21365 Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with internal fixation and multiple surgical approaches

Name of the Procedure:

Open Treatment of Complicated Fracture(s) of Malar Area, Including Zygomatic Arch and Malar Tripod with Internal Fixation and Multiple Surgical Approaches

Summary

The procedure involves surgically repairing complex fractures in the malar (cheek) area including the zygomatic arch. This is typically done through multiple surgical approaches and involves the use of internal fixation devices, like plates and screws, to stabilize the bones.

Purpose

Medical Condition:

• Complex fractures in the cheekbone area, possibly involving multiple bones and crucial anatomical structures like cranial nerve foramina. ##### Goals:
• To properly align and stabilize fractured bones.
• To restore facial symmetry and function.
• To prevent complications like nerve damage or disfigurement.

Indications

Symptoms:

• Visible deformity or asymmetry in the cheek area.
• Difficulty in moving the jaw or other facial structures.
• Numbness or tingling in the face. ##### Appropriate for Patients:
• Suffering from comminuted fractures or fractures involving cranial nerve foramina.
• Requiring acute surgical intervention for optimal recovery.

Preparation

• Pre-Procedure Instructions: Fasting typically required for 6-8 hours before the procedure. Abstain from certain medications as advised by the surgeon.
• Assessments: Diagnostic imaging (CT or X-rays) to evaluate the extent of fractures. Blood tests and medical history review.

Procedure Description

1. Anesthesia: General anesthesia to ensure the patient is unconscious and pain-free.
2. Surgical Access: Multiple incisions may be made to access the fractured areas.
3. Bone Alignment: Fractured bone segments are realigned to their normal anatomical positions.
4. Internal Fixation: Plates, screws, or other devices are used to stabilize and fix the bones in place.
5. Closure: Incisions are closed with sutures, and sterile dressings are applied.

Tools and Equipment:

• Surgical plates, screws, and other fixation devices.
• Standard surgical instruments for bone manipulation and alignment.

Duration

Approximately 2-4 hours, depending on the complexity of the fractures.

Setting

Typically performed in a hospital operating room.

Personnel

• Orthopedic or maxillofacial surgeon.
• Surgical nurses.
• Anesthesiologist.
• Surgical technicians.

Risks and Complications

• Infection.
• Bleeding or hematoma.
• Nerve damage leading to numbness or tingling.
• Nonunion or malunion of bones.
• Scarring or cosmetic differences.

Benefits

• Properly aligned and stable facial bones.
• Restoration of facial symmetry and function.
• Prevention of long-term complications.
• Improved quality of life and appearance.

Recovery

• Post-Procedure Care: Pain management with prescribed medications. Antibiotics if needed.
• Recovery Time: Initial swelling and bruising subside in 2-3 weeks. Full recovery may take several months.
• Restrictions: Avoid strenuous activities for several weeks. Follow specific dietary guidelines if jaw movement is affected.
• Follow-Up: Regular check-ups to monitor healing and remove any hardware if necessary.

Alternatives

• Non-Surgical Management: For less severe fractures, involving immobilization and rest.
• Minimally Invasive Procedures: In selected cases, minimally invasive approaches may be suitable.
• Pros and Cons: Non-surgical options typically involve longer recovery and may not fully restore function or appearance.

Patient Experience

• During the Procedure: Under anesthesia, the patient will not feel or be aware of the surgery.
• After the Procedure: Expect discomfort, swelling, and bruising, managed with pain medications. Some may experience temporary numbness or tingling.
• Comfort Measures: Application of cold compresses to reduce swelling, elevation of the head, and adherence to medication regimes.

By adhering to the outlined steps and considerations, this surgical procedure aims to achieve optimal outcomes for patients suffering from complex facial fractures.