CPT® Code 42220

1. Indications

The secondary lengthening procedure, coded as CPT® 42220, is indicated for patients who have a cleft palate and require further surgical intervention to enhance the closure of the defect and improve velopharyngeal function. This procedure is typically performed when the initial palatoplasty has not achieved satisfactory results, leading to ongoing issues with speech intelligibility, eating, or breathing. The following conditions may warrant the performance of this procedure:

• Residual Defect Patients who exhibit a residual defect in the palate following a primary palatoplasty that affects their ability to function normally.
• Speech Difficulties Individuals who continue to experience speech difficulties due to inadequate closure of the palate.
• Feeding Issues Patients who have ongoing feeding difficulties related to the structural integrity of the palate.

2. Procedure

The procedure for CPT® 42220 involves several critical steps to ensure the effective lengthening of the palate. The following outlines the procedural steps involved:

• Step 1: Flap Creation The surgeon begins by creating two posterior unipedicle flaps, ensuring the preservation of the greater palatine artery. This step is crucial for maintaining blood supply to the tissue that will be manipulated during the procedure.
• Step 2: Anterior Flap Preparation One or two anterior pedicle flaps are then created. These flaps are carefully rotated over the anterior aspect of the defect to facilitate closure.
• Step 3: Suturing Anterior Flaps The anterior flaps are sutured together at the midline, establishing a foundation for the subsequent steps of the procedure.
• Step 4: V-Y Advancement Technique The posterior flaps are rotated over the defect and advanced towards the anterior flaps using the V-Y advancement technique. This technique is designed to increase the length of the palate effectively.
• Step 5: Final Suturing Finally, the posterior flaps are sutured to the anterior flaps and to each other at the midline, completing the closure of the defect and ensuring stability of the newly formed palate.

3. Post-Procedure

After the completion of the secondary lengthening procedure, patients typically require careful monitoring and follow-up care to assess healing and functional outcomes. Post-procedure care may include pain management, dietary modifications to accommodate healing, and speech therapy to address any ongoing communication challenges. The expected recovery period can vary based on individual patient factors and the extent of the surgical intervention. It is essential for healthcare providers to provide comprehensive instructions regarding care at the surgical site and to schedule follow-up appointments to evaluate the success of the procedure and the patient's overall progress.