Kisha
Networker
I SAY....... 21462, 27637, 20900 (27637 FOR EXCISION or CAN I BILL THIS CODE)
OPERATIVE PROCEDURE:
1. Open reduction and internal fixation.
2. Bone graft augmentation from left tibia to right mandibular body.
The attention was first directed to the right neck, where the inferior
border of the mandible was marked out. Approximately 6 mL of 0.5% Marcaine
with 1:200,000 epinephrine was infiltrated locally. A 14 cm incision,
approximately 2 fingerbreadths below the inferior border of the mandible in
a neck crease was then incised through skin and subcutaneous tissue. All
bleeding was controlled by electrocautery. Blunt dissection was carried
through the superficial subcutaneous tissues until the platysma was
encountered. The platysma was then sharply dissected, dissection carried
to the SCM where the superficial layer of the deep cervical fascia was
encountered. This was again sharply incised. Blunt dissection was carried
up to the submandibular gland where the superficial layer of the deep
cervical fascia was then incised. Blunt dissection was carried through
along the entire length of the incision. The facial vein and artery were
then identified and ligated using 2-0 silk ties. The __________ was found
to be necrotic and approximately 12 mm. This was removed and sent for
pathology. The blunt dissection was carried to the pterygoid-masseteric
sling. Once encountered, it was sharply dissected using Bovie
electrocautery. The inferior border of the mandible was then identified.
The proximal and distal segments were fused in a fibrous union and mobile.
Then, a 2.5 mm Synthes locking Recon plate was then used with approximately
3 holes proximal and 3 holes distal with 1 hole in the middle spanning the
fibrous union. Using 10 and 12 mm locking screws, the plate was fixated to
the mandible anatomically, reduced to the bone.
Attention was then directed to the left tibia. Approximately 5 mL of 0.5%
Marcaine with 1:200,000 epinephrine and 2% lidocaine with 1:100,000
epinephrine were injected into the medial aspect of her superior tibia. An
incision approximately 2.5 cm long was carried through the skin, down to
the subcutaneous tissues. Dissection was carried down to the medial aspect
of her tibia. A small corticotomy window was then created using a core
drill. Cancellous bone was then scooped out of the marrow space.
Approximately 25 mL of cancellous bone was harvested. The donor site was
then packed with Avitene and closed in layers using 4-0 Vicryl and 3-0
Monocryl. A Tegaderm was placed as well as a pressure dressing with an Ace
bandage.
The harvested bone was then packed into the area of the nonunion.
Approximately 15 mL were used. The area was then inspected for any
excessive bleeding. This was controlled using electrocautery. The wound
was then closed in an interrupted fashion using 3-0 Vicryl popoffs in a
layered fashion, first with the superficial deep cervical fascia, platysmal
layer, deep dermals. The dressing was then dressed with Dermabond. The
patient was then rotated back. Both surgical areas were then inspected for
any excessive bleeding. The patient was then turned over to Anesthesia
where she was extubated without any complications and transferred to the
PACU in stable condition.
I SAY....... 21462, 27637, 20900 (27637 FOR EXCISION or CAN I BILL THIS CODE)
OPERATIVE PROCEDURE:
1. Open reduction and internal fixation.
2. Bone graft augmentation from left tibia to right mandibular body.
The attention was first directed to the right neck, where the inferior
border of the mandible was marked out. Approximately 6 mL of 0.5% Marcaine
with 1:200,000 epinephrine was infiltrated locally. A 14 cm incision,
approximately 2 fingerbreadths below the inferior border of the mandible in
a neck crease was then incised through skin and subcutaneous tissue. All
bleeding was controlled by electrocautery. Blunt dissection was carried
through the superficial subcutaneous tissues until the platysma was
encountered. The platysma was then sharply dissected, dissection carried
to the SCM where the superficial layer of the deep cervical fascia was
encountered. This was again sharply incised. Blunt dissection was carried
up to the submandibular gland where the superficial layer of the deep
cervical fascia was then incised. Blunt dissection was carried through
along the entire length of the incision. The facial vein and artery were
then identified and ligated using 2-0 silk ties. The __________ was found
to be necrotic and approximately 12 mm. This was removed and sent for
pathology. The blunt dissection was carried to the pterygoid-masseteric
sling. Once encountered, it was sharply dissected using Bovie
electrocautery. The inferior border of the mandible was then identified.
The proximal and distal segments were fused in a fibrous union and mobile.
Then, a 2.5 mm Synthes locking Recon plate was then used with approximately
3 holes proximal and 3 holes distal with 1 hole in the middle spanning the
fibrous union. Using 10 and 12 mm locking screws, the plate was fixated to
the mandible anatomically, reduced to the bone.
Attention was then directed to the left tibia. Approximately 5 mL of 0.5%
Marcaine with 1:200,000 epinephrine and 2% lidocaine with 1:100,000
epinephrine were injected into the medial aspect of her superior tibia. An
incision approximately 2.5 cm long was carried through the skin, down to
the subcutaneous tissues. Dissection was carried down to the medial aspect
of her tibia. A small corticotomy window was then created using a core
drill. Cancellous bone was then scooped out of the marrow space.
Approximately 25 mL of cancellous bone was harvested. The donor site was
then packed with Avitene and closed in layers using 4-0 Vicryl and 3-0
Monocryl. A Tegaderm was placed as well as a pressure dressing with an Ace
bandage.
The harvested bone was then packed into the area of the nonunion.
Approximately 15 mL were used. The area was then inspected for any
excessive bleeding. This was controlled using electrocautery. The wound
was then closed in an interrupted fashion using 3-0 Vicryl popoffs in a
layered fashion, first with the superficial deep cervical fascia, platysmal
layer, deep dermals. The dressing was then dressed with Dermabond. The
patient was then rotated back. Both surgical areas were then inspected for
any excessive bleeding. The patient was then turned over to Anesthesia
where she was extubated without any complications and transferred to the
PACU in stable condition.
I SAY....... 21462, 27637, 20900 (27637 FOR EXCISION or CAN I BILL THIS CODE)