CPT® Code 42226

1. Indications

The procedure associated with CPT® Code 42226 is indicated for patients who require surgical intervention to lengthen the palate, particularly in cases where there is a defect that affects the velopharyngeal closure. This may include conditions such as:

• Cleft Palate A congenital condition where there is an opening in the roof of the mouth, which can lead to difficulties in speech and feeding.
• Velopharyngeal Insufficiency A condition where the soft palate fails to close properly against the back of the throat during speech, resulting in nasal speech and other complications.
• Acquired Palatal Defects Defects that may arise due to trauma, surgery, or disease processes that compromise the integrity of the palate.

2. Procedure

The procedure for CPT® Code 42226 involves several critical steps to ensure the successful lengthening of the palate through the creation of a pharyngeal flap. The steps are as follows:

• Step 1: Incision at the Uvula The surgical process begins with an incision made at the uvula, which is the small structure located at the back of the throat. This incision is essential for accessing the soft palate.
• Step 2: Extension of the Incision The initial incision is then extended anteriorly towards the hard palate. This extension is crucial for creating a superiorly based flap that will be used to lengthen the palate.
• Step 3: Elevation of the Flap Once the incision is made, the flap is carefully elevated off the prevertebral fascia. This step requires precision to ensure that the flap remains viable and retains its blood supply.
• Step 4: Rotation and Insetting of the Flap After the flap is elevated, it is rotated and inset over the defect in the palate. This positioning is vital for achieving the desired lengthening effect and restoring function.
• Step 5: Closure of the Donor Site Finally, the donor site from which the flap was harvested is closed with sutures. This closure is important for promoting healing and minimizing complications at the surgical site.

3. Post-Procedure

Post-procedure care following the lengthening of the palate with a pharyngeal flap involves monitoring the surgical site for any signs of infection or complications. Patients may be advised to follow a specific diet to avoid irritation to the surgical area and to facilitate healing. Pain management may also be necessary, and follow-up appointments will be scheduled to assess the healing process and the effectiveness of the procedure in improving velopharyngeal function. It is essential for patients to adhere to the post-operative instructions provided by their healthcare provider to ensure optimal recovery.