21047 Excision of benign tumor or cyst of mandible; requiring extra-oral osteotomy and partial mandibulectomy (eg, locally aggressive or destructive lesion[s])

Name of the Procedure:

Excision of benign tumor or cyst of mandible; requiring extra-oral osteotomy and partial mandibulectomy

Summary

This surgical procedure involves the removal of a benign tumor or cyst from the mandible (lower jawbone). It requires making an incision outside the mouth, cutting through the bone, and removing part of the mandible to excise the lesion.

Purpose

The procedure addresses benign but potentially locally aggressive or destructive lesions in the mandible. The goal is to completely remove the tumor or cyst, prevent recurrence, and preserve as much of the jaw’s structure and function as possible.

Indications

• Presence of a benign tumor or cyst on the mandible that is locally aggressive or destructive.
• Pain, swelling, or other symptoms caused by the lesion.
• Diagnostic imaging indicating the lesion’s impact on surrounding bone and tissues.

Preparation

• Patients may be instructed to fast for several hours before the surgery.
• Adjustments to medications, especially blood thinners, might be required.
• Pre-operative imaging studies, such as X-rays, CT scans, or MRIs, are performed to assess the size and location of the lesion.

Procedure Description

1. The patient is placed under general anesthesia to ensure comfort and immobility.
2. An incision is made on the outside of the jaw (extra-oral) to access the lesion.
3. Surgical instruments are used to perform an osteotomy (cutting the bone) and expose the mandible.
4. The affected portion of the mandible, along with the tumor or cyst, is carefully removed (partial mandibulectomy).
5. The surgical site is cleaned, and any necessary reconstructive measures are undertaken to restore jaw function.
6. The incision is closed with sutures, and a dressing is applied.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and size of the lesion.

Setting

This surgery is performed in a hospital or surgical center with facilities for general anesthesia and post-operative care.

Personnel

• Oral and Maxillofacial Surgeon
• Surgical nurses
• Anesthesiologist
• Support staff

Risks and Complications

• Common risks: Infection, bleeding, swelling, pain, and bruising.
• Rare risks: Nerve damage resulting in numbness or loss of function, adverse reactions to anesthesia, and issues with bone healing.

Benefits

• Effective removal of the benign tumor or cyst.
• Relief from symptoms associated with the lesion.
• Prevention of potential complications arising from untreated lesions.

Recovery

• Post-operative care includes pain management, antibiotics to prevent infection, and instructions for oral hygiene.
• Initial recovery from surgery may take a few weeks, with bone healing requiring several months.
• Follow-up appointments are necessary to monitor healing and recovery.

Alternatives

• Observation or “watchful waiting” for non-aggressive lesions.
• Less invasive surgical procedures if applicable.
• Benefits of the described procedure include complete removal and lower risk of recurrence, whereas alternatives might be less effective but carry fewer risks.

Patient Experience

• Patients will be under general anesthesia and will not feel pain during the procedure.
• Post-operative pain and swelling are common but managed with medications.
• A hospital stay of 1-2 days may be required, followed by several weeks of home recovery.
• Supportive care will include dietary recommendations and activity restrictions to aid in healing.