Name of the Procedure:

Reconstruction of the Midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); without LeFort I

Summary

This surgical procedure is designed to reconstruct the midface (the area between the eyes and mouth) using bone grafts. It involves the LeFort III osteotomy, a specific method of cutting and repositioning bone to correct facial deformities without involving a LeFort I cut (upper jaw).

Purpose

The surgery aims to correct facial deformities that impact aesthetics, function, or both, often due to congenital conditions, trauma, or disease. The goals are to restore normal appearance, improve function (such as breathing and chewing), and enhance overall quality of life.

Indications

• Congenital facial deformities (e.g., craniofacial syndromes)
• Trauma resulting in midface fractures
• Severe maxillary hypoplasia (underdevelopment of the upper jaw)
• Post-tumor resection reconstruction

Patients eligible for this procedure usually have symptoms like difficulty breathing or chewing, facial asymmetry, or significant aesthetic concerns.

Preparation

• Patients may need to fast for a period before surgery.
• Medication adjustments might be required.
• Pre-operative assessments include imaging studies (CT or MRI scans) to plan the surgery.
• Blood tests and a thorough medical evaluation are also necessary.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incisions: The surgeon makes careful incisions in the appropriate areas of the face.
3. Osteotomy: Bones of the midface are cut and repositioned according to the LeFort III method.
4. Grafts: Bone grafts are obtained from another part of the patient's body or a donor (autograft) and shaped to fit into the reconstructed area.
5. Fixation: The repositioned bones and grafts are secured with plates, screws, or other fixation devices.
6. Closure: Incisions are closed with sutures, and the area is bandaged.

Duration

The procedure typically takes around 4 to 8 hours, depending on the complexity of the case.

Setting

This surgery is performed in a hospital setting, often in a specialized surgical suite equipped for complex facial reconstructions.

Personnel

• Lead Surgeon: A plastic or craniofacial surgeon.
• Assistant Surgeons: Additional surgeons to help with the procedure.
• Anesthesiologist: Monitors the patient's vital signs and manages anesthesia.
• Surgical Nurses: Assist with the operation and patient care.

Risks and Complications

• Infection
• Bleeding or hematoma
• Nerve damage causing numbness or weakness
• Scarring
• Failure of bone grafts to integrate
• Misalignment or relapse of reconstructed structures

Benefits

• Improved facial symmetry and aesthetics
• Enhanced function (e.g., better breathing and chewing)
• Increased self-esteem and quality of life

Benefits generally become noticeable as healing progresses, typically within a few weeks to months.

Recovery

• Patients may need to stay in the hospital for several days post-surgery.
• Pain and swelling are common and managed with medications.
• Instructions include wound care, activity restrictions, and dietary modifications.
• Follow-up appointments are crucial to monitor healing.
• Full recovery can take several months.

Alternatives

• Orthognathic surgery involving different techniques.
• Non-surgical options like orthodontics or prosthetic masks (less effective in severe cases).

Pros and cons of alternatives depend on the individual patient's condition and goals.

Patient Experience

• Patients are under general anesthesia during the procedure, so there is no pain felt.
• Post-operative discomfort is managed with pain relief measures.
• They may experience swelling, bruising, and temporary numbness or tightness.
• Emotional support and counseling may help with the adaptation to physical changes.