CPT® Code 21160

Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); with LeFort I

The procedure described by CPT® Code 21160 involves a complex surgical intervention known as midface reconstruction using a LeFort III osteotomy, which is a type of facial surgery that addresses significant structural deformities in the midface region. This procedure is particularly intricate as it encompasses both extraoral and intracranial components, indicating that the surgery extends beyond the facial structures into the cranial area. The term "forehead advancement" refers to the repositioning of the forehead and upper facial structures, often performed in conjunction with a mono bloc technique, which involves moving the midface and forehead as a single unit. The procedure necessitates the use of bone grafts, which are harvested from the patient's own body—typically from the hip, rib, or skull—to provide the necessary material for reconstructing the facial skeleton. The LeFort I procedure, which is also included in this code, involves the repositioning of the maxilla (upper jaw) to correct alignment and improve function and aesthetics. The surgical approach requires general anesthesia, and the surgeon makes various incisions, which may include transoral (through the mouth), lower eyelid, and scalp incisions, to access the facial bones. During the operation, the midfacial and frontal bones are carefully manipulated and detached from the cranial base, allowing for precise repositioning. The use of specialized instruments such as osteotomes, saws, and burs is essential for reshaping the bone structures as needed. After the midface and maxilla are repositioned, the harvested bone grafts are inserted into designated areas to support the new structure. Fixation of the bones is achieved using plates, screws, and wires to ensure stability during the healing process. An antibiotic solution is applied to reduce the risk of infection, and the incisions are meticulously closed. In some cases, intermaxillary fixation may be required to maintain the position of the jaw during recovery.