21210 Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)

Name of the Procedure:

Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)
Common Names: Bone graft surgery, nasal bone graft, maxillary bone graft, malar (cheek) bone graft

Summary

A bone graft in the nasal, maxillary, or malar areas involves transferring a piece of bone from one part of the body to these facial regions. The procedure is used to repair or augment bone structure, often for reconstructive or cosmetic purposes.

Purpose

Medical Condition: Used to address bone loss, deformities, or deficiencies in the nasal, maxillary (upper jaw), or malar (cheek) areas.
Goals: To restore normal function and appearance by providing a stable bone structure. Expected outcomes include improved facial symmetry, enhanced support for dental implants, or the repair of traumatic injuries.

Indications

Symptoms or Conditions: Bone defects due to trauma, congenital deformities, bone atrophy, or prior surgical resections.
Patient Criteria: Suitable for people with insufficient bone structure in the nasal, maxillary, or malar regions, requiring reconstructive surgery.

Preparation

Instructions:

• Fasting for at least 6-8 hours before the procedure.
• Adjusting medications as directed by the healthcare provider.
• Ceasing smoking to enhance healing.
• Diagnostic tests such as X-rays or CT scans to assess bone structure.

Procedure Description

Steps:

1. Anesthesia is administered (general or local with sedation).
2. A donor site is selected, commonly the hip, rib, or other bone tissue.
3. Bone graft is harvested from the donor site.
4. An incision is made in the target facial area.
5. The bone graft is shaped and positioned in the nasal, maxillary, or malar region.
6. The graft is secured using plates, screws, or wires.
7. The incision is closed with sutures. Tools/Equipment: Surgical instruments, bone grafting materials, fixation devices. Anesthesia: General anesthesia (typically), or local anesthesia with sedation.

Duration

The procedure typically takes 1 to 3 hours depending on the complexity and extent of the grafting required.

Setting

Performed in a hospital operating room or outpatient surgical center.

Personnel

• Surgeon (often a maxillofacial or plastic surgeon)
• Surgical nurses
• Anesthesiologist or nurse anesthetist

Risks and Complications

Common Risks: Infection, bleeding, pain, swelling.
Rare Risks: Bone graft rejection, nerve damage, complications from anesthesia, non-union of the graft (failure to integrate properly).
Management: Antibiotics for infection, pain management strategies, monitoring and follow-up for complications.

Benefits

Expected Benefits: Improved bone structure, enhanced facial symmetry and function.
Timeline: Benefits such as improved appearance and functionality can typically be seen within weeks as swelling subsides and the graft integrates.

Recovery

Post-Procedure Care:

• Pain management with prescribed medications.
• Instructions for wound care.
• Avoiding strenuous activities for several weeks.
• Follow-up appointments to monitor healing and graft integration. Recovery Time: Several weeks to a few months, depending on individual healing.

Alternatives

Other Options: Synthetic bone substitute grafts, tissue scaffolds, or autogenous bone grafts from different donor sites.
Pros and Cons: Alternatives might have different risks and benefits, such as shorter recovery time or different rejection rates.

Patient Experience

During Procedure: The patient will be under anesthesia and should not feel pain.
Post-Procedure: Pain and swelling managed with medications; some discomfort and restrictions on activity.