21356 Open treatment of depressed zygomatic arch fracture (eg, Gillies approach)

Name of the Procedure:

Open treatment of depressed zygomatic arch fracture (e.g., Gillies approach)

Summary

This surgical procedure involves repositioning a broken and displaced zygomatic arch (cheekbone) back to its normal alignment. The Gillies approach is a specific method used to access and correct the fracture with minimal incisions.

Purpose

This procedure addresses facial fractures that cause cosmetic deformity or functional issues like difficulty chewing or vision problems. The main goal is to restore the normal appearance and function of the cheekbone.

Indications

• Visible deformity of the cheekbone
• Pain and swelling
• Difficulty opening the mouth or chewing
• Vision problems due to the fracture
• Confirmed zygomatic arch fracture via imaging

Preparation

• Patients may need to fast for several hours before surgery.
• Adjustments to medications, particularly blood thinners, as directed by the healthcare provider.
• Preoperative imaging studies such as CT scans to assess the fracture.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made near the temporal region to avoid direct facial cuts.
3. Specialized instruments are inserted to elevate and reposition the fractured bone.
4. Once aligned, the instruments are removed, and the incision is closed.
5. A compression dressing may be applied.

Duration

Approximately 1 to 2 hours.

Setting

Hospital or surgical center.

Personnel

• Orthopedic or maxillofacial surgeon
• Nurse(s)
• Anesthesiologist

Risks and Complications

• Infection
• Bleeding
• Scarring
• Nerve damage leading to facial numbness or weakness
• Incorrect bone alignment requiring further treatment

Benefits

• Improved facial symmetry and appearance
• Relief from pain and swelling
• Restored function of the jaw and alleviation of vision problems
• Recovery of facial sensation and expression

Recovery

• Pain and swelling management with prescribed medications.
• Ice packs and head elevation recommended.
• Avoid strenuous activities and chewing hard foods for several weeks.
• Follow-up appointments to monitor healing and remove sutures.

Alternatives

• Non-surgical management with pain relief and observation, appropriate for non-displaced fractures.
• Closed reduction, which involves manipulating the bone without open surgery; less invasive but may be less precise.
• Pros of non-surgical methods include lower risk and faster recovery, while cons include potential issues with bone alignment not being addressed.

Patient Experience

Patients will be under anesthesia during the procedure and should not feel pain. Post-operatively, they may experience swelling, bruising, and discomfort managed with medications. Comfort measures like ice packs help reduce swelling. Most patients can return to normal activities within a few weeks, with full recovery typically taking several months.