21193 Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without bone graft

Name of the Procedure:

Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without bone graft
Common Name(s): Mandibular osteotomy, jaw realignment surgery

Summary

Reconstruction of the mandibular rami involves surgically cutting and repositioning parts of the lower jaw (mandible) without using a bone graft. This procedure can help correct jaw misalignment, improve function, and enhance facial symmetry.

Purpose

The procedure addresses jaw misalignment and related problems. The goals are to improve the patient's ability to chew, speak, and breathe properly, and to achieve better facial aesthetics.

Indications

• Malocclusion (improper bite)
• Jaw asymmetry
• Temporomandibular joint disorders (TMD)
• Obstructive sleep apnea
• Facial trauma or congenital deformities

Preparation

• Pre-operative fasting (usually 6-8 hours before surgery)
• Adjustment or cessation of certain medications as advised
• Pre-operative imaging studies (e.g., X-rays, CT scans)
• Detailed physical examination and medical history review
• Pre-anesthesia assessment

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: A small incision is made inside the mouth along the lower gum line to access the mandible.
3. Osteotomy: Using specialized surgical instruments, the surgeon cuts the mandibular bone at specified locations (horizontal, vertical, C, or L-shaped cuts) to reposition the jaw sections.
4. Realignment: The jaw is realigned into the correct position.
5. Stabilization: The repositioned jaw is secured with screws and plates.
6. Closure: The incision is sutured closed, and the area inside the mouth is cleaned.

Duration

The procedure typically takes 2 to 4 hours, depending on complexity and specific surgical requirements.

Setting

Performed in a hospital or surgical center equipped for maxillofacial surgery.

Personnel

• Oral and maxillofacial surgeon
• Surgical nurses
• Anesthesiologist
• Possible support staff (e.g., surgical technicians)

Risks and Complications

• Infection
• Bleeding
• Nerve injury leading to numbness or tingling
• Jaw stiffness
• Malocclusion recurrence
• Scarring (rare, as incisions are typically inside the mouth)
• Anesthesia-related complications

Benefits

• Improved jaw function (chewing, speaking)
• Enhanced facial symmetry and aesthetics
• Relief from pain or discomfort related to jaw misalignment
• Improved breathing in cases with sleep apnea

Recovery

• Initial swelling and discomfort managed with pain medication and ice packs
• Soft or liquid diet recommended for several weeks
• Oral hygiene instructions to prevent infection
• Regular follow-up appointments to monitor healing and jaw alignment
• Most patients return to normal activities within 6 to 8 weeks

Alternatives

• Orthodontic treatment (braces) for minor misalignments
• Non-surgical treatments for TMD, such as physical therapy or dental splints
• Continuous positive airway pressure (CPAP) therapy for sleep apnea
• Each alternative has its benefits and limitations compared to surgical intervention, with surgery often providing more definitive outcomes for severe cases.

Patient Experience

Patients can expect general anesthesia during the procedure, thus no pain will be felt during surgery. Post-operatively, some discomfort, swelling, and a sense of tightness in the jaw area are common but manageable with prescribed medications. Following the surgeon’s aftercare instructions closely will aid in a smoother and quicker recovery, minimizing potential complications.