21256 Reconstruction of orbit with osteotomies (extracranial) and with bone grafts (includes obtaining autografts) (eg, micro-ophthalmia)

Name of the Procedure:

Reconstruction of orbit with osteotomies (extracranial) and with bone grafts (includes obtaining autografts)
Technical terms: Orbital reconstruction, extracranial osteotomy, autograft bone reconstruction

Summary

Reconstruction of the orbit with osteotomies and bone grafts is a surgical procedure to rebuild the eye socket, or orbit. This involves cutting bone (osteotomy) outside the skull (extracranial method), and using bone grafts, often taken from another part of the patient’s body (autografts), to repair or reconstruct the area.

Purpose

The procedure addresses issues such as deformities, trauma, or congenital conditions like micro-ophthalmia where the eye socket is underdeveloped. The goal is to restore normal anatomy and function, improve appearance, and allow for better prosthetic fitting if necessary.

Indications

• Congenital conditions like micro-ophthalmia
• Orbital fractures or trauma
• Tumors affecting the orbital bone
• Severe orbital deformities
• Need for improved facial symmetry

Preparation

• Fasting typically required 6-8 hours prior to surgery.
• Review of current medications with a doctor and adjustment if necessary.
• Pre-operative imaging studies such as CT scans to assess the extent of the deformity or damage.
• Routine blood tests and physical examination.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A carefully planned incision is made to access the orbital bones.
3. Osteotomy: Specific bones are cut to reshape or remove damaged areas.
4. Bone Grafting: Autografts, which are small pieces of bone usually taken from the pelvis or rib, are prepared and placed in the orbital area to rebuild and reshape the socket.
5. Fixation: Implants or screws may be used to secure the bone grafts in place.
6. Closing: The incision is closed with sutures, and a dressing is applied.

Tools and Equipment:

• Surgical saws and drills for osteotomies
• Instruments for handling bone grafts
• Fixation devices like plates and screws

Duration

The procedure typically takes 3-6 hours depending on the complexity.

Setting

Performed in a hospital or specialized surgical center with access to complex surgical and anesthesia resources.

Personnel

• Plastic/Reconstructive Surgeon or Maxillofacial Surgeon
• Anesthesiologist
• Surgical Nurses
• Operating Room Technicians

Risks and Complications

Common Risks

• Infection
• Bleeding
• Swelling and bruising

Rare Complications

• Nerve damage causing numbness or loss of function
• Bone graft failure or rejection
• Misalignment requiring additional surgery

Benefits

• Restored orbital anatomy and function
• Improved facial symmetry and appearance
• Enhanced ability to fit and hold a prosthetic eye if needed
• Possible overall improvement in vision-related functions if applicable

Recovery

• Hospital stay of 1-2 days for monitoring
• Pain management with prescribed medications
• Use of cold compresses to reduce swelling
• Avoid strenuous activities for 4-6 weeks
• Follow-up appointments for suture removal and progress monitoring

Alternatives

• Non-surgical options may include prosthetics without reconstruction, though these might not offer the same level of functional and cosmetic improvement.
• Less complex surgeries for minor deformities.
• Risks and benefits of alternatives vary and should be discussed with a healthcare provider.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel pain. Post-operatively, mild to moderate pain, swelling, and bruising are common. Pain is managed with medications, and cold compresses can alleviate discomfort. Instructions on activity limitations and wound care will be provided to aid in recovery and ensure optimal outcomes.