21470 Open treatment of complicated mandibular fracture by multiple surgical approaches including internal fixation, interdental fixation, and/or wiring of dentures or splints

Name of the Procedure:

Open Treatment of Complicated Mandibular Fracture
Common names: Jaw surgery, Mandible fracture repair
Medical terms: Open reduction and internal fixation (ORIF) of mandibular fracture

Summary

This surgical procedure involves repairing a complicated fracture of the lower jaw (mandible) using multiple approaches. It includes the use of internal and interdental fixation, and may involve wiring dentures or splints to stabilize the jaw during healing.

Purpose

• Address the issue of a complicated mandibular fracture.
• Restore normal function and alignment of the jaw.
• Promote proper healing of the bone.
• Alleviate pain and prevent future complications.

Indications

• Severe or complicated fractures of the mandible that cannot heal properly without surgical intervention.
• Misaligned jaw due to trauma.
• Patient exhibits symptoms such as difficulty in speaking, eating, or severe pain in the jaw area.

Preparation

• Patient may be advised to fast for several hours prior to surgery.
• Adjustments to current medications, particularly any that affect blood clotting.
• Preoperative imaging studies such as X-rays or CT scans to assess the extent of the fracture.

Procedure Description

1. Administration of general anesthesia to ensure the patient is asleep and pain-free.
2. Making precise incisions to access the fractured bone.
3. Realigning the broken fragments of the mandible.
4. Fixing the bones using plates and screws (internal fixation).
5. Sometimes, using interdental fixation techniques including wiring of dentures or splints to stabilize the jaw.
6. Closing incisions with sutures.
7. Applying a sterile dressing to the surgical site.

Tools/Equipment: Surgical instruments, internal fixation devices (plates and screws), wires for dental fixation, imaging tools for intraoperative assessment.

Duration

The procedure typically takes 2 to 3 hours, depending on the complexity of the fracture.

Setting

This procedure is performed in a hospital's operating room.

Personnel

• Oral and maxillofacial surgeon.
• Anesthesiologist.
• Surgical nurses and assistants.
• Radiology technician (if intraoperative imaging is needed).

Risks and Complications

• Common risks: Infection, bleeding, swelling, and bruising.
• Rare risks: Nerve damage leading to numbness or altered sensation, non-union of the fracture, issues with hardware (plates and screws).
• Possible management: Antibiotics for infection, follow-up surgeries for hardware issues or non-union.

Benefits

• Proper alignment and stabilization of the jaw.
• Reduced pain and improved function.
• Faster and more predictable healing process.
• Prevention of future complications associated with misaligned jaw bones.

Recovery

• Post-operative care includes pain management, antibiotics, and instructions on oral hygiene.
• A soft diet is usually recommended for several weeks.
• Physical activity may need to be limited.
• Follow-up appointments to monitor healing and remove any non-resorbable fixation devices.

Alternatives

• Conservative treatment with closed reduction and immobilization, but this is generally less effective for complicated fractures.
• Pros and cons: Non-surgical methods involve fewer risks but may not ensure proper alignment and healing, potentially resulting in longer recovery and more complications.

Patient Experience

• During the procedure: The patient will be under general anesthesia and will not feel any pain.
• After the procedure: Expect some discomfort, swelling, and limited jaw movement. Pain management options will be provided.
• Immediate post-operative discomfort may be alleviated with prescribed medications and cold compresses.