21145 Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)

Name of the Procedure:

Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts).

Summary

This procedure involves reconstructing the midface, specifically the LeFort I region, which is the area of the upper jaw and adjacent facial structures. It entails repositioning the bone in one piece and may involve moving segments in any direction. The surgery requires bone grafts, often using bone harvested from other parts of the patient's body.

Purpose

This surgical procedure aims to correct deformities, physical damage, or anomalies in the midface. It can improve facial symmetry, function, and aesthetics and is often performed to address problems with breathing, speaking, chewing, and overall facial appearance.

Indications

• Congenital conditions like cleft palate or craniofacial syndromes.
• Traumatic injuries to the midface.
• Severe malocclusions or bite issues.
• Secondary reconstruction cases where previous surgeries were inadequate.
• Facial asymmetry or significant aesthetic concerns.

Preparation

• Preoperative consultations to discuss goals, expectations, and medical history.
• Diagnostic imaging like X-rays, CT scans, or MRIs to plan the surgery.
• Patients may need to fast and avoid certain medications before the procedure.
• Blood tests and possibly a pre-operative physical exam.

Procedure Description

1. Anesthesia: The patient is given general anesthesia.
2. Incisions: Surgeons make incisions inside the mouth to access the facial bones without visible scarring.
3. Repositioning: The upper jaw (maxilla) is carefully cut and moved as needed.
4. Bone Grafts: Bone grafts, often harvested from the patient's hip or rib, are placed to support the new structure.
5. Fixation: The bones are secured in their new position with plates, screws, or wires.
6. Closure: Incisions are closed with sutures.

Tools and equipment used include surgical saws for bone cutting, fixation devices, and instrumentation for bone grafting.

Duration

The procedure typically takes between 3 to 6 hours, depending on the complexity.

Setting

This surgery is performed in a hospital or specialized surgical center equipped for complex craniofacial procedures.

Personnel

• Oral and maxillofacial surgeons or craniofacial surgeons.
• Anesthesiologists.
• Surgical nurses and assistants.
• Possibly a plastic surgeon, depending on the extent of reconstruction needed.

Risks and Complications

• Infection at the surgery or bone graft sites.
• Bleeding or hematoma formation.
• Nerve damage leading to numbness or altered sensation.
• Nonunion or malunion of bone segments.
• Relapse of the corrected position over time.

Benefits

• Improved facial symmetry and aesthetics.
• Enhanced function in speaking, chewing, and breathing.
• Better alignment of jaws and teeth.
• Increased self-confidence and quality of life. Benefits are typically realized gradually over several months as swelling subsides and healing progresses.

Recovery

• Initial hospital stay of a few days for observation.
• Pain management with medications.
• Soft or liquid diet for several weeks.
• Follow-up visits to monitor healing and remove sutures if necessary.
• Physical therapy may be recommended to aid in recovery.
• Full recovery and return to normal activities can take several months.

Alternatives

• Orthognathic surgery without bone grafting.
• Non-surgical treatments like orthodontics, though less effective for severe cases.
• Minimally invasive procedures if the problem is less severe.

Each alternative has its pros and cons, and the choice depends on the individual patient's condition and overall health.

Patient Experience

During the procedure, the patient will be under anesthesia and experience no pain. Postoperatively, there may be discomfort, swelling, and limited function, managed with pain medications and supportive care. Full participation in normal activities will gradually resume as healing progresses.