CPT® Code 65114

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 the complete removal of the contents of the orbit, which includes the eye itself and any associated tissues. 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. If only the skin of the eyelid is preserved, incisions are made at the same locations but only through the skin layer. The dissection continues through the eyelid skin and into the underlying subcutaneous tissue, extending both superiorly and inferiorly to the level of the orbital rim. In instances where the eyelids are entirely excised, full-thickness incisions are made through the skin and soft tissue along the orbital rim. The periosteum, which is the connective tissue covering the bone, is then carefully dissected away from the underlying bone in a circular manner until the entire globe and orbital contents are completely liberated. Following this, the globe and all orbital contents are removed, and the underlying bony structures are examined for any signs of tumor extension. If tumor presence is detected in the orbital bones, the affected bony tissue is excised as well. Depending on whether the eyelids or their skin have been preserved, the closure of the surgical site may vary. If the eyelids are preserved, they are closed in layers. Conversely, if the eyelids are completely excised, separate reportable skin grafts may be utilized to close the resulting defect. The procedure may also involve the use of a muscle or myocutaneous flap to facilitate closure of the surgical defect, which is indicated by the specific CPT® code 65114. A free muscle or myocutaneous flap is developed with careful attention to maintaining the blood supply to the flap, commonly utilizing muscle flaps such as the rectus abdominis or latissimus dorsi. The flap is then trimmed to the appropriate size and shape, and its blood vessels are sutured to the blood vessels surrounding the eye, with the edges of the flap secured using sutures.