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

Name of the Procedure:

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

Summary

This surgical procedure involves removing infected or damaged bone tissue from the facial bones. It is commonly performed to treat conditions such as osteomyelitis (a bone infection) or abscesses (pockets of pus).

Purpose

The procedure aims to remove the infected or damaged bone to prevent the spread of infection and to promote healing. It helps alleviate symptoms such as pain, swelling, and infection, restoring normal facial function and appearance.

Indications

• Persistent facial pain and swelling
• Evidence of bone infection (osteomyelitis) shown via imaging tests
• Presence of a bone abscess
• Unsuccessful response to antibiotic treatment

Preparation

• The patient may need to fast for 6-8 hours prior to the procedure if general anesthesia is used.
• Adjustments to medications, especially blood thinners, may be necessary.
• Preoperative imaging studies such as MRI or CT scans to evaluate the extent of infection or damage.
• Blood tests to assess overall health and infection markers.

Procedure Description

1. Anesthesia: The patient is given general anesthesia to ensure they are asleep and pain-free during the procedure.
2. Incision: The surgeon makes an incision over the affected area of the face to access the underlying bone.
3. Bone Removal: Using specialized tools, the surgeon carefully removes the infected or damaged bone tissue.
4. Debridement: Surrounding tissues are cleaned, and any necrotic (dead) tissue is removed.
5. Closure: The incision is closed with sutures, and a sterile bandage is applied.

Duration

The procedure typically takes 1-3 hours, depending on the extent of the infection and the amount of bone removed.

Setting

The procedure is usually performed in a hospital or a specialized surgical center.

Personnel

• A specialized surgeon, often an oral and maxillofacial surgeon or an ENT (ear, nose, and throat) surgeon.
• An anesthesiologist to administer and monitor anesthesia.
• Surgical nurses and assistants.

Risks and Complications

• Infection
• Bleeding
• Facial nerve injury
• Scarring
• Recurrence of infection
• Anesthesia-related complications

Benefits

• Relief from pain and swelling
• Elimination of infection
• Prevention of further bone damage
• Improvement in overall facial function and appearance Benefits may be realized immediately, although full recovery can take several weeks.

Recovery

• Patients typically stay in the hospital for 1-2 days.
• Analgesics for pain management.
• Antibiotics to prevent infection.
• Follow-up appointments to monitor healing.
• Physical activity restrictions and dietary modifications may be necessary for a few weeks.
• Instructions on proper wound care.

Alternatives

• Long-term antibiotic therapy for less severe infections.
• Hyperbaric oxygen therapy (in some cases).
• Drainage of abscesses without bone removal.
• Conservative management such as pain control and regular monitoring.

Patient Experience

• Patients will be asleep and feel no pain during the procedure due to general anesthesia.
• Postoperative discomfort managed with pain medications.
• Swelling and bruising around the surgical site are common but usually resolve within a few weeks.
• Patients might experience temporary numbness or changes in sensation in the affected area.