Extraoral Particulate Bone Graft

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Preoperative Considerations


  • Infection and failure risk
  • Possible need for re-grafting in the future
  • Swelling if using BMP


  • Nasal or submental tube if planning MMF
  • Otherwise oral tube OK if no intraoral communication is expected


  • None


  • Local anesthesia
  • #15 or #10 blade
  • Monopolar/bipolar electrocautery
  • Skin hooks
  • "Lone star/fish hook" self-retaining retractors
  • Nerve stimulator
  • #9 periosteal elevator
  • Bone graft material
    • Allograft or autograft
  • Mesh
  • BMP
  • Vicryl sutures
  • Skin sutures
  • Drain
  • Hemostatic agent PRN


  • Determined defect size to approximate size of mesh and volume of bone that will be needed
  • Trim mesh so it can be adapted to span the defect, allowing for adequate space to fixate on either side
  • Screw the mesh to the mandible, this can be done with self-drilling screws

Postoperative Considerations


  • Normotension, monitor for bleeding

Follow Up:

  • Routine neck incision follow up

Operative Note

Surgeon(s): ***

Assistant Surgeon(s):  ***

Preoperative Diagnosis: ***

Postoperative Diagnosis: Same

Procedure(s): ***

Anesthesia: General

Implants: None


Drains: None

Fluids: See anesthesia record

EBL: Minimal

Complications: None

Counts:  Correct x2

Indications: ​***

Findings: As expected

Procedure in Detail:

The patient was seen in the preoperative holding area with a H&P was updated, consents were verified, surgical site marked, and all questions and concerns related to the proposed procedure were discussed in detail.  The patient was transferred to the operating room by the anesthesia team.  The patient underwent general anesthesia with endotracheal intubation. Tegaderms were placed over the eyes. The patient was prepped and draped in the standard fashion for maxillofacial procedures.  A time-out was performed and the procedure began.

Attention was directed to the neck. A skin incision was made from the mandibular angle to the midline. Dissection was carried through the subcutaneous tissue and platysma. A subplatysmal flap was elevated superiorly to the inferior border of the mandible. The superficial layer of deep cervical fascia was then sharply incised at the inferior pole of the submandibular gland and a subscapsular dissection was carried to the inferior border. The facial artery and vein wereidentified and ligated and transected. The periosteum at the inferior border was then opened and the mandible was exposed. The defect was measured and a titanium mesh was sized and adapted to the defect. It was then secured with screws. All sites were irrigated copiously with NS. Particulate bone graft was packed into the mesh and the site was covered with BMP. Hemostasis was obtained. Hemostatic agent was applied. The tissues were redraped and platysma was closed with 3-0 vicryl. The Skin was then closed with 5-0 plain gut. Bacitracin was applied to the incision.

The patient's face was then cleaned and the posterior pharynx was suctioned. An OG tube was used to suction out the contents of the stomach. Tegaderms were removed from the eyes. Dressings were placed. The patient was then transferred back to the care of the anesthesia team for extubation and recovery.


  • 20930: Allograft, morselized, or placement of cancellous bone or bone marrow with percutaneous skeletal fixation, with or without other skeletal fixation (includes obtaining bone graft)
  • 21210: Graft; mandible, extraoral incision (includes obtaining graft)
  • 21215: Graft; mandible, endosteal (includes obtaining graft)
  • 21230: Graft; mandible, onlay (includes obtaining graft)
  • 21240: Graft; mandible, alveolar ridge augmentation (ridge-split procedure) (includes obtaining graft)