Maxillectomy; without orbital exenteration
CPT4 code
Name of the Procedure:
Maxillectomy (without orbital exenteration)
Summary
Maxillectomy is a surgical procedure to remove part or all of the maxilla (upper jaw) without involving the removal of the eye and related structures. This operation is usually performed to treat tumors or severe infections in the maxillary region.
Purpose
The medical condition or problem it addresses:
- Treatment of malignant or benign tumors in the maxillary region
- Management of severe infections or other pathological conditions affecting the upper jaw
The goals or expected outcomes of the procedure:
- Complete removal of the affected tissue
- Preservation of eye function and appearance
- Improvement in symptoms and prevention of disease spread
Indications
Specific symptoms or conditions that warrant the procedure:
- Presence of malignant tumors such as squamous cell carcinoma, sarcomas
- Benign but aggressive growths like ameloblastomas
- Chronic infections or osteomyelitis not responsive to other treatments
Patient criteria or factors that make the procedure appropriate:
- Diagnosis confirmed through imaging (CT, MRI) and biopsy
- Health status allowing for surgery under general anesthesia
Preparation
Pre-procedure instructions for the patient:
- Fasting for at least 8 hours prior to surgery
- Adjustment or discontinuation of certain medications as advised by the physician
Any diagnostic tests or assessments required beforehand:
- Comprehensive imaging studies (CT, MRI)
- Biopsy of the lesion
- Blood tests and pre-surgical clearance
Procedure Description
Detailed step-by-step explanation of what the procedure involves:
- Administration of general anesthesia
- Incision made in the gingival (gum) region or through the facial skin
- Careful dissection to expose the maxilla
- Removal of the affected portion of the maxilla while sparing the orbital structures
- Reconstruction using grafts or implants if necessary
- Closure of the surgical site with sutures
Tools, equipment, or technology used:
- Surgical instruments (scalpels, retractors, saws)
- Imaging guidance as needed
- Possible use of grafting materials or implants for reconstruction
Anesthesia or sedation details:
- General anesthesia is used to ensure the patient is unconscious and pain-free throughout the procedure
Duration
How long the procedure typically takes:
- Approximately 3 to 6 hours, depending on the extent of the surgery and the complexity of the case
Setting
Where the procedure is performed:
- Hospital operating room or specialized surgical center
Personnel
Healthcare professionals involved:
- Oral and maxillofacial surgeon or head and neck surgeon
- Anesthesiologist
- Surgical nurses and assistants
Risks and Complications
Common and rare risks associated with the procedure:
- Bleeding and infection
- Damage to adjacent structures, such as facial nerves
- Complications related to anesthesia
- Difficulty with speech and eating post-surgery
Possible complications and their management:
- Infection managed with antibiotics
- Pain managed with prescribed medications
- Surgical revisions if necessary for complications
Benefits
Expected benefits and how soon they might be realized:
- Removal of diseased tissue and potential cure
- Symptom relief and improved quality of life
- Recovery of facial function and aesthetics, though immediate benefits depend on individual healing and reconstruction
Recovery
Post-procedure care and instructions:
- Pain management with prescribed medications
- Regular follow-up appointments to monitor healing
- Instructions on diet and oral hygiene during recovery
Expected recovery time and any restrictions:
- Initial recovery period of several weeks
- Full recovery and adjustment may take several months
- Possible temporary or permanent dietary adjustments
Alternatives
Other treatment options available:
- Radiation therapy or chemotherapy if surgery is not viable
- Less extensive surgical options for smaller or less aggressive lesions
Pros and cons of alternatives compared to the described procedure:
- Non-surgical options may avoid invasive surgery but may not be as effective for complete removal
- Surgery offers definitive removal but has higher immediate risks and requires longer recovery
Patient Experience
What the patient might feel or experience during and after the procedure:
- During surgery: Patient is under general anesthesia and will not feel or remember the operation
- After surgery: Pain, swelling, and discomfort managed with medications
- Possible temporary numbness or difficulty with facial movements due to nerve involvement
- Gradual improvement in function and appearance as healing progresses
Pain management and comfort measures:
- Prescription pain medications and possible use of ice packs
- Soft or liquid diet recommendations initially
- Gentle oral care to prevent infection and promote healing