21360 Open treatment of depressed malar fracture, including zygomatic arch and malar tripod

Name of the Procedure:

Open treatment of depressed malar fracture, including zygomatic arch and malar tripod
Common name(s): Open reduction of cheekbone fracture, Zygomaticomaxillary complex (ZMC) fracture repair.

Summary

Open treatment of a depressed malar fracture involves an operative procedure to realign and stabilize broken bones in the cheek area. This process often includes repairing the zygomatic arch and the malar tripod that comprise the cheekbone structure.

Purpose

The procedure addresses fractures to the cheekbone (malar bone) often resulting from trauma such as accidents or sports injuries. The goals include restoring the normal appearance of the face, ensuring proper alignment of facial bones, and preserving functions such as chewing and vision.

Indications

• Facial asymmetry or deformity following trauma
• Difficulty opening the mouth or chewing
• Persistent pain in the cheek area
• Vision problems due to bone displacement affecting the eye socket

Preparation

• Patients may be required to fast for several hours before the procedure.
• Any blood-thinning medications may need to be adjusted or stopped.
• Preoperative imaging (CT scan, X-rays) is done to plan the surgery.
• Basic blood tests and medical evaluations might be conducted.

Procedure Description

1. The patient is placed under general anesthesia.
2. A surgical cut is made, typically inside the mouth or possibly around the eyelid to minimize visible scarring.
3. The surgeon accesses the fractured bones through the incision.
4. The bones are realigned to their natural positions.
5. Plates, screws, or wires may be used to stabilize and hold the bones in place.
6. The incision is closed with sutures.
7. Sterile dressings are applied to protect the site.

Duration

The procedure generally takes 1 to 2 hours, depending on the complexity of the fracture.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

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

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Nerve damage leading to numbness or loss of sensation
• Swelling and bruising
• Issues with bone healing or misalignment
• Scarring

Benefits

• Restoration of facial symmetry and normal appearance
• Improved ability to chew and open the mouth
• Resolution of pain and discomfort
• Prevention of long-term complications from misaligned bones

Recovery

• The patient may need to stay in the hospital for monitoring overnight.
• Pain management will be provided, including medications.
• Swelling and bruising are expected but will subside over a few weeks.
• Follow-up appointments are necessary to check the healing process.
• Physical activity, particularly contact sports, should be avoided for several weeks.
• Instructions on oral hygiene and care of the incision site are provided.

Alternatives

• Closed reduction without surgery, although this is less precise for bone alignment.
• Observation and management of symptoms in minor fractures.
• Each alternative is less likely to achieve the same level of restoration and functional outcome as the open treatment.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel pain. Post-operatively, there may be discomfort, swelling, and bruising, which can be managed with medication. Detailed care instructions and follow-up visits help ensure a smooth recovery process.