CPT® Code 21261

The procedure described by CPT® Code 21261 involves periorbital osteotomies specifically performed for the correction of orbital hypertelorism, which is a condition characterized by an abnormal distance between the orbits (eye sockets). This surgical intervention employs a combined intra- and extracranial approach, meaning that the procedure is conducted both within the cranial cavity and externally. During the operation, a segment of the frontal bone is temporarily excised to facilitate access for making intracranial cuts. This step is crucial as it allows the surgeon to retract the brain safely while performing the necessary modifications to the orbital structure. The procedure also involves harvesting bone grafts from the patient's own body, typically sourced from areas such as the hip, rib, or skull. These grafts are essential for reconstructing the orbital area after repositioning. The surgeon gains access to the orbits and the nasoorbital region through various incision points, which may include the lower eyelid, eyebrow, or maxillary vestibule, depending on the specific surgical plan. Once the orbits are accessed, the surgeon utilizes specialized tools, including drills and saws, to create precise incisions in the orbital rims. This step may also involve the removal of portions of the nasal and ethmoidal bones to achieve the desired repositioning of the orbits. After the orbits are correctly aligned, they are secured in place using wires, screws, and plates to ensure stability. The harvested bone grafts are then placed into the recipient sites to fill any defects resulting from the orbital repositioning. Finally, the frontal bone is reattached using plates or screws, allowing the brain to return to its original position, and all incisions are meticulously closed to promote healing.