ORIF Parasymphysis (Intraoral Approach)

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Preoperative Considerations


  • Numbness in lip


  • Nasal tube
  • OK to paralyze



  • Local anesthesia
  • Chlorhexidine or betadine mouth prep
  • Dental extraction instruments PRN
  • #15 blade
  • Monopolar/bipolar electrocautery with Colorado tip
  • #9 periosteal elevator
  • Langenbeck retractors (S,M,L)
  • Drill with fissure bur, pineapple bur
  • Bone reduction forcep
  • Plating system with drill bits, plates, screws. Trocar system PRN
  • Arch bars or means of maxillomandibular fixation
  • 3-0 chromic or vicryl sutures

If Extraoral

  • Nerve stimulator (if extraoral)
  • Vascular clips (S,M)
  • 2-0 or 3-0 silk ties
  • Hemostatic agent
  • Drain (penrose, etc.)
  • 2-0 or 3-0 vicryl sutures
  • Skin sutures i.e. 5-0 plain gut


Postoperative Considerations


  • Headwrap for 24 hours

Follow Up:

  • Monitor occlusion, guiding elastics as needed

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.

The fractured segments were grossly aligned and mandibular arch bars were applied. A #15 blade was used to make a vestibular incision. Dissection was carried through the mentalis to the mandible. Dissection was carried in a subperiosteal plane until both fractured segments were identified. The mental nerve was identified and protected. The patient was then placed into maxillomandibular fixation. A fissure bur was used to make monocortical holes on either side of the fracture and bone reduction forcep was applied and the fracture was reduced. A 6-hole reconstruction plate was adapted and fixated All sites were irrigated copiously with NS. The maxillomandibular fixation was released and the occclusion was noted to be stable and reproducible bilaterally. The mentalis was resuspended and mucosal incisions were closed with 3-0 chromic gut.

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. Guiding elastics were placed. 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.


  • CPT Code 21457: Open treatment of mandibular and/or maxillary alveolar ridge fracture (separate procedure); without internal fixation
  • CPT Code 21461: Open treatment of mandibular subcondylar and/or condylar neck fracture (separate procedure); without internal fixation
  • CPT Code 21462: Open treatment of mandibular subcondylar and/or condylar neck fracture (separate procedure); with internal fixation
  • CPT Code 21480: Open treatment of mandibular body fracture (separate procedure); without internal fixation
  • CPT Code 21485: Open treatment of mandibular body fracture (separate procedure); with internal fixation