CPT® Code 21261

1. Indications

The procedure described by CPT® Code 21261 is indicated for patients presenting with orbital hypertelorism, a condition that may lead to aesthetic concerns and potential functional impairments. The following are specific indications for performing this surgical intervention:

• Orbital Hypertelorism This condition is characterized by an increased distance between the orbits, which can affect facial symmetry and aesthetics.
• Facial Dysmorphology Patients may have associated facial structural abnormalities that necessitate correction to improve overall facial appearance.
• Functional Impairments In some cases, the abnormal positioning of the orbits may lead to visual disturbances or other functional issues that require surgical intervention.

2. Procedure

The surgical procedure for CPT® Code 21261 involves several critical steps to achieve the desired correction of orbital hypertelorism. Each step is detailed as follows:

• Step 1: Frontal Bone Removal The procedure begins with the temporary removal of a portion of the frontal bone. This step is essential as it allows the surgeon to access the intracranial space and make necessary cuts while ensuring the brain is safely retracted during the operation.
• Step 2: Bone Graft Harvesting Bone grafts are harvested from the patient's own body, typically from the hip, rib, or skull. These grafts will be used later to fill the defects created during the repositioning of the orbits.
• Step 3: Incision Access The surgeon accesses the orbits and nasoorbital region through various incision points, which may include the lower eyelid, eyebrow, or maxillary vestibule. The choice of incision depends on the specific surgical approach and the patient's anatomy.
• Step 4: Orbital Rim Incisions Using drills and saws, the surgeon creates incisions into the orbital rims. This step is crucial for allowing the repositioning of the orbits to correct the hypertelorism.
• Step 5: Bone Removal Portions of the nasal and ethmoidal bones may be removed to facilitate the repositioning of the orbits. This step is necessary to achieve the desired alignment and symmetry.
• Step 6: Repositioning the Orbits The orbits are then repositioned to the correct anatomical location. This realignment is critical for both aesthetic and functional outcomes.
• Step 7: Securing the Orbits Once the orbits are in the desired position, they are secured using wires, screws, and plates to ensure stability and proper healing.
• Step 8: Graft Placement The harvested bone grafts are placed into the recipient beds to fill the defects caused by the orbital repositioning, providing structural support and promoting healing.
• Step 9: Reattaching the Frontal Bone The previously removed portion of the frontal bone is reattached using plates or screws, allowing the brain to return to its original position.
• Step 10: Closing Incisions Finally, all incisions are meticulously closed to promote healing and minimize scarring.

3. Post-Procedure

After the completion of the procedure, patients typically require careful monitoring and post-operative care to ensure proper recovery. Expected post-procedure considerations include managing pain and swelling, monitoring for any signs of infection, and following specific instructions regarding activity restrictions. Patients may also need follow-up appointments to assess healing and the success of the orbital repositioning. It is essential for patients to adhere to the post-operative care plan provided by their healthcare team to achieve optimal outcomes.