CPT® Code 21454

1. Indications

The open treatment of a mandibular fracture with external fixation, as described by CPT® Code 21454, is indicated for specific conditions related to the mandible. These indications include:

• Mandibular Fracture A fracture of the lower jaw that may result from trauma, such as a fall, accident, or physical altercation, necessitating surgical intervention for proper alignment and healing.
• Displacement of Fracture When the fractured segments of the mandible are misaligned or displaced, requiring surgical manipulation to restore normal anatomy.
• Inadequate Healing Cases where conservative treatment methods, such as splinting or immobilization, have failed to achieve adequate healing of the fracture.

2. Procedure

The procedure for the open treatment of a mandibular fracture with external fixation involves several critical steps, which are detailed as follows:

• Step 1: Incision The surgeon begins by making an incision either in the oral cavity or on the skin directly above the fracture site. This incision is strategically placed to provide optimal access to the fractured mandible while minimizing damage to surrounding tissues.
• Step 2: Exposure and Visualization After the incision is made, the surgeon carefully isolates the fracture site. This involves retracting surrounding tissues to visualize the fracture clearly, allowing for precise manipulation and assessment of the fracture alignment.
• Step 3: Reduction of the Fracture Once the fracture is adequately exposed, the physician manipulates the fractured segments back into their correct anatomical position. This step is crucial for ensuring that the mandible heals properly and maintains its function.
• Step 4: Drilling Holes Following the reduction, the surgeon drills holes into the mandible through the previously made incisions. These holes are essential for the placement of fixation devices that will stabilize the fracture during the healing process.
• Step 5: Insertion of Fixation Devices Rods or pins are then inserted into the drilled holes. These devices protrude through the skin and are designed to provide external stabilization to the mandible.
• Step 6: Stabilization The protruding rods or pins are secured by a traction bar, which helps maintain the proper alignment of the fractured mandible and provides the necessary support during the healing phase.
• Step 7: Closure of Incision Finally, the main incision is closed using appropriate suturing techniques to promote healing and minimize scarring.

3. Post-Procedure

After the open treatment of a mandibular fracture with external fixation, patients typically require careful monitoring and follow-up care. Post-procedure care may include pain management, instructions for oral hygiene, and dietary modifications to accommodate the healing jaw. Patients are often advised to avoid hard or chewy foods that could disrupt the healing process. Regular follow-up appointments are essential to assess the healing of the fracture and the stability of the external fixation devices. The physician may also provide guidance on when it is safe to resume normal activities and any necessary rehabilitation exercises to restore jaw function.