Name of the Procedure:

Reconstruction Midface, LeFort I; 3 or More Pieces, Segment Movement in Any Direction, Without Bone Graft

Summary

In this surgical procedure, the midface (the area including the upper jaw, nose, and eye sockets) is reconstructed by realigning the bone segments into better positions. It involves moving the segments in any necessary direction but does not use bone graft materials.

Purpose

This procedure addresses facial deformities or injuries affecting the midface, such as congenital anomalies, trauma, or post-tumor resections. The goal is to restore normal facial structure, improve function (like chewing and speaking), and enhance aesthetic appearance.

Indications

• Severe facial trauma
• Congenital facial deformities (e.g., cleft palate)
• Post-cancer reconstruction
• Misalignment of the jaws causing functional issues Patients who require comprehensive midface realignment and do not require additional support from bone grafts are prime candidates.

Preparation

Patients are typically instructed to:

• Undergo fasting for at least 8 hours before surgery
• Cease certain medications like blood thinners as advised by the surgeon
• Complete pre-operative imaging (CT scans, X-rays) to assist with surgical planning
• Possibly attend a pre-surgical interview or meet with an anesthesiologist

Procedure Description

1. The patient is placed under general anesthesia.
2. Incisions are made inside the mouth to avoid visible scarring.
3. The surgeon carefully cuts the bones of the midface into three or more segments.
4. These segments are then repositioned and realigned to achieve the desired facial contour and functionality.
5. Plates, screws, or wires secure the bone segments in place.
6. The incisions are closed using sutures that typically dissolve over time.

Duration

The procedure typically takes between 4 to 6 hours, depending on the complexity.

Setting

This surgery is performed in a hospital operating room equipped for specialized facial surgeries.

Personnel

• Head and Neck Surgeon or Maxillofacial Surgeon
• Surgical Nurses
• Anesthesiologist
• Possibly a Plastic Surgeon if additional aesthetic refinements are needed

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Nerve damage resulting in numbness or altered sensation
• Difficulty breathing (rare)
• Malalignment requiring revision surgery

Benefits

• Improved facial symmetry and appearance
• Enhanced ability to chew, speak, and breathe
• Restoration of normal facial function Patients may notice improvements in facial appearance and functionality within a few weeks post-surgery, with continued improvement as healing progresses.

Recovery

• Hospital stay of 1-3 days typically required
• Pain management with prescribed medication
• Swelling and bruising which should lessen within 1-2 weeks
• Soft diet recommended initially
• Follow-up appointments to monitor healing and remove sutures if necessary
• Normal activities can usually be resumed within 4-6 weeks

Alternatives

• Osteotomies with bone grafting
• Less invasive orthodontic treatments
• Facial prosthetics
• Each alternative comes with its own set of benefits and potential drawbacks, which should be discussed with the surgeon.

Patient Experience

Patients can expect significant swelling, bruising, and some discomfort post-surgery, managed with pain relief medications. They should follow a soft diet initially and adhere to post-operative care instructions for optimal recovery. Normal activities and functions generally resume within a month.