CPT® Code 21154

Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); without LeFort I

The procedure described by CPT® Code 21154 refers to a Le Fort III osteotomy, which is a surgical intervention aimed at reconstructing the midface region. This procedure specifically targets the high maxillary area, which encompasses several critical anatomical structures, including the zygoma, the lateral orbital rim, and the zygomatic arch. The Le Fort III osteotomy is performed using an extracranial approach, meaning that the surgical access is made externally rather than through the cranial cavity. The surgery involves making precise bone cuts that allow for the repositioning of facial bones, either anteriorly or superiorly, to correct deformities in the facial structure. During the procedure, a coronal incision is made, extending from one ear, across the forehead, and down to the opposite ear, allowing for adequate exposure of the supraorbital region, nasal bones, and malar complex. The surgical team may also utilize a supplemental orbital floor approach to enhance visibility and access to the surgical site. Bone grafts are often required, and these can be harvested from the iliac crest, which involves making an incision over the iliac crest to access the bone. The harvested bone is then shaped and secured in place using fixation devices such as wires, miniplates, or screws. This procedure is critical for patients with significant facial deformities, as it aims to restore both function and aesthetic appearance to the midface region.