CPT® Code 21295

1. Indications

Reduction of masseter muscle and bone (CPT® Code 21295) is indicated for the treatment of benign masseteric hypertrophy. This condition may present with the following symptoms or conditions:

• Benign Masseteric Hypertrophy - A rare disorder characterized by the abnormal enlargement of the masseter muscle and the underlying bone at the mandibular angle, leading to cosmetic concerns and potential functional issues.

2. Procedure

The procedure for the reduction of masseter muscle and bone involves several key steps, which are detailed as follows:

• Step 1: Incision - The surgeon begins by making an extraoral incision in the preauricular area, which is located just in front of the ear. This approach provides optimal access to the masseter muscle and the mandible.
• Step 2: Subperiosteal Dissection - Following the incision, the surgeon performs a subperiosteal dissection to carefully separate the masseter muscle from the underlying bone. This step is crucial for accessing the area that requires reduction.
• Step 3: Detachment of the Masseter Muscle - The masseter muscle is then detached at its inferior posterior border, allowing for further manipulation and reduction of both the muscle and the bone.
• Step 4: Bone Reduction - A bur is utilized to reduce the bony prominence at the mandibular angle. Alternatively, a saw may be employed to reshape the posterior border of the mandible, creating a more obtuse angle as needed.
• Step 5: Additional Bone Contouring - If necessary, further contouring of the bone is performed using a bur, chisel, or osteotome to achieve the desired shape and contour of the mandible.
• Step 6: Muscle Resection and Reattachment - Once the bone contour is satisfactory, the masseter muscle is resected to reduce its size. The muscle is then reattached to the mandible to restore its function.
• Step 7: Closure of Incisions - Finally, the incisions made during the procedure are closed, completing the surgical intervention.

3. Post-Procedure

Post-procedure care following the reduction of masseter muscle and bone typically involves monitoring for any complications, managing pain, and ensuring proper healing of the surgical site. Patients may be advised to follow specific postoperative instructions, including dietary modifications and activity restrictions, to facilitate recovery. Follow-up appointments are essential to assess healing and the functional outcome of the procedure.