CPT® Code 61590

Infratemporal pre-auricular approach to middle cranial fossa (parapharyngeal space, infratemporal and midline skull base, nasopharynx), with or without disarticulation of the mandible, including parotidectomy, craniotomy, decompression and/or mobilization of the facial nerve and/or petrous carotid artery

The CPT® Code 61590 refers to a surgical procedure that utilizes an infratemporal pre-auricular approach to access the middle cranial fossa. This approach is particularly beneficial for exposing extradural or intradural lesions located in the parapharyngeal space, infratemporal region, midline skull base, and nasopharynx. The procedure begins with an incision that starts near the midline at the top of the skull, extending laterally over the temporal region, and then descending in front of the ear along the pre-auricular crease, reaching down to the level of the tragus. This incision is further extended into the neck to facilitate access to the internal carotid artery, allowing for better control during the procedure. The surgical technique involves elevating a scalp flap and the temporalis muscle from the temporal fossa, followed by dissection of the fascia of the masseter muscle to expose the parotid gland, which may be removed during a parotidectomy. For enhanced visibility and access, the mandible may be disarticulated from its attachments to the temporal bone. A temporal craniotomy is then performed, with the specific placement of osteotomies guided by the lesion's location. Once the cranium is opened, protective measures are taken for the orbital soft tissues, and the frontal lobe is retracted to allow for further dissection. The procedure includes identifying and decompressing or mobilizing critical neurovascular structures such as the facial nerve and the petrous carotid artery. After ensuring the preservation of these structures, the dissection of the lesion commences, which is documented separately. This comprehensive approach allows for effective management of complex lesions within the specified anatomical regions.