CPT® Code 21263

1. Indications

The procedure described by CPT® Code 21263 is indicated for patients presenting with orbital hypertelorism, which may be associated with various congenital conditions. 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 lead to aesthetic concerns and potential functional issues.
• Facial Contour Improvement Patients seeking enhancement of facial aesthetics due to the disproportionate appearance caused by widely spaced orbits may be candidates for this procedure.
• Associated Craniofacial Anomalies Individuals with craniofacial syndromes that include orbital hypertelorism may require this surgery as part of a comprehensive treatment plan.

2. Procedure

The surgical procedure for CPT® Code 21263 involves several critical steps to achieve the desired repositioning of the orbits and advancement of the forehead. Each step is detailed as follows:

• Step 1: Incision and Access The surgeon begins by making incisions at strategic points, which may include the lower eyelid, eyebrow, or maxillary vestibule. These incisions provide access to the orbits and nasoorbital region, allowing the surgeon to perform the necessary osteotomies.
• Step 2: Frontal Bone Removal A portion of the frontal bone is temporarily excised to facilitate intracranial access. This step is crucial as it allows the surgeon to make the necessary cuts within the cranial cavity while ensuring the brain is safely retracted during the procedure.
• Step 3: Orbital Rim Incisions Using specialized drills and saws, the surgeon creates incisions into the orbital rims. This step is essential for repositioning the orbits closer together, as it allows for the removal of portions of the nasal and ethmoidal bones.
• Step 4: Repositioning the Orbits Once the incisions are made, the orbits are carefully repositioned to the desired location. The surgeon secures the orbits using wires, screws, and plates to ensure stability and proper alignment.
• Step 5: Graft Placement Bone grafts harvested from the patient's hip, rib, or skull are then placed into the recipient beds to fill the defects created by the orbital repositioning. This step is vital for maintaining structural integrity and promoting healing.
• Step 6: Reattachment of Frontal Bone After the grafts are in place, the frontal bone is reattached in a more forward position. The surgeon uses plates or screws to secure the bone, ensuring it remains stable during the healing process.
• Step 7: Closure of Incisions Finally, the surgeon meticulously closes all incisions, ensuring that the skin is properly aligned to promote optimal healing and minimize scarring.

3. Post-Procedure

Post-procedure care following CPT® Code 21263 involves monitoring the patient for any complications and ensuring proper recovery. Patients may experience swelling and discomfort in the surgical area, which can be managed with prescribed pain medications. Follow-up appointments are essential to assess healing and the positioning of the orbits and frontal bone. Patients are typically advised to avoid strenuous activities and to follow specific care instructions regarding incision sites to prevent infection. The overall recovery period may vary depending on individual healing responses, but close observation during the initial postoperative phase is crucial for optimal outcomes.