CPT® Code 40700

1. Indications

The procedure described by CPT® Code 40700 is indicated for the surgical repair of a unilateral cleft lip and associated nasal deformity. The following conditions may warrant this procedure:

• Unilateral Cleft Lip: A congenital deformity characterized by a split or opening in the upper lip on one side, which may be partial or complete.
• Nasal Deformity: Associated nasal deformities that occur alongside a unilateral cleft lip, requiring correction to restore normal nasal structure and function.

2. Procedure

The procedure for CPT® Code 40700 involves several critical steps to effectively repair the cleft lip and associated nasal deformity. Each step is essential for achieving optimal surgical outcomes.

• Step 1: Identification of Anatomical Landmarks The physician begins by identifying key anatomical landmarks, including the center of Cupid's bow, the peak of Cupid's bow on the noncleft side, the midline of the columella, and the alar base on both sides of the nose. This identification is crucial for planning the reconstruction of the cleft lip and ensuring symmetry in the final result.
• Step 2: Marking Incision Lines Once the anatomical landmarks are established, the physician marks the planned incision lines on the skin. This step is vital for guiding the surgical approach and ensuring that the incisions are made in a manner that facilitates optimal healing and aesthetic appearance.
• Step 3: Creation of Flaps The surgeon then creates a series of flaps from the surrounding tissue to repair the cleft lip. This involves carefully dissecting the tissue to restore continuity of the orbicularis muscle, which is essential for normal lip function and appearance.
• Step 4: Correction of Nasal Deformity In conjunction with the lip repair, the nasal deformity is addressed. This is achieved by undermining the nasal skin on the cleft side, freeing it from the underlying nasal skeleton. This step allows for better manipulation and correction of the nasal structure.
• Step 5: Elevation of Depressed Cartilage The procedure also includes elevating the depressed alar cartilage on the cleft side. The lateral crus and alar base are advanced medially to restore the normal contour and function of the nose, ensuring that the nasal appearance is harmonious with the repaired lip.

3. Post-Procedure

After the completion of the surgical repair, post-procedure care is essential for optimal recovery. Patients may require monitoring for any signs of complications, such as infection or poor healing. Pain management and instructions for wound care will be provided to ensure proper healing of the surgical site. Follow-up appointments are typically scheduled to assess the healing process and to make any necessary adjustments to the surgical outcome. The expected recovery period may vary depending on the extent of the repair and the individual patient's healing response.