Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid fixation
CPT4 code
Name of the Procedure:
Reconstruction of Mandibular Rami and/or Body, Sagittal Split with Internal Rigid Fixation
Common Name(s): Mandibular sagittal split osteotomy, Jaw reconstruction surgery
Technical Term(s): Bilateral Sagittal Split Osteotomy (BSSO)
Summary
Reconstruction of mandibular rami and/or body using a sagittal split technique with internal rigid fixation is a surgical procedure to correct jaw deformities. It involves cutting the lower jaw bone, repositioning it, and securing it with plates and screws.
Purpose
Addresses: Misaligned jaws, mandibular deformities, and bite discrepancies.
Goals/Outcomes: To improve jaw function, aesthetics, and overall oral health by ensuring proper alignment and stability of the jaw.
Indications
Symptoms/Conditions: Jaw misalignment, difficulty chewing, speech problems, sleep apnea caused by jaw structure, facial asymmetry.
Patient Criteria: Suitable for patients with significant mandibular discrepancies not correctable by orthodontics alone.
Preparation
Instructions: Typically includes fasting for 8-12 hours prior, cessation of certain medications as advised, and smoking cessation.
Assessments: Dental impressions, X-rays, CT scans, and sometimes 3D modeling of the jaw are required for surgical planning.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incisions: Incisions are made inside the mouth to access the mandibular bone to avoid visible scars.
- Osteotomy: The surgeon performs a sagittal split of the mandibular bone.
- Repositioning: The jaw segments are repositioned to the desired alignment.
- Fixation: The segments are fixed in place using titanium plates and screws.
- Closure: Incisions are closed with sutures.
Tools/Equipment: Surgical drill, bone saw, titanium plates, and screws.
Anesthesia Details: General anesthesia is used to ensure the patient is unconscious and pain-free.
Duration
The procedure typically takes 2 to 4 hours, depending on the complexity of the case.
Setting
Performed in a hospital or specialized surgical center with operating room facilities.
Personnel
Healthcare Professionals: Oral and maxillofacial surgeon, anesthesiologist, surgical nurses, and sometimes orthodontists for planning.
Risks and Complications
Common Risks: Infection, bleeding, swelling, bruising, and temporary numbness.
Rare Risks: Permanent nerve damage, relapse of jaw position, and issues with fixation hardware.
Management: Post-operative antibiotics, pain management, follow-up visits for monitoring.
Benefits
Expected Benefits: Improved bite function, better jaw alignment, enhanced facial symmetry, and longer-term oral health benefits.
Realization: Benefits are typically realized within a few months as swelling subsides and healing progresses.
Recovery
Post-Procedure Care: Pain management, soft or liquid diet for several weeks, oral hygiene instructions, and wound care.
Expected Recovery Time: 6 to 12 weeks for initial recovery, with full healing taking several months.
Restrictions/Follow-up: Limitation on strenuous activities, regular follow-up appointments to monitor healing and orthodontic adjustments if necessary.
Alternatives
Other Options: Orthodontic treatment alone, genioplasty (chin surgery), or non-surgical treatments for mild cases.
Pros/Cons of Alternatives: Non-surgical options may be less invasive but potentially less effective for severe jaw discrepancies. Surgical alternatives may not address all functional issues as effectively.
Patient Experience
During Procedure: Under general anesthesia, the patient will be unconscious and will not feel pain.
After Procedure: Patients may experience swelling, discomfort, and tightness in the jaw. Pain is managed with medication, and discomfort usually decreases significantly after the first week.
Pain management and comfort measures include prescribed pain relievers and maintaining an elevated head position to reduce swelling.