CPT® Code 21159

1. Indications

The LeFort III reconstruction procedure is indicated for patients presenting with specific facial deformities or conditions that necessitate midfacial correction. The following are the explicitly provided indications for this procedure:

• Facial Deformities Patients with significant midfacial deformities that affect aesthetics and function may require this surgical intervention.
• Trauma Individuals who have sustained traumatic injuries to the midface that result in misalignment or structural damage may benefit from this reconstruction.
• Congenital Anomalies Patients born with congenital facial anomalies that impact the midface region may be candidates for this procedure to restore normal anatomy.
• Malocclusion Severe malocclusion resulting from midfacial discrepancies can also indicate the need for a LeFort III osteotomy.

2. Procedure

The procedure for a LeFort III reconstruction involves several critical steps that ensure the successful repositioning of the midface. Each step is essential for achieving the desired outcome.

• Step 1: Anesthesia Administration The procedure begins with the administration of general anesthesia, ensuring that the patient is completely unconscious and free from pain during the surgery.
• Step 2: Incision Creation The surgeon makes multiple incisions in strategic locations, including transoral, lower eyelid, and scalp, to provide adequate access to the midfacial structures.
• Step 3: Bone Manipulation The midfacial bones are carefully manipulated and completely disconnected from the cranial base, allowing for the necessary adjustments to be made.
• Step 4: Bone Graft Insertion Once the midface is repositioned, bone grafts are inserted into the appropriate sites to provide structural support and facilitate healing.
• Step 5: Bone Reshaping The surgeon utilizes osteotomes, saws, and burs to correct any misshapen areas of bone, ensuring a proper fit and alignment.
• Step 6: Fixation To secure the repositioned bones, the surgeon employs plates, screws, and wires, which are critical for maintaining stability during the healing process.
• Step 7: Antibiotic Application An antibiotic solution is applied to the surgical site to reduce the risk of postoperative infection.
• Step 8: Incision Closure Finally, the incisions are meticulously closed, ensuring proper healing and minimizing scarring.
• Step 9: Intermaxillary Fixation (if necessary) In some cases, intermaxillary fixation may be applied to stabilize the jaw and maintain alignment during recovery.

3. Post-Procedure

After the LeFort III reconstruction procedure, patients can expect a recovery period that may involve swelling, bruising, and discomfort in the midfacial region. Post-operative care is crucial for ensuring proper healing and includes monitoring for any signs of infection or complications. Patients may be advised to follow a soft diet to minimize strain on the jaw and to avoid strenuous activities during the initial recovery phase. Follow-up appointments will be necessary to assess healing and to remove any fixation devices if applicable. The physician will provide specific instructions regarding pain management, oral hygiene, and activity restrictions to support a smooth recovery process.