CPT® Code 21183

1. Indications

The procedure described by CPT® Code 21183 is indicated for patients who require reconstruction of the orbital walls, rims, forehead, and nasoethmoid complex following the excision of benign tumors of the cranial bone. The specific conditions that may necessitate this procedure include:

• Benign Tumors of Cranial Bone These may include conditions such as fibrous dysplasia, which can lead to structural deformities or functional impairments that require surgical intervention.

2. Procedure

The procedure involves several critical steps to ensure successful reconstruction of the affected areas. The steps are as follows:

• Step 1: Anesthesia Administration The patient is placed under general anesthesia to ensure comfort and immobility during the surgical procedure. This is a crucial first step that allows the surgeon to perform the operation safely and effectively.
• Step 2: Incision Creation The surgeon makes various incisions, which may include those in the eyelid and scalp, to gain access to the surgical site. These incisions are strategically placed to minimize scarring and facilitate optimal access to the areas requiring reconstruction.
• Step 3: Tumor Excision The benign tumors are excised using both intra- and extracranial approaches. This step is critical as it involves the careful removal of the tumor while preserving surrounding healthy tissue as much as possible.
• Step 4: Bone Fracturing and Repositioning After tumor excision, the affected bones are precisely fractured and repositioned to restore their anatomical alignment. This step is essential for ensuring the structural integrity of the facial skeleton.
• Step 5: Graft Harvesting Bone grafts are harvested from the patient's own body, typically from the hip, rib, or skull. This autografting technique is employed to provide the necessary material for reconstruction.
• Step 6: Graft Insertion The harvested bone grafts are then inserted into the designated areas to augment and stabilize the sites where the tumors have been removed. This step is vital for restoring the volume and shape of the affected structures.
• Step 7: Fixation To maintain the proper shape and alignment of the facial bones, fixation devices such as wires, plates, and screws are used. This ensures that the reconstructed areas remain stable during the healing process.
• Step 8: Closure of Incisions Finally, the incisions made during the procedure are closed in layers. This layered closure technique promotes optimal healing and minimizes the risk of complications.

3. Post-Procedure

Post-procedure care is essential for ensuring proper recovery and minimizing complications. After the surgery, patients are typically monitored in a recovery area until they are stable. Pain management is provided as needed, and patients may be advised to avoid strenuous activities for a specified period. Follow-up appointments are crucial to assess healing, monitor for any signs of infection, and ensure that the grafts are integrating properly. Patients may also receive specific instructions regarding wound care and any restrictions on activities to promote optimal recovery.