CPT® Code 21188

The procedure described by CPT® Code 21188 involves the reconstruction of the midface through the use of osteotomies that are not classified as LeFort type. This surgical intervention is typically performed under general anesthesia and is aimed at correcting deformities or malformations in the midfacial region. The term 'osteotomy' refers to the surgical cutting of bone, which allows for the repositioning of the midfacial structures. During the procedure, the physician makes various incisions, which may include transoral (through the mouth), lower eyelid, and scalp incisions, to access the midfacial bones effectively. Once accessed, the midfacial bones are carefully manipulated and completely disconnected from the cranial base, allowing for precise adjustments to be made. The midface is then repositioned to achieve the desired anatomical alignment, and bone grafts are inserted into specific sites to support the new positioning of the bones. These grafts can be harvested from the patient's own body, commonly from areas such as the hip, rib, or skull, ensuring compatibility and reducing the risk of rejection. The use of surgical instruments such as osteotomes, saws, and burs is essential for correcting any misshapen areas of bone during the procedure. Additionally, fixation of the repositioned bones is accomplished using plates, screws, and wires to ensure stability during the healing process. An antibiotic solution is typically applied to minimize the risk of infection, and the incisions are subsequently closed. In some cases, intermaxillary fixation may be required to maintain the position of the midface during recovery.