Excision of benign tumor or cyst of maxilla; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesion[s])
CPT4 code
Name of the Procedure:
Excision of Benign Tumor or Cyst of Maxilla; requiring Intra-oral Osteotomy (e.g., Locally Aggressive or Destructive Lesion[s])
Summary
This surgical procedure involves the removal of a non-cancerous tumor or cyst located in the upper jaw (maxilla). The surgery is performed through the mouth and involves cutting through bone (osteotomy) to access and remove the lesion.
Purpose
The procedure addresses benign tumors or cysts that are locally aggressive or destructive, which can cause pain, swelling, structural damage, or impede function. The goal is to remove the lesion completely, relieve symptoms, and restore normal anatomy and function.
Indications
- Persistent pain or swelling in the maxilla
- Difficulty in chewing, speaking, or breathing
- Presence of a radiographically detected lesion in the maxilla
- History of recurrent infections related to the cyst or tumor
- Significant cosmetic issues due to the lesion
- Lesions causing destruction or displacement of surrounding tissues
Preparation
- Detailed medical history and physical examination
- Imaging studies such as X-rays, CT scans, or MRIs for detailed view of the lesion
- Blood tests to ensure overall health and readiness for surgery
- Fasting for 8 hours before the procedure if general anesthesia is used
- Adjustment of current medications as advised by the healthcare provider
Procedure Description
- The patient will receive either local or general anesthesia based on the extent of the surgery.
- An incision is made inside the mouth to access the maxilla.
- The surgeon performs an osteotomy, cutting through the bone to reach the tumor or cyst.
- The lesion is carefully excised from the surrounding tissues.
- Bone and soft tissues are reconstructed and the incision is closed with sutures.
- Final steps include ensuring proper hemostasis (stopping of blood flow) before the patient is moved to recovery.
Duration
The procedure typically takes 1 to 3 hours, depending on the complexity and size of the lesion.
Setting
The surgery is usually performed in a hospital or a specialized surgical center.
Personnel
- Oral and Maxillofacial Surgeon
- Surgical Nurses
- Anesthesiologist
- Surgical Technicians
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma formation
- Nerve injury leading to numbness or altered sensation
- Damage to adjacent teeth or structures
- Difficulty in healing, leading to fistulas or persistent drainage
- Rarely, recurrence of the lesion
Benefits
- Relief from symptoms such as pain and swelling
- Restoration of normal function related to eating, speaking, and breathing
- Improved cosmetic appearance
- Prevention of further destruction of maxillary structures
Recovery
- Immediate post-operative care includes monitoring for bleeding and infection.
- Pain management with prescribed medications.
- Soft or liquid diet may be required initially.
- Keeping the mouth clean to prevent infection.
- Follow-up appointments to monitor healing and remove stitches if necessary.
- Full recovery may take several weeks to months, depending on the extent of surgery.
Alternatives
- Observation and regular monitoring if the lesion is small and asymptomatic.
- Less invasive procedures like aspiration for cysts.
- Medication management for symptom control.
- Radiation therapy in rare cases where lesions are not solely benign.
- Pros and cons of these alternatives vary based on the lesion’s nature and patient’s overall health.
Patient Experience
During the procedure, the patient will be under anesthesia, so they will not feel pain. Post-procedure, they may experience swelling, discomfort, and pain, which can be managed with medications. Strict adherence to post-operative instructions is crucial for a smooth recovery and minimizing complications.