21215 Graft, bone; mandible (includes obtaining graft)

Name of the Procedure:

Graft, bone; mandible (includes obtaining graft)
Common Name: Mandibular bone graft
Technical Terms: Autogenous bone grafting, mandibular reconstruction

Summary

A mandibular bone graft is a surgical procedure to replace or augment bone in the lower jaw (mandible) using bone harvested from another site in the patient's body.

Purpose

Condition: Reconstruction of the jaw due to deformities, trauma, disease, or congenital defects.
Goals: Restore jaw function, improve aesthetics, support dental implants, and enhance overall oral health.

Indications

• Severe bone loss in the mandible
• Pathological fractures or osteonecrosis
• Preparation for dental implants
• Jaw defects due to injury or surgical removal of tumors
• Congenital abnormalities

Preparation

• Preoperative consultation and assessment
• Imaging studies like X-rays or CT scans
• Blood tests and medical evaluations
• Fasting for a specific period before surgery
• Adjustments or cessation of certain medications as advised

Procedure Description

1. Administration of general or local anesthesia.
2. Incision made in the donor site (commonly the hip, rib, or chin) to harvest bone.
3. Incision made in the mandibular area needing grafting.
4. Shaping the harvested bone and securing it in place in the mandible using screws or plates.
5. Closing the incisions with sutures.
6. Covering the surgical sites with sterile dressings.

Tools and Equipment: Surgical scalpel, bone harvesting instruments, screws, plates, suturing materials.

Duration

Typically lasts 2-4 hours, depending on the complexity of the case.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Oral and maxillofacial surgeon or plastic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technicians

Risks and Complications

Common Risks: Infection, bleeding, pain, swelling.
Rare Risks: Nerve damage, graft rejection or failure, anesthesia complications, damage to surrounding structures.
Management: Antibiotics for infection, pain management, follow-up procedures if necessary.

Benefits

• Restoration of jaw function and stability
• Improved facial aesthetics
• Ability to support dental implants
• Enhanced overall oral health

Realization: Benefits can typically be seen within a few months post-surgery once healing is complete.

Recovery

• Post-operative pain management with prescribed medications
• Guidelines for diet, often starting with a liquid or soft diet
• Oral hygiene instructions to prevent infection
• Physical restrictions (e.g., avoiding strenuous activities) for a few weeks
• Regular follow-up appointments for monitoring progress

Recovery Time: Several weeks to a few months, depending on individual healing response.

Alternatives

• Synthetic bone graft materials
• Allografts (donor bone from a different individual)
• Distraction osteogenesis (bone lengthening technique)
• Pros and Cons: Alternative methods may have varied compatibility, healing times, and success rates compared to autogenous bone grafting.

Patient Experience

During Procedure: Sedation ensures no pain or awareness of the procedure.
After Procedure: Initial discomfort, swelling, pain, and a potential feeling of tightness in the jaw. Pain can be managed with prescribed medications. Steps are taken to ensure comfort during recovery, including dietary adjustments and activity restrictions.

Pain management and comfort measures are prioritized to ensure a smooth recovery process.