21435 Open treatment of craniofacial separation (LeFort III type); complicated, utilizing internal and/or external fixation techniques (eg, head cap, halo device, and/or intermaxillary fixation)

Name of the Procedure:

Open Treatment of Craniofacial Separation (LeFort III Type); Complicated, Utilizing Internal and/or External Fixation Techniques

• Common names: LeFort III Fracture Surgery, Craniofacial Reconstruction

Summary

In this specialized surgical procedure, a severe form of facial fracture, known as a LeFort III fracture, is corrected. This involves the separation of the midface from the skull base. The surgery uses internal and/or external fixation devices, like head caps, halo devices, and/or intermaxillary fixation, to realign and stabilize the bones.

Purpose

Condition Addressed:

• Severe facial trauma resulting in LeFort III fractures.

Goals/Outcomes:

• Realign and stabilize the facial bones to restore normal structure and function.
• Enhance facial appearance and relieve associated symptoms like difficulty breathing or eating.

Indications

Symptoms/Conditions:

• Significant trauma to the face.
• Misalignment of the facial bones.
• Difficulty with breathing, vision, or jaw movement.

Patient Criteria:

• Patients with confirmed LeFort III fractures via diagnostic imaging.
• Patients in good overall health to withstand surgery.

Preparation

Pre-Procedure Instructions:

• Fasting for at least 8 hours before surgery.
• Adjustment of medications as advised by the physician.
• Arranging for post-surgical transportation and support.

Diagnostics:

• CT scans and X-rays to assess the extent of the fracture.
• Pre-surgical consultations with specialists like an anesthetist and a maxillofacial surgeon.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: Incisions are made strategically to access the fracture site.
3. Reduction: The bones are realigned to their normal position.
4. Fixation: Devices such as head caps, halo devices, and intermaxillary fixation are used to stabilize the bones. Internal plates and screws may also be installed.
5. Closure: Incisions are closed with sutures, and dressings are applied.

Tools/Technology:

• Fixation devices (head cap, halo, intermaxillary).
• Surgical instruments for bone realignment.
• Imaging tools for real-time guidance.

Duration

Typically, the procedure lasts between 4 to 8 hours, depending on the complexity.

Setting

The surgery takes place in a hospital's operating room equipped with specialized surgical and imaging equipment.

Personnel

• Surgeon: A maxillofacial or craniofacial surgeon.
• Anesthesiologist: To administer and monitor anesthesia.
• Surgical Nurses: To assist with the procedure.
• Radiology Technician: To provide necessary imaging support.

Risks and Complications

• Common Risks: Infection, bleeding, scarring, anesthesia-related issues.
• Rare Complications: Nerve damage, non-union of bones, implant failure. Management includes antibiotics, pain management, and sometimes additional corrective surgery.

Benefits

• Restoration of facial symmetry and function.
• Improved ability to breathe, eat, and speak.
• Enhanced aesthetic appearance.
• Benefits may be noticeable immediately but complete healing can take several months.

Recovery

Post-Procedure Care:

• Hospital stay for a few days post-surgery.
• Pain management with prescribed medications.
• Follow-up appointments for monitoring and removal of fixation devices.

Recovery Time:

• Initial recovery within 6-8 weeks.
• Full recovery and bone healing up to 6 months.

Restrictions:

• Avoid strenuous activities for several months.
• Maintain soft diet initially if intermaxillary fixation is used.

Alternatives

• Non-Surgical Options: Primarily for less severe fractures (may include conservative management with pain relief and watchful waiting).
• Other Surgical Techniques: Less invasive procedures might be an option for different types of fractures.

Pros and Cons of Alternatives:

• Non-surgical: Less risk and recovery time but may not restore full function or appearance.
• Other surgical techniques: May offer less recovery time but might not be suitable for severe fractures.

Patient Experience

During Procedure: Under general anesthesia, so no pain or awareness during the surgery.

After Procedure:

• Initial pain and swelling managed with medications.
• Temporary discomfort from fixation devices.
• Detailed postoperative care plan provided to ensure comfort and safety.