CPT® Code 21142

The procedure described by CPT® Code 21142 involves the reconstruction of the midface using a LeFort I osteotomy technique, which is specifically designed for patients with congenital facial bone deformities or for cosmetic enhancements. This surgical intervention is characterized by the movement of two segments of the maxilla, which is the upper jawbone, without the use of bone grafts. The LeFort I osteotomy focuses on the lower maxillary region, which is anatomically defined as the area below the infraorbital nerve and medial to the zygomatic-maxillary suture. The procedure is initiated with the extraction of premolars and last molars as necessary to facilitate access to the surgical site. To minimize trauma to the palatal tissues during the osteotomy, the palatal mucosa is carefully tunneled. A buccal incision is made in the sulcus, extending from the first molar on one side to the first molar on the opposite side, allowing for exposure of the lateral aspect of the nasal cavity. The nasal mucosa is then elevated to provide a clear view of the underlying structures. Precise measurements taken prior to the surgery guide the physician in marking the planned bone cuts in the maxilla. The lateral wall of the maxilla is then cut using a bur, and a thin osteotome is employed to apply gentle pressure, facilitating the fracture of the medial and posterior walls of the maxilla. The procedure continues with the separation of the pterygoid plate from the maxilla using a pterygoid osteotome, followed by careful dissection of the pterygoid hamulus. This meticulous approach is mirrored on the opposite side of the maxilla. The nasal septum cartilage and vomer are also separated from the maxilla using a septal gouge or osteotome, ensuring that the anterior nasal spine is fractured appropriately. The maxilla is then downfractured and mobilized, allowing for repositioning and stabilization with wires. Throughout the procedure, the physician checks measurements to confirm the desired repositioning of the maxilla, as well as the alignment of the lip position and occlusion. An intermaxillary fixation device is applied to maintain the new position of the maxilla, and the buccal incision is subsequently closed. This comprehensive approach ensures that the midface is reconstructed effectively, addressing both functional and aesthetic concerns.