CPT® Code 65110

Exenteration of the orbit is a surgical procedure primarily indicated for the removal of orbital tumors or intraocular tumors that have extended into the orbit or surrounding extraorbital structures, which may include the eyelids or the bony structures surrounding the eye. The procedure involves a comprehensive approach to ensure complete removal of the affected orbital contents while preserving as much healthy tissue as possible. In cases where the eyelid anatomy is unaffected by disease, incisions are made through the entire thickness of the eyelid, positioned just above the upper lash line and just below the lower lash line. This allows for careful dissection of the eyelid skin from the underlying subcutaneous tissue, extending both superiorly and inferiorly to the level of the orbital rim. If the eyelids are entirely removed, full-thickness incisions are made along the orbital rim through the skin and soft tissue. The periosteum, which is the connective tissue covering the bones, is then meticulously dissected away from the underlying bone in a circular manner until the globe and all orbital contents are completely liberated. Following this, the entire globe and orbital contents are excised, and the underlying bony structures are examined for any signs of tumor extension. If tumor involvement is detected in the orbital bones, the affected bony tissue is also excised. Depending on the extent of eyelid preservation, the surgical closure may vary; if the eyelids are preserved, they are closed in layers, whereas if they are completely excised, separate reportable skin grafts may be utilized to close the resulting defect. The procedure is coded as 65110 when no bone is removed and the defect can be closed without the use of muscle or myocutaneous flaps. If bone is removed, the appropriate code is 65112, and if muscle or myocutaneous flap techniques are employed for closure, the code 65114 should be used. In cases where a free muscle or myocutaneous flap is developed, careful attention is given to preserving the blood supply to the flap, which may involve using commonly utilized free muscle flaps such as the rectus abdominis or latissimus dorsi muscles. The free flap is then trimmed to the required size and shape, and its blood vessels are sutured to the surrounding blood vessels near the eye, with the edges of the flap secured using sutures.