CPT® Code 21345

1. Indications

The closed treatment of a nasomaxillary complex fracture (LeFort II type) is indicated for patients who have sustained a fracture in the nasomaxillary region, which may result from trauma such as vehicular accidents, falls, or sports injuries. This procedure is typically performed when the fracture is stable enough to be treated without surgical exposure, and when the alignment of the bones can be effectively maintained through non-invasive fixation methods.

• Facial Trauma Patients presenting with facial trauma that results in a LeFort II type fracture.
• Fracture Stability Cases where the fracture is deemed stable enough for closed treatment without the need for open surgical intervention.
• Non-displaced Fractures Instances of non-displaced or minimally displaced fractures that can be managed with interdental fixation.

2. Procedure

The procedure for the closed treatment of a nasomaxillary complex fracture involves several key steps to ensure proper alignment and stabilization of the fracture. Initially, the physician will assess the fracture through clinical examination and imaging studies to confirm the diagnosis and determine the appropriate treatment approach.

• Step 1: Assessment The physician conducts a thorough assessment of the patient's facial structure and the extent of the fracture using imaging techniques such as X-rays or CT scans. This evaluation is critical to understanding the fracture's characteristics and planning the treatment.
• Step 2: Closed Reduction Once the assessment is complete, the physician performs a closed reduction, which involves manually manipulating the fractured segments back into their correct anatomical position without making any incisions. This step is essential for ensuring that the bones are properly aligned.
• Step 3: Stabilization After achieving the desired alignment, the physician applies interdental wire fixation or utilizes dentures or splints to stabilize the fracture. This fixation method helps maintain the position of the bones during the healing process, preventing any movement that could lead to complications.
• Step 4: Post-Fixation Care Following the stabilization, the physician will provide instructions for post-procedure care, which may include pain management and guidelines for activity restrictions to promote optimal healing.

3. Post-Procedure

Post-procedure care for patients who have undergone closed treatment of a nasomaxillary complex fracture typically involves monitoring for any signs of complications, such as infection or misalignment. Patients are advised to follow specific care instructions, which may include the use of pain relief medications, maintaining a soft diet to avoid stress on the jaw, and avoiding strenuous activities that could jeopardize the healing process. Follow-up appointments are essential to assess the healing progress and to make any necessary adjustments to the fixation if required. The expected recovery time may vary depending on the individual case, but adherence to post-procedure guidelines is crucial for a successful outcome.