21246 Reconstruction of mandible or maxilla, subperiosteal implant; complete

Name of the Procedure:

Reconstruction of Mandible or Maxilla, Subperiosteal Implant; Complete

Summary

This surgical procedure involves placing a subperiosteal implant onto the jawbone to reconstruct either the mandible (lower jaw) or maxilla (upper jaw). The implant sits on top of the bone but beneath the periosteum (a layer of tissue that covers the bones). This procedure is used to restore function and aesthetics in patients with significant jawbone loss.

Purpose

The procedure aims to address severe jawbone loss that can result from congenital defects, trauma, tumor resection, or advanced atrophy. The expected outcomes include improved oral function, support for dentures or other dental prosthetics, and enhanced facial aesthetics.

Indications

• Severe bone loss in the mandible or maxilla
• Inability to use conventional dentures due to inadequate bone support
• Reconstruction following tumor removal or trauma
• Congenital jawbone deficiencies

Preparation

• Fasting for at least 8 hours prior to surgery
• Medication adjustments as instructed by the healthcare provider
• Pre-operative imaging (e.g., CT scans)
• Blood tests and medical clearance

Procedure Description

1. Anesthesia: The patient is given general anesthesia or local anesthesia with sedation.
2. Incision and Exposure: Incisions are made in the gum tissue to expose the underlying bone.
3. Implant Placement: A custom-fabricated subperiosteal implant is positioned on top of the jawbone but beneath the periosteum.
4. Secure Implant: The implant is secured with screws or other fixation devices.
5. Closure: The gum tissue is sutured back into place over the implant.
6. Post-Operative Care: Gauze packs may be used to control bleeding and a dressing is applied.

Tools used:

• Surgical scalpel
• Custom subperiosteal implant
• Screws or fixation devices
• Sutures
• Imaging and navigation systems (if applicable)

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and extent of reconstruction.

Setting

This surgery is usually performed in a hospital or surgical center with specialized facilities.

Personnel

• Oral and maxillofacial surgeon or specialized reconstructive surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses and assistants

Risks and Complications

• Infection
• Implant failure or loosening
• Bleeding or hematoma
• Damage to nearby nerves or structures
• Anesthetic complications
• Delayed healing or tissue necrosis

Benefits

• Improved oral function and ability to chew
• Enhanced support for dental prosthetics
• Improved facial aesthetics
• Enhanced quality of life and self-esteem

Recovery

• Initial post-op recovery in a monitored setting
• Pain management with prescribed medications
• Soft diet for a few weeks post-surgery
• Follow-up visits for monitoring healing and implant integration
• Avoidance of strenuous activities for several weeks

Alternatives

• Conventional dentures (less invasive but may not be suitable for severe bone loss)
• Bone grafting and conventional dental implants (involves additional surgeries)
• Distraction osteogenesis (gradual bone lengthening procedure)

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-operatively, discomfort, swelling, and bruising are common but manageable with pain medications and proper care. Patients will gradually feel the benefits once healing progresses and prosthetics are fitted.