CPT® Code 40702

1. Indications

The procedure associated with CPT® Code 40702 is indicated for patients presenting with a bilateral cleft lip and associated nasal deformity. The following conditions may warrant this surgical intervention:

• Bilateral Cleft Lip Deformity A congenital condition where the upper lip is split on both sides, requiring surgical repair to restore normal appearance and function.
• Nasal Deformity Associated nasal structural abnormalities that occur alongside bilateral cleft lip, necessitating correction to improve aesthetic and functional outcomes.

2. Procedure

The surgical procedure for CPT® Code 40702 involves several critical steps, executed over two stages to achieve optimal results. Each stage is designed to address specific aspects of the cleft lip and nasal deformity.

• Stage One: Initial Repair In the first stage, the surgeon begins by tattooing the anatomic landmarks and marking the incision lines on the patient's lip and nose. This precise marking is crucial for ensuring accurate alignment during the repair. The orbicularis muscle, which encircles the mouth, is carefully dissected from the overlying skin, and the muscle bundles are divided to facilitate the reconstruction. The portion of the muscle that will contribute to the formation of the vermilion of Cupid's bow is preserved and left attached to the mucosa. A cutaneous labial flap is then created, along with mucosal flaps that are turned over to form the vermilion and Cupid's bow. The nasal repair involves freeing the overlying tissue from the nasal skeleton, allowing for proper alignment of the nasal structures. The nasal domes are approximated, and the lower lateral cartilage is suspended from the upper lateral cartilage on each side to restore the nasal contour. Finally, the muscle bundles of the orbicularis muscle are approximated to ensure functional integrity, and all skin incisions are closed using fine sutures or skin adhesive.
• Stage Two: Final Repair The second stage of the procedure is performed at a later date, where the surgeon revisits the surgical site to complete the repair. This stage may involve further refinement of the lip and nasal structures, ensuring that the aesthetic and functional outcomes are optimized. The specific techniques used in this stage will depend on the initial healing and the individual needs of the patient, but they generally follow similar principles of tissue manipulation and closure as in the first stage.

3. Post-Procedure

After the completion of both stages of the procedure, patients typically require careful post-operative care to ensure proper healing and minimize complications. This may include monitoring for signs of infection, managing pain, and ensuring that the surgical site remains clean and dry. Patients may also be advised on dietary modifications to avoid strain on the surgical area during the initial recovery phase. Follow-up appointments are essential to assess healing progress and to determine if any additional interventions are necessary. The expected recovery time can vary based on individual factors, but patients are generally encouraged to adhere to their surgeon's post-operative instructions for optimal outcomes.