21422 Open treatment of palatal or maxillary fracture (LeFort I type)

Name of the Procedure:

Open Treatment of Palatal or Maxillary Fracture (LeFort I Type)

• Common Name: Open reduction of LeFort I fracture
• Technical Terms: LeFort I osteotomy, Maxillary fracture repair

Summary

This surgical procedure involves the realignment and fixation of a fractured upper jaw (maxilla) that primarily affects the lower portion of the maxilla right above the teeth. It is necessary when the maxilla has been broken in such a way that the upper teeth alignment is disrupted.

Purpose

• Condition Addressed: Broken or fractured maxilla (LeFort I type).
• Goals: To stabilize and realign the broken segments of the upper jaw, restore normal function and aesthetics, and prevent complications such as misalignment of teeth or improper healing.

Indications

• Symptoms: Severe pain in the midface, swelling, bruising, malocclusion (misalignment of teeth), difficulty chewing or speaking.
• Criteria: Confirmed LeFort I fracture via radiographic imaging, significant displacement of maxillary segments, or failure of non-surgical treatment to stabilize the fracture.

Preparation

• Instructions: Patients are typically required to fast for at least 8 hours prior to surgery.
• Medication Adjustments: Review and potentially adjust medications, especially blood thinners.
• Tests: Preoperative imaging studies such as X-rays or CT scans, blood tests, and a thorough physical examination.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: An incision is made inside the mouth along the gum line above the teeth.
3. Exposure: The fractured bone segments are exposed.
4. Reduction: The fractured bones are then realigned into their correct anatomical positions.
5. Fixation: The realigned bones are secured with plates and screws.
6. Closure: The incision is closed with sutures that typically dissolve on their own.

Duration

The procedure typically takes between 1 to 3 hours, depending on the complexity of the fracture.

Setting

This surgery is usually performed in a hospital operating room or a surgical center equipped for complex maxillofacial surgery.

Personnel

The procedure is conducted by an oral and maxillofacial surgeon, supported by surgical nurses, an anesthesiologist, and potentially other surgical assistants.

Risks and Complications

• Common Risks: Infection, bleeding, swelling, pain, and bruising.
• Rare Complications: Nerve damage, improper alignment or non-union of the bone, damage to adjacent teeth, sinus issues, and need for additional surgery.

Benefits

• Expected Benefits: Realigned jaw, improved function and appearance, proper teeth alignment.
• Timeline: Benefits are typically noticeable immediately post-surgery, with full recovery over several weeks.

Recovery

• Post-procedure Care: Patients may need to follow a liquid or soft diet initially, maintain good oral hygiene, and take prescribed medications to manage pain and prevent infection.
• Recovery Time: Full recovery usually takes 6 to 8 weeks.
• Restrictions: Patients may need to avoid strenuous activities and follow up with regular appointments to monitor healing.

Alternatives

• Non-Surgical Treatment: In minor fractures, conservative treatments like maxillomandibular fixation (wiring the jaws together) may be considered, though it has limitations in more severe cases.
• Pros and Cons: Non-surgical options might be less invasive but often do not provide the stability and alignment that surgical correction offers.

Patient Experience

• During Procedure: The patient will be under general anesthesia and will not feel pain during the surgery.
• After Procedure: The patient might experience discomfort, swelling, and bruising, managed with pain medications and cold compresses. Gradual improvement is expected within the first few weeks.