CPT® Code 21431

A Le Fort III fracture, commonly referred to as craniofacial separation or dysjunction, represents a significant injury characterized by a transverse fracture of the midface. This type of fracture initiates at the nasofrontal and frontomaxillary sutures, extending posteriorly along the medial wall of the orbit, traversing through the nasolacrimal groove and the ethmoid bones. The fracture path continues along the floor of the orbit at the inferior orbital fissure, subsequently affecting the lateral orbital wall, zygomaticofrontal junction, and zygomatic arch. Additionally, a branch of the fracture may extend through the base of the perpendicular plate of the ethmoid and vomer, as well as the interface of the pterygoid plates leading to the base of the sphenoid. The procedure described by CPT® Code 21431 involves a closed treatment approach, where disimpaction of the maxillary bone is achieved through the use of disimpaction forceps or other instruments that are inserted either intranasally or intraorally. Following the disimpaction, anatomic reduction of the fracture is confirmed through radiographic imaging, and stabilization is accomplished using arch bars that are affixed to the upper and lower molars, along with interdental wire fixation. This method is distinct from the open reduction technique outlined in CPT® Code 21432, which involves surgical incisions and the use of miniplates and screws for stabilization.