CPT® Code 21260

1. Indications

The procedure of periorbital osteotomies for orbital hypertelorism with bone grafts is indicated for patients presenting with the following conditions:

• Orbital Hypertelorism - A condition characterized by an increased distance between the orbits, which can lead to aesthetic concerns and potential functional issues.
• Facial Dysmorphology - Patients with facial structural abnormalities that may benefit from orbital repositioning to improve facial symmetry and appearance.
• Congenital Anomalies - Individuals born with congenital defects affecting the orbits and surrounding structures that necessitate surgical intervention for correction.

2. Procedure

The procedure involves several critical steps to ensure successful correction of orbital hypertelorism:

• Step 1: Incision - The surgeon begins by making incisions at strategic locations, which may include the lower eyelid, eyebrow, or maxillary vestibule. These incisions provide access to the orbits while minimizing visible scarring.
• Step 2: Accessing the Orbits - Once the incisions are made, the physician carefully dissects the tissue to access the orbital cavities and the naso-orbital region, ensuring that surrounding structures are preserved.
• Step 3: Bone Removal - Using specialized surgical instruments such as drills and saws, the surgeon creates incisions in the orbital rims and removes portions of the nasal and ethmoidal bones as necessary to facilitate the repositioning of the orbits.
• Step 4: Repositioning the Orbits - The orbits are then repositioned to the desired location, correcting the hypertelorism. This step is crucial for restoring both aesthetic appearance and functional alignment.
• Step 5: Securing the Orbits - After repositioning, the orbits are secured in place using wires, screws, and plates to ensure stability and proper healing during recovery.
• Step 6: Graft Placement - Bone grafts harvested from the patient’s hip, rib, or skull are placed into the recipient beds to fill any defects created by the repositioning of the orbits, providing structural support.
• Step 7: Closure of Incisions - Finally, the surgeon meticulously closes all incisions to promote healing and minimize postoperative complications, ensuring that the surgical site is secure.

3. Post-Procedure

Post-procedure care is essential for optimal recovery following periorbital osteotomies. Patients are typically monitored for any signs of complications, such as infection or excessive swelling. Pain management is provided as needed, and patients may be advised to avoid strenuous activities for a specified period to allow for proper healing. Follow-up appointments are crucial to assess the healing process and the success of the orbital repositioning. Additionally, patients may receive instructions on wound care and any necessary restrictions on activities to ensure a smooth recovery.