CPT® Code 67440

The procedure described by CPT® Code 67440 involves an orbitotomy, which is a surgical intervention aimed at accessing the orbit, the bony cavity that contains the eye. This specific procedure utilizes a lateral approach, meaning that the incision is made on the side of the eye, allowing for direct access to the orbital contents. A bone flap or window is created during the surgery, which involves removing a section of bone to facilitate access. The operation begins with a lazy-S incision made in the upper eyelid crease, which helps to minimize visible scarring. The lateral rectus muscle, one of the extraocular muscles responsible for eye movement, is then exposed and retracted to provide a clear view of the underlying structures. The surgeon dissects through the soft tissues to expose the zygomatic bone, which is part of the facial skeleton. The periosteum, a dense layer of connective tissue covering the bone, is incised, and the edges are undermined to reveal the hard cortical bone of the zygoma. To create the bone window or flap, holes are drilled into the bone, which are subsequently connected using an oscillating saw. This technique allows for the removal of a precise section of bone, providing access to the orbit. Once the periorbita, the fibrous tissue surrounding the orbit, is incised, the surgeon dissects through the underlying fat and soft tissue attachments to fully expose the orbital cavity. The primary goal of this procedure is to locate and drain any fluid collections that may be present within the orbit, which could be due to various pathological conditions. Once the fluid collection is identified, the surgeon incises the tissues to access and drain the fluid. After drainage, the operative site is typically flushed with sterile saline or an antibiotic solution to reduce the risk of infection. Following the completion of the drainage, the orbital tissues are carefully reapproximated, and the periorbita is closed. The bone window or flap is then replaced and secured in position using miniplates and screws to ensure stability. Finally, the periosteum is closed, and the soft tissues, including the skin of the eyelid, are closed in layers to promote optimal healing and cosmetic outcomes.