CPT® Code 42894

Resection of pharyngeal wall requiring closure with myocutaneous or fasciocutaneous flap or free muscle, skin, or fascial flap with microvascular anastomosis

The procedure described by CPT® Code 42894 involves the surgical resection of the lateral wall of the pharynx or the pyriform sinus, which is a funnel-shaped recess located in the anterolateral wall of the nasopharynx adjacent to the vestibule of the larynx. This surgical intervention is primarily indicated for the treatment of malignant tumors affecting the pharynx or pyriform sinus, although it may also be utilized for the excision of benign lesions or strictures that may obstruct normal function. The operation begins with a horizontal incision made in the neck, specifically over the thyrohyoid membrane, allowing access to the underlying structures. The suprahyoid muscles are carefully separated from the hyoid bone laterally to facilitate exposure of the pharynx. Once the valleculae are accessed, the larynx is retracted inferiorly while the tongue is elevated superiorly, providing a clear view of the lateral pharynx and/or pyriform sinus. The surgeon identifies the lesion or defect, which is then excised along with a margin of healthy tissue to ensure complete removal of any malignant cells. Unlike the procedure described in CPT® Code 42892, where the defect is closed by advancing the lateral and posterior pharyngeal walls, CPT® Code 42894 requires the use of a myocutaneous flap for closure. Commonly utilized flaps for this purpose include the latissimus dorsi and pectoralis major flaps. The procedure involves careful planning and measurement of the defect size, marking the skin over the flap site, and identifying the vessels that supply the flap. The flap is then developed by incising the skin and muscle, rotated into the neck with the skin side facing inward, and sutured to the pharyngeal wall to effectively close the defect. Finally, the overlying subcutaneous tissue and skin are closed over the flap, completing the surgical reconstruction.