CPT® Code 21145

Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)

The procedure described by CPT® Code 21145 involves the surgical reconstruction of the midface using a technique known as LeFort I osteotomy. This procedure is typically indicated for patients who have facial bone deformities or for those seeking 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 physician may need to extract premolars and last molars to facilitate access and ensure proper alignment of the maxilla. The surgical approach includes tunneling the palatal mucosa to minimize tissue damage during the osteotomy. An incision is made in the buccal 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 and elevation of the nasal mucosa. Precise measurements are taken prior to surgery to guide the planned bone cuts in the maxilla. The procedure involves careful manipulation of the maxilla, including cutting, fracturing, and mobilizing the bone, followed by stabilization and repositioning with the use of bone grafts. The inclusion of bone grafts, which may be harvested from the iliac crest or other sites, is essential for achieving the desired structural support and aesthetic outcome. This comprehensive approach ensures that the midface is reconstructed effectively, addressing both functional and cosmetic needs.