21146 Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)

Name of the Procedure:

Reconstruction of the midface, LeFort I Osteotomy; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (e.g., ungrafted unilateral alveolar cleft).

Summary

This surgical procedure involves realigning and reconstructing the midface by moving bone segments in various directions. The process typically includes the use of bone grafts, which may be taken from another part of the patient's body. It is frequently used to correct deformities or defects in the midface region.

Purpose

The procedure addresses deformities or defects in the midface, such as those caused by congenital conditions (e.g., clefts) or trauma. The goal is to improve facial aesthetics, function (including breathing and chewing), and overall symmetry.

Indications

• Ungrafted unilateral alveolar cleft.
• Midface hypoplasia or underdevelopment.
• Facial asymmetry due to congenital conditions or trauma.
• Difficulty with chewing, breathing, or speaking due to midface irregularities.

Preparation

• Pre-procedure fasting as per doctor’s instructions.
• Adjustments in medication, particularly blood thinners.
• Preoperative imaging studies, such as CT scans, to plan the surgery.
• Pre-surgical consultations, including discussions about the source of bone grafts.

Procedure Description

1. Anesthesia: General anesthesia is administered to keep the patient asleep and pain-free.
2. Incision: Incisions are made inside the mouth to avoid visible scars.
3. Osteotomy: The LeFort I osteotomy is performed, and the midface bones are carefully cut and segmented.
4. Bone Grafting: Bone grafts obtained from the patient’s own body (autografts) are positioned to support the new bone alignment.
5. Realignment: The bone segments are moved to the desired locations.
6. Stabilization: The bones are fixed in place using plates and screws.
7. Closure: Incisions are closed with sutures.

Tools and Equipment

• Surgical drills and saws for osteotomy.
• Plates and screws for stabilization.
• Bone grafting tools.
• Imaging technology for precise surgical planning.

Duration

The procedure typically takes 3 to 5 hours, depending on the complexity.

Setting

The procedure is performed in a hospital setting, often in a specialized surgical suite.

Personnel

• Oral and maxillofacial surgeon or plastic surgeon.
• Surgical assistants.
• Anesthesiologist.
• Nursing staff.

Risks and Complications

• Infection at the surgical site.
• Bleeding or hematoma formation.
• Nerve damage leading to numbness or altered sensation.
• Nonunion or malunion of the bone.
• Potential need for revision surgery.

Benefits

• Improved facial symmetry and aesthetics.
• Enhanced function, including better breathing, chewing, and speech.
• High success rate and long-term stability of results.

Recovery

• Hospital stay of 1-2 days post-surgery.
• Soft diet for several weeks to allow for healing.
• Pain management with prescribed medications.
• Follow-up appointments to monitor healing.
• Avoid strenuous activity for several weeks.

Alternatives

• Orthognathic surgery without bone grafting (limited to specific cases).
• Custom-made prosthetics for facial defects (less natural but non-surgical).
• Non-surgical facial fillers (temporary solution for minor corrections).

Patient Experience

Patients will be under general anesthesia during the procedure and will typically wake up with some facial swelling, discomfort, and minor pain, managed by medication. Full recovery can take several months, with improved functionality and appearance becoming apparent as the swelling subsides.