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2 Jaw Surgery

Surgical cosmetic procedure to correct alignment of upper and lower jaw.

01 - Patient Setup

Pre-op Meds: Ancef or clindamycin, 8 mg Decadron, Tranexamic acid

Anesthesia:  General, hypotensive MAP 55-60mm Hg

Patient position: Supine

Bed position: 90° surgeon away from anesthesia machine on R patient's side

DVT ppx:  Compression boots on - working BEFORE induction of anesthesia

Side Table: Xeroform strip gauze, 2-0 prolene,  scissors, tape, blue towels forceps, tegaderm, lido w epi 30cc (see image side table below)

Lights: Surgeon headlamp

Power: Rem B drill, reciprocating saw. 1 short reciprocating blade

Bovie Settings: 30-30 w/ Teflon guarded but tip

Preinjection: Inject 10 mL lidocaine 1% 1/100 K epinephrine into each side

Prep: Betadine on face, chlorhexidine in mouth

Drapes:  Jaw head wrap (see video) (4 towels around face + split sheet)

Instrument sets: Craniomax set and Mandibular osteotomy set

02 - Instrument Sets (Updated)

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Instrument Set: Mandibular osteotomy set

03 - Case Details

Special Instruments: None

Devices/Implants: Stryker mandibular osteotomy set

Hypodermic needles:  27 gauge needle

Syringes: 10 mL syringe 

Drains: None

Suture: 3-0 chromic SH, 5-0 monocryl taper, 6-0 prolene taper

Anesthesia on field: 1% lidocaine 1/100 K epinephrine

Dressing:  Jaw bra

 

04 - Post-Op Information

Admission status: A.M. admission

Estimated time: 2 hrs

Coding: Check w/ surgeon

Post-op wound care:  ___

Post-op activity restrictions:  ___

Follow up:  ___

 

Nursing Steps

Flow Chart to Streamline the OR

01: General Prep

04: Return to BSSO

  • Have Stryker Hybrid MMF in room-ask Dr Baker whether to open or just have available

  • Verify rep has splints, plates, etc at 0700

  • Have nonsterile ETT, head drape and local on nonsterile back table prior to pt in room

  • Suture nasal ETT

  • Head drape

  • Inject prior to prep 30cc 1% lido w 1/100k epi

  • Prep/drape

  • Guarded blunt tip Bovie 30/30

  • Fraser and Yankeur suctions up and on

  • Test Sonapet and all drills/saws for power

  • Round diamond bur to equilibrate occlusion

02: BSSO

  • Remove small drill bit and replace with mandible screw (color coded) drill bit

  • Complete mandible split with osteotomes and Smith spreader

  • Place in MMF with elastics

  • Trocar for mandible screws

  • 15 blade for trocar incision

  • Apply mandible screw fixation

  • Verify occlusion

  • Reapply elastics for MMF

05: Closing

  • Maxilla 4-0 chromic RB-1 x 2

  • Mandible intraoral 3-0 chromic SH x 2

  • Trocar incisions 5-0 Monocryl x 1 and 6-0 Prolene x 1

06: Final Notes

  • Small recip saw blade

  • Mayo set up as per website image

  • Once sawing of mandible complete, we go to maxilla

  • If genioplasty, see genioplasty site

  • Nasogastric suction

  • Extubation

03: LeFort

  • Have screw drill bit in drill

  • Change small recip saw blade to large recip saw blade

  • Incision

  • Custom cutting guide

  • Drill screw holes

  • Sonapet for osteotomy cut

  • Large blade recip saw

  • Down fracture

  • Rongeurs

  • Fix custom plates with crews/screwdrivers 5mm screw length

  • Verify occlusion with intermediate splint

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