CPT® Code 21433

Open treatment of craniofacial separation (LeFort III type); complicated (eg, comminuted or involving cranial nerve foramina), multiple surgical approaches

A Le Fort III fracture, commonly referred to as craniofacial separation or dysjunction, represents a significant and complex 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 moving through the lateral orbital wall, the zygomaticofrontal junction, and the zygomatic arch. Additionally, a branch of the fracture extends 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 procedure denoted by CPT® Code 21433 involves the open treatment of a complicated Le Fort III fracture, which may be classified as complicated due to characteristics such as comminution or involvement of cranial nerve foramina. The surgical intervention necessitates multiple surgical approaches to adequately address the complexity of the fracture. Surgical exposure may be achieved through various incisions, including sublabial incisions for maxillary access, subciliary or transconjunctival incisions for orbital rim access, and columellar-septal transfixion incisions for access to the piriform aperture and front maxillary region. In cases where further exposure is required, additional incisions may be made in the lateral brow glabellar fold or a bicoronal scalp flap may be utilized. The procedure aims to reduce the fracture and verify anatomic reduction through radiographic means, followed by stabilization using interdental fixation.