CPT® Code 21390

The procedure described by CPT® Code 21390 involves the open treatment of an orbital floor blowout fracture through a periorbital approach, utilizing an alloplastic or other type of implant. This surgical intervention aims to restore both the anatomical structure and functional capabilities of the eye and surrounding facial area. Orbital floor blowout fractures are frequently associated with mid-facial trauma, which can lead to complications such as entrapment of extraocular muscles, resulting in restricted eye movement, as well as aesthetic deformities of the face. The surgical technique begins with an incision made along the lower eyelid, specifically through the conjunctiva, which is positioned just below the base of the tarsus. This incision allows for the placement of traction sutures that facilitate the elevation of the conjunctiva to protect the cornea during the procedure. Following this, a careful dissection is performed between the orbital septum and the orbicularis muscle, extending to the orbital rim. The periosteum, a layer of tissue covering the bone, is then opened and elevated from the orbital floor to access the fracture site. Any herniated orbital tissue is either removed or repositioned back into the orbit to restore normal anatomy. The fracture itself is reduced, and an orbital implant made from materials such as porous polyethylene, silicone, Teflon, Supramid, titanium mesh, bioresorbable copolymer plates, or Vicryl mesh is inserted to fill the resulting bony defect. The procedure concludes with a thorough check for hemostasis, followed by the removal of traction sutures, repositioning of the conjunctiva, and closure of the incision with sutures, ensuring a secure and aesthetically pleasing result.