CPT® Code 21184

1. Indications

The procedure is indicated for patients who have benign tumors of the cranial bone, such as fibrous dysplasia, that necessitate surgical excision. The reconstruction of the orbital walls, rims, forehead, and nasoethmoid complex is performed to restore the structural integrity and aesthetic appearance of the facial skeleton following tumor removal.

• Benign Tumors The presence of benign tumors in the cranial bone that require excision.
• Structural Defects The need to reconstruct facial structures due to defects caused by tumor excision.
• Facial Aesthetics The desire to restore the aesthetic appearance of the face following surgical intervention.

2. Procedure

The procedure begins with the patient being placed under general anesthesia to ensure comfort and immobility during surgery. The surgeon then makes various incisions, which may include those in the eyelid and scalp, to gain access to the surgical site. This access allows for both intra- and extracranial approaches to effectively excise the benign tumors from the cranial bone. Once the tumors are removed, the surgeon carefully fractures the affected bones and repositions them to their proper anatomical locations. Following this, bone grafts are harvested from the patient's own body, typically from the hip, rib, or skull. These grafts are then inserted into the areas where the tumors were excised, providing necessary support and stabilization. To maintain the correct shape and alignment of the facial bones, the surgeon employs fixation devices, including wires, plates, and screws. Finally, the incisions are closed in layers to promote healing and minimize scarring.

• Anesthesia The patient is placed under general anesthesia for the duration of the procedure.
• Incision Creation Various incisions are made, including eyelid and scalp incisions, to access the surgical site.
• Tumor Excision The benign tumors are excised using both intra- and extracranial approaches.
• Bone Fracturing and Repositioning The affected bones are fractured and repositioned to restore anatomical alignment.
• Bone Graft Harvesting Bone grafts are harvested from the patient's hip, rib, or skull.
• Graft Insertion The harvested grafts are inserted into the areas where tumors were removed to provide support.
• Fixation Fixation devices such as wires, plates, and screws are used to maintain the shape of the facial bones.
• Incision Closure The incisions are closed in layers to facilitate healing.

3. Post-Procedure

After the procedure, patients are typically monitored in a recovery area until the effects of anesthesia wear off. Post-operative care may include pain management, monitoring for any signs of infection, and ensuring proper healing of the surgical sites. Patients may be advised to avoid strenuous activities and follow specific instructions regarding wound care. Follow-up appointments are essential to assess the healing process and the success of the reconstruction. The expected recovery time may vary depending on the extent of the surgery and the individual patient's health status.