21244 Reconstruction of mandible, extraoral, with transosteal bone plate (eg, mandibular staple bone plate)

Name of the Procedure:

Reconstruction of mandible, extraoral, with transosteal bone plate (e.g., mandibular staple bone plate)

Summary

This surgical procedure involves rebuilding the lower jaw (mandible) from the outside of the mouth using special bone plates, often called mandibular staple bone plates.

Purpose

The procedure addresses significant structural damage or deformity of the mandible caused by trauma, cancer, congenital defects, or other medical conditions. The goals are to restore functionality, improve aesthetics, and enable normal activities like chewing and speaking.

Indications

• Severe mandibular fractures
• Tumor resection areas
• Congenital mandibular deformities
• Previous failed reconstructive surgeries

Patients who have significant structural damage to their mandible that cannot be corrected through less invasive means are typically candidates for this procedure.

Preparation

• Fasting for at least 6-8 hours before surgery
• Adjusting current medications (consultation with a healthcare provider)
• Pre-operative imaging (CT scans, X-rays) to assess the mandibular condition
• Blood tests to ensure the patient is fit for surgery

Procedure Description

1. Anesthesia is administered (general anesthesia).
2. The surgeon makes an incision on the outer part of the lower jaw.
3. The damaged or deformed mandibular bone is exposed and prepared.
4. A preformed transosteal bone plate (mandibular staple bone plate) is fitted and secured with screws.
5. The surgeon ensures proper alignment and fixation of the bone plate.
6. The incision is closed with sutures, and a dressing is applied.

Special tools include surgical drills, screws, and the bone plate for fixation.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity of the case.

Setting

The procedure is performed in a hospital operating room.

Personnel

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

Risks and Complications

• Infection at the surgical site
• Nerve damage leading to numbness or loss of function
• Poor healing or bone non-union
• Plate or screw loosening or failure
• Adverse reactions to anesthesia

Benefits

• Restoration of the jaw's structural integrity
• Improved functionality for chewing and speaking
• Enhanced cosmetic appearance
• Long-term stability and support

Benefits are typically realized within a few weeks to months following the procedure, as the bone heals and adapts to the plate.

Recovery

• Pain management with medications
• Soft food diet for a few weeks
• Regular follow-up visits to monitor healing
• Possible physiotherapy for jaw function recovery
• Avoidance of strenuous activity for several weeks

Full recovery can take several months, with gradual improvement.

Alternatives

• Non-surgical management (limited to less severe cases)
• Use of different types of bone grafts or implants
• Distraction osteogenesis (bone lengthening technique)

Each alternative has its own risks and benefits; however, they may not be as immediately effective or suitable for severe cases as the described procedure.

Patient Experience

The patient will be under general anesthesia during the procedure and will not feel anything. Post-operatively, there will be swelling, some pain, and discomfort managed through medications. Patients may have to adhere to a modified diet and follow specific care instructions to ensure proper healing. Pain typically reduces significantly within the first few days to weeks, and overall comfort improves gradually as recovery progresses.