CPT® Code 21143

The procedure described by CPT® Code 21143 involves the reconstruction of the midface using a LeFort I osteotomy technique, which is performed without the use of bone grafts. This surgical intervention is typically indicated for patients presenting with congenital facial bone deformities or for cosmetic enhancements. The LeFort I osteotomy specifically targets the lower maxillary region, which is anatomically defined as the area below the infraorbital nerve and medial to the zygomatic-maxillary suture. During the procedure, the surgeon may extract premolars and last molars as necessary to facilitate access and manipulation of the maxilla. To minimize trauma to the palatal tissues, the palatal mucosa is carefully tunneled prior to making the osteotomy cuts. The surgical approach includes an incision in the buccal sulcus that extends 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 and elevation of the nasal mucosa. The surgeon then marks the planned bone cuts in the maxilla based on preoperative measurements, ensuring precision in the reconstruction process. This complex procedure allows for the movement of three or more bone segments in any direction, thereby enabling significant adjustments to the midface structure for functional and aesthetic purposes.