21195 Reconstruction of mandibular rami and/or body, sagittal split; without internal rigid fixation

Name of the Procedure:

Reconstruction of Mandibular Rami and/or Body, Sagittal Split; Without Internal Rigid Fixation

Summary

This surgical procedure repairs and reconstructs the lower jaw (mandible) using a technique called sagittal split osteotomy without the use of internal rigid fixation. It is used to correct misalignment or defects in the jawbone, often resulting from injury, congenital deformities, or other medical conditions.

Purpose

The primary goal of this procedure is to correct jaw misalignment, restore normal jaw function, and improve facial aesthetics. It can address problems such as difficulty chewing, speaking, and pain due to improper jaw alignment.

Indications

• Severe overbite or underbite.
• Misaligned teeth and jaw affecting chewing and speech.
• Congenital jaw deformities.
• Injuries or trauma to the jaw.
• Patients for whom rigid internal fixation is not suitable.

Preparation

• Patients may be advised to fast for at least 8 hours before the procedure.
• Adjustments to medications, especially blood thinners and anti-inflammatories.
• Preoperative dental impressions and imaging studies like X-rays or CT scans.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incisions: Small incisions are made inside the mouth, avoiding external scars.
3. Osteotomy: The surgeon performs a sagittal split osteotomy, carefully separating the mandible along the desired line.
4. Repositioning: The separated bone segments are repositioned to the correct alignment.
5. Stabilization: Instead of using rigid fixation, other methods like wiring may be used to stabilize the bones temporarily.
6. Closure: Incisions are sutured closed.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity.

Setting

This surgery is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Oral and maxillofacial surgeon.
• Anesthesiologist.
• Surgical nurses and technicians.

Risks and Complications

• Infection at surgical sites.
• Bleeding or blood clots.
• Nerve damage causing numbness or tingling.
• Non-union or improper healing of the bone.
• Jaw stiffness and limited movement.
• Possible need for additional surgeries.

Benefits

• Improved jaw function and alignment.
• Better chewing, speaking abilities.
• Enhanced facial aesthetics.
• Relief from pain and discomfort related to jaw misalignment.
• Benefits are typically realized within a few months post-surgery.

Recovery

• Immediate post-operative care includes pain management and monitoring for complications.
• Soft diet for several weeks to avoid stressing the jaw.
• Regular follow-ups with the surgeon to assess healing.
• Physical therapy may be recommended to improve jaw function.
• Full recovery can take several weeks to months.

Alternatives

• Orthodontic treatment alone for minor misalignments.
• Other types of jaw surgery, such as Lefort osteotomy.
• Use of external appliances for temporary correction, though less effective long-term.

Patient Experience

During the procedure, the patient will not feel anything due to general anesthesia. Post-surgery, patients may experience swelling, discomfort, and numbness, which can be managed with prescribed medications and proper care. Gradual improvement in jaw function and aesthetics can be expected over the recovery period.