CPT® Code 21432

A Le Fort III fracture, commonly referred to as a 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. The fracture path traverses through the nasolacrimal groove and the ethmoid bones, continuing along the floor of the orbit at the inferior orbital fissure. It further extends through the lateral orbital wall, the zygomaticofrontal junction, and the zygomatic arch. Additionally, a branch of the fracture may extend through the base of the perpendicular plate of the ethmoid and the vomer, as well as the interface of the pterygoid plates leading to the base of the sphenoid. The treatment for this type of fracture can vary; for instance, CPT® Code 21431 involves a closed reduction, where disimpaction of the maxillary bone is achieved using specialized instruments. In contrast, CPT® Code 21432 pertains to the open treatment of the craniofacial separation, which involves surgical intervention through an incision made intraorally in the buccal sulcus, or alternatively through subciliary or transconjunctival incisions. This procedure allows for direct access to the fracture site, enabling the surgeon to perform an open reduction and stabilize the fracture using wiring and/or internal fixation methods, such as miniplates and monocortical self-tapping screws, ensuring proper anatomical alignment and stabilization of the fractured segments.