CPT® Code 64738

1. Indications

The procedure described by CPT® Code 64738 is indicated for patients experiencing chronic pain that is associated with the inferior alveolar nerve. This may include conditions such as:

• Chronic Pain Persistent pain in the lower jaw region that may not respond to conservative treatments.
• Neuropathic Pain Pain resulting from nerve damage or dysfunction affecting the inferior alveolar nerve.
• Trigeminal Neuralgia A condition characterized by severe facial pain that may involve the distribution of the inferior alveolar nerve.

2. Procedure

The procedure for CPT® Code 64738 involves several critical steps to ensure proper access and transection or avulsion of the inferior alveolar nerve:

• Step 1: Approach The surgeon may choose to approach the inferior alveolar nerve either intraorally or extraorally. In the extraoral approach, an incision is made below and parallel to the angle of the mandible to expose the mental nerve and foramen.
• Step 2: Incision of the Periosteum Once the approach is established, the periosteum over the mandibular ramus is incised to allow access to the underlying bone.
• Step 3: Bone Opening The surgeon creates an opening in the bone, typically using a drill. This drilling continues through the cortical bone until the denser bone covering the neural canal is reached.
• Step 4: Neural Canal Exposure The neural canal is then opened, providing access to the inferior alveolar nerve.
• Step 5: Transection or Avulsion The inferior alveolar nerve is exposed and can be transected or avulsed. Transection involves grasping the nerve and dividing it proximally, while avulsion may involve twisting the nerve over a hemostat to sever it within the foramen.

3. Post-Procedure

Post-procedure care for patients undergoing the transection or avulsion of the inferior alveolar nerve includes monitoring for any complications such as infection or excessive bleeding. Patients may experience numbness in the lower jaw and should be advised on pain management strategies. Follow-up appointments are essential to assess recovery and address any ongoing symptoms. The expected recovery time may vary based on individual patient factors and the extent of the procedure performed.