CPT® Code 21154

1. Indications

The Le Fort III osteotomy, as described by CPT® Code 21154, is indicated for patients presenting with specific facial deformities that require surgical intervention to restore normal anatomical structure and function. The following conditions may warrant this procedure:

• Facial Deformities Patients with significant midfacial deformities that affect aesthetics and function may require reconstruction through this surgical approach.
• Maxillary Hypoplasia Individuals with underdeveloped maxillary structures may benefit from the repositioning of facial bones to achieve a more balanced facial profile.
• Trauma Patients who have sustained facial trauma resulting in misalignment or deformity of the midface may require this procedure for correction.
• Congenital Anomalies Congenital conditions that affect the midface, such as craniofacial syndromes, may necessitate surgical intervention to improve function and appearance.

2. Procedure

The Le Fort III osteotomy procedure involves several critical steps to ensure successful reconstruction of the midface. The following outlines the procedural steps:

• Incision and Flap Creation The procedure begins with a coronal incision that extends from one ear, along the hairline, across the forehead, and down to the opposite ear. This incision allows for the dissection of soft tissues and the creation of a coronal flap, providing access to the underlying structures.
• Exposure of Facial Structures Once the flap is created, the surgeon exposes the supraorbital region, nasal bones, and malar complex. In some cases, a supplemental orbital floor approach may be utilized to enhance visibility and access to the surgical site.
• Bone Marking and Cutting Using preoperative measurements, the surgeon marks the planned bone cuts on both sides of the face. Bone cuts are then made to separate the facial bones from the cranial base, allowing for the necessary repositioning to correct the deformity.
• Bone Harvesting Bone grafts are harvested from the iliac crest. This involves making a skin incision over the iliac crest, stripping the muscle to expose the bone surface, and then harvesting cortical and/or cancellous bone as needed.
• Bone Graft Preparation The harvested bone is shaped to the desired size and configuration. Cancellous bone may be morcellized and prepared for placement at the surgical site.
• Fixation The repositioned facial bones and bone grafts are secured in place using fixation devices such as wires, miniplates, or screws to ensure stability during the healing process.
• Closure Finally, the incisions are meticulously closed to promote optimal healing and minimize scarring.

3. Post-Procedure

After the completion of the Le Fort III osteotomy, patients typically require careful monitoring and follow-up care. Post-procedure care may include pain management, instructions for oral hygiene, and dietary modifications to accommodate healing. Patients are often advised to avoid strenuous activities and follow specific guidelines to ensure proper recovery. Follow-up appointments are essential to assess the healing process, check the positioning of the bones, and address any complications that may arise. The expected recovery period may vary based on individual circumstances, but adherence to post-operative instructions is crucial for achieving the best possible outcomes.