CPT® Code 40701

1. Indications

The procedure associated with CPT® Code 40701 is indicated for the correction of bilateral cleft lip and associated nasal deformities. The following conditions may warrant this surgical intervention:

• Bilateral Cleft Lip Deformity A congenital condition characterized by a gap in the upper lip that affects both sides, leading to functional and aesthetic challenges.
• Nasal Deformity Associated nasal structural abnormalities that occur alongside bilateral cleft lip, requiring surgical correction to improve appearance and function.
• Functional Impairment Issues related to feeding, speech, and overall oral function that may arise from the presence of a bilateral cleft lip.
• Aesthetic Concerns The need for cosmetic improvement to enhance the appearance of the lip and nose, which can significantly impact the patient's quality of life.

2. Procedure

The procedure for CPT® Code 40701 involves several critical steps to achieve a successful repair of the bilateral cleft lip and nasal deformity:

• Step 1: Preoperative Marking The surgeon begins by tattooing the anatomical landmarks and marking the incision lines on the patient's lip and nose. This step is crucial for ensuring precision during the surgical procedure.
• Step 2: Dissection of Orbicularis Muscle The orbicularis muscle is carefully dissected from the overlying skin. This dissection allows for better access to the underlying structures and facilitates the repair process.
• Step 3: Division of Muscle Bundles The muscle bundles of the orbicularis muscle are divided, except for the portion that will be utilized to create the vermillion of Cupid's bow, which remains attached to the mucosa.
• Step 4: Creation of Flaps A cutaneous labial flap is created, along with mucosal flaps that are turned over to form the vermilion and Cupid's bow, restoring the natural contour of the lip.
• Step 5: Nasal Repair The surgeon then addresses the nasal deformity by freeing the overlying tissue from the nasal skeleton. This step is essential for achieving proper alignment and aesthetics of the nasal structure.
• Step 6: Approximation of Nasal Domes The nasal domes are approximated, and the lower lateral cartilage is suspended from the upper lateral cartilage on each side, ensuring structural integrity and symmetry.
• Step 7: Muscle Approximation The muscle bundles of the orbicularis muscle are approximated to restore function and support to the lip.
• Step 8: Closure of Incisions Finally, all skin incisions are meticulously closed using fine sutures or skin adhesive, promoting optimal healing and minimizing scarring.

3. Post-Procedure

After the completion of the procedure coded under CPT® 40701, the patient will require careful monitoring and post-operative care. Expected recovery includes managing any discomfort and ensuring proper healing of the surgical site. Patients may be advised on specific care instructions, such as keeping the surgical area clean and avoiding certain activities that could strain the repaired lip and nose. Follow-up appointments will be necessary to assess healing progress and address any complications that may arise. The overall goal of post-procedure care is to support optimal recovery and achieve the best possible aesthetic and functional outcomes for the patient.