CPT® Code 67445

The procedure described by CPT® Code 67445 refers to an orbitotomy performed through a lateral approach, specifically utilizing a bone flap or window technique. This surgical intervention is primarily aimed at decompressing the orbit, which is the bony cavity that houses the eye. The term 'orbitotomy' indicates that the surgery involves making an incision to access the orbit for exploration and treatment. In this case, the lateral approach allows the surgeon to reach the orbit by creating a bone flap or window in the zygomatic bone, which is located on the side of the face. The procedure begins with a lazy-S incision made in the upper eyelid crease, which helps to minimize visible scarring. During the surgery, the lateral rectus muscle, one of the muscles controlling eye movement, is carefully exposed and retracted to provide access to the underlying structures. The surgeon then dissects through the soft tissues to expose the zygomatic bone, incising the periosteum, which is the membrane covering the bone. This step is crucial as it allows for the drilling of holes in the bone, which are subsequently connected using an oscillating saw to create a window or flap. The periorbita, a layer of tissue surrounding the orbit, is also incised to facilitate access to the orbital contents. Once the orbit is accessed, the surgeon identifies the area requiring decompression, which may involve excising bone that is causing pressure on the orbital contents. After the necessary decompression is achieved, the orbital tissues are carefully reapproximated, and the zygomatic bone flap is replaced and secured in position using miniplates and screws. Finally, the periosteum, soft tissues, and skin of the eyelid are closed in layers, ensuring proper healing and restoration of the eyelid's appearance. This detailed approach is essential for alleviating pressure within the orbit and addressing any underlying conditions that may necessitate such a surgical intervention.