CPT® Code 21188

1. Indications

The procedure described by CPT® Code 21188 is indicated for various conditions that necessitate midfacial reconstruction. These may include:

• Facial Trauma: Injuries to the midface resulting from accidents or violence that have caused fractures or deformities.
• Congenital Deformities: Birth defects affecting the structure and appearance of the midface, such as cleft palate or other craniofacial anomalies.
• Malignancies: Tumors in the midfacial region that require surgical removal and subsequent reconstruction to restore normal anatomy.
• Post-Surgical Reconstruction: Cases where previous surgeries have resulted in unsatisfactory aesthetic or functional outcomes, necessitating further corrective procedures.

2. Procedure

The procedure involves several critical steps to ensure successful midfacial reconstruction:

• Step 1: Anesthesia Administration The procedure begins with the administration of general anesthesia to ensure the patient is completely unconscious and pain-free throughout the surgery.
• Step 2: Incision Creation The surgeon makes various incisions, which may include transoral, lower eyelid, and scalp incisions, to gain access to the midfacial bones. These incisions are strategically placed to minimize visible scarring while providing adequate access.
• Step 3: Bone Manipulation Once access is achieved, the midfacial bones are carefully manipulated and completely disconnected from the cranial base. This step is crucial for allowing the midface to be repositioned accurately.
• Step 4: Midface Repositioning The midface is then moved into the desired position, correcting any deformities or misalignments that were present prior to the procedure.
• Step 5: Bone Graft Harvesting Bone grafts are harvested from the patient's own body, typically from the hip, rib, or skull, to be used in the reconstruction process. This autograft technique helps to ensure compatibility and reduce the risk of rejection.
• Step 6: Graft Placement The harvested bone grafts are inserted into the appropriate sites within the surgical area to provide structural support for the repositioned midface.
• Step 7: Fixation The repositioned bones are secured using plates, screws, and wires to maintain stability during the healing process. This fixation is essential for ensuring that the midface remains in the correct position as it heals.
• Step 8: Antibiotic Application An antibiotic solution is applied to the surgical area to minimize the risk of infection following the procedure.
• Step 9: Incision Closure Finally, the incisions made during the procedure are closed using sutures or other closure techniques, ensuring that the surgical site is properly sealed.
• Step 10: Intermaxillary Fixation (if necessary) In some cases, intermaxillary fixation may be applied to maintain the position of the midface during the initial recovery phase.

3. Post-Procedure

After the completion of the procedure, patients can expect a recovery period that may involve monitoring for complications such as infection or bleeding. Pain management will be provided as needed, and patients may be advised to follow specific post-operative care instructions, including dietary modifications and activity restrictions. Follow-up appointments will be necessary to assess healing and ensure that the midface is properly aligned and stable. The duration of recovery can vary based on the extent of the surgery and the individual patient's healing process.