Exposure: The diseased area of the bone is exposed by retracting the surrounding tissues.
4. Excision: The infected or damaged portion of the mandible is carefully removed using surgical tools like bone saws and curettes.
5. Irrigation: The area is thoroughly irrigated with a sterile saline solution to cleanse it.
6. Closure: The incision is closed with sutures, and a dressing may be applied to protect the site.

Duration

The procedure typically takes 1-2 hours, depending on the extent of the infection and the amount of bone to be removed.

Setting

The procedure is performed in a hospital or surgical center, often as an inpatient surgery.

Personnel

The surgical team usually includes:

• Oral and Maxillofacial Surgeon
• Anesthesiologist
• Surgical Nurses

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Damage to surrounding nerves, leading to numbness or tingling
• Jaw stiffness or difficulty chewing
• Potential for fracture in the remaining bone
• Complications related to anesthesia

Benefits

• Relief from pain and infection symptoms
• Prevention of further spread of infection
• Potentially quicker overall recovery compared to non-surgical treatment failures
• Improved quality of life and oral function

Recovery

• Pain management with prescribed medications.
• Soft diet and careful oral hygiene to avoid irritation at the surgical site.
• Avoiding strenuous activities and smoking.
• Follow-up appointments for monitoring healing and removing sutures if necessary. Recovery time can vary but typically ranges from a few weeks to a few months, depending on the extent of the surgery and individual healing factors.

Alternatives

• Long-term antibiotic therapy, which may not be effective for severe infections.
• Hyperbaric oxygen therapy, combined with antibiotics, for osteomyelitis.
• Abscess drainage without bone removal, which may not fully resolve the infection.

Patient Experience

Patients can expect some discomfort and swelling after the procedure. Pain is generally manageable with medications. There may be temporary changes in sensation or limited jaw movement. The healthcare team will provide comprehensive care instructions to ensure a smooth recovery.