21347 Open treatment of nasomaxillary complex fracture (LeFort II type); requiring multiple open approaches

Name of the Procedure:

Open treatment of nasomaxillary complex fracture (LeFort II type); requiring multiple open approaches

Summary

This procedure involves surgical intervention to repair fractures in the midface region, specifically targeting the nasomaxillary complex (LeFort II fractures). Multiple open surgical approaches are necessary to properly access and stabilize the fractured bones.

Purpose

This surgery aims to correct fractures in the middle part of the face, ensuring proper alignment and stabilization of the bones. The expected outcomes include restored facial symmetry, function, and the alleviation of pain and discomfort.

Indications

• Traumatic injury resulting in a midface fracture
• Symptoms such as facial deformity, difficulty breathing, eating, or speaking
• Patients with fractures that cannot be addressed through non-surgical means

Preparation

• Fasting for 8-12 hours before surgery
• Pre-operative medical evaluation and clearance
• Diagnostic imaging like CT scans to assess the extent of the fracture
• Discussion of current medications with the surgeon; some may need to be adjusted or stopped

Procedure Description

1. Administration of general anesthesia to ensure the patient is unconscious and pain-free
2. Multiple surgical incisions are made to access the fracture areas
3. Fractured bones are realigned and stabilized using plates, screws, and/or wires
4. Soft tissues are sutured back into place
5. Incisions are closed with stitches and covered with appropriate dressings

Technical equipment used includes surgical instruments, stabilization materials (plates, screws), and imaging tools for intraoperative guidance.

Duration

Typically, the procedure lasts between 3 to 5 hours, depending on the complexity of the fractures.

Setting

The procedure is performed in a hospital operating room equipped for advanced surgical care.

Personnel

• Oral and maxillofacial surgeon or plastic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technician

Risks and Complications

• Infection
• Bleeding
• Scarring
• Nerve damage, resulting in numbness or altered sensation
• Misalignment or non-union of bone fragments
• Need for revision surgery

Benefits

• Restored facial symmetry and aesthetics
• Improved function (eating, speaking, breathing)
• Alleviation of pain and discomfort
• Enhanced quality of life

Recovery

• Hospital stay for 1-3 days post-surgery
• Pain management using prescribed medications
• Instructions for oral hygiene and care of incision sites
• Limitation of physical activities for several weeks
• Follow-up visits for monitoring healing and removing sutures

Alternatives

• Closed reduction and maxillomandibular fixation, but less effective for severe fractures
• Non-surgical management, which may include pain management and diet modifications, but without structural repair

Patient Experience

Patients will be under general anesthesia during the procedure, ensuring no pain. Post-surgery, they may experience swelling, bruising, and discomfort, which are managed with medications and supportive care. It is essential to follow all post-operative instructions to ensure a smooth recovery.