CPT® Code 21435

Open treatment of craniofacial separation (LeFort III type); complicated, utilizing internal and/or external fixation techniques (eg, head cap, halo device, and/or intermaxillary fixation)

The CPT® Code 21435 refers to the open treatment of a craniofacial separation, specifically a LeFort III type fracture, which is classified as complicated. This type of fracture involves a significant disruption of the midface, characterized by a transverse fracture that begins at the nasofrontal and frontomaxillary sutures. The fracture extends posteriorly along the medial wall of the orbit, traversing through the nasolacrimal groove and the ethmoid bones. It continues along the floor of the orbit at the inferior orbital fissure and through the lateral orbital wall, zygomaticofrontal junction, and zygomatic arch. Additionally, 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 to the base of the sphenoid. Complicated fractures, as defined in this context, are those that are comminuted or involve the cranial nerve foramina, necessitating a more intricate surgical approach. The surgical exposure for this procedure may involve various incisions, such as a sublabial incision to access the maxilla, subciliary or transconjunctival incisions for the orbital rim, or columellar-septal transfixion incisions for 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. During the procedure, the fracture is disimpacted and reduced through multiple surgical approaches, with stabilization achieved using miniplates, screws, and/or interosseous wiring. In certain cases, external fixation techniques, such as a head cap, halo device, or intermaxillary fixation, may be employed either as a primary method or in conjunction with internal fixation, particularly in the presence of extensive panfacial fractures. This comprehensive approach ensures that the fractured segments are properly aligned and stabilized, facilitating optimal healing and recovery.