Thanks so much for your help guys! I'm used to only doing E&M and OB visits, so this is a whole different area for me.
OP procedure:
1. Internal vertical ramus osteotomies bilaterally with placement of maxilla mandibular fixation.
2. Implant reconstruction, left maxilla with bone graft and pericardial freeflap graft.
Description of operation:
Attention was first directed to the edentulous left maxilla. A full-thickness mucoperiosteal flap was elevated. There was some irritation to the gingival tissues. The area of the endentulous maxilla was approached with a round bur, then a 3.4 taper drill to a depth of 13 mm, then a 5.0 taper drill to a depth of 13 mm, then a 6.0 taper drill to a depth of 13 mm.
A 6.0 x 13 mm implant was placed into the area. There was some overexposure of the threads of the implant. OraGraft was placed over this area, and then a pericardia graft was placed over the area. The pericardium was sutured into place, with horizontal mattress sutures of 301 Vicryl suture.
The area was stabilized, then attention was directed to the left mandible. An arch bar was adapted to the left mandible and secured to each tooth with interdental wires from the left side to the right side into position. An arch bar was then adapted to the maxillary dentition with itnerdental wires in that area as well.
Attention was directed to the left mandible retromolar area. An incision was made in the left retromolar area, halfway up the ramus, of about a 2 cm incision. The ramus was exposed on the left side. The area of the left ramus was approached first with an oscillating saw. Initially this was sued superiorly. When it came down to inferiorly a significant amount of bleeding was approached. This portion was terminated.
The right side was approached in a similar manner. A right angle drill with a #8 round bur was utilized up throught the area to the mandible from between the condylar neckand the coronoid process and the notch. This was taken downard and posteriorly through the inferior angle of the mandible. A curved chisel was utilized in the area, an dthe caudal area was seperated from the distal area.
The left side was approached the same. Drill was used in the posterior aspect of themandible here. Directed in an upward to a downard position, the osteotomy was finished there with the curved chisel. This allowed for the condyles to be disarticulated from the rest of the mandible.
The patient was placed into maxilla mandibular fixation with 4 wire loops.