CPT® Code 21407

The CPT® Code 21407 refers to the open treatment of a fracture of the orbit, specifically excluding blowout fractures, and involves the use of an implant. This procedure is designed to restore the orbit, which is the bony cavity that houses the eye, to its natural anatomical shape and function. The process begins with a thorough evaluation of the natural skin creases around the eye, followed by the careful marking of incision lines to minimize scarring. A temporary tarsorrhaphy, which is a surgical procedure that partially closes the eyelids, may be performed to protect the cornea during the operation. This is achieved by placing a mattress suture through the edges of the upper and lower eyelids, allowing for the closure of the eyelids over the eye, thus providing additional protection. Once the eyelids are secured, an incision is made along the pre-marked lines to access the underlying orbicular muscle. The incision is extended subcutaneously to create a skin flap that allows for better visualization and access to the orbital area. The surgeon then creates a dissection plane between the orbicularis oculi muscle and the septum orbitale, which is the fibrous membrane that separates the orbit from the surrounding structures. This dissection is performed carefully to preserve the integrity of the orbital septum. The procedure continues with the extension of the suborbicular pocket, which is a space created for the surgical intervention, and involves careful manipulation of the muscle and surrounding tissues. The identification and preservation of the intraorbital nerve are critical steps to avoid complications. The surgeon then identifies the fracture borders and reduces any herniated orbital soft tissue, ensuring that the fracture is properly aligned. An orbital implant, which can be made from various materials such as porous polyethylene, silicone, Teflon, Supramid, titanium mesh, or bioresorbable copolymer plates, is inserted into the bony deficit. This implant serves to prevent the prolapse of orbital soft tissue and to restore the natural contour and volume of the orbit. Finally, the periosteum, which is the connective tissue covering the bone, is redraped over the implant and secured with sutures, completing the procedure.