CPT® Code 42260

1. Indications

The repair of a nasolabial fistula, as described by CPT® Code 42260, is indicated in the following situations:

• Cleft Palate Repair Complications The procedure is commonly performed to address complications arising from previous cleft palate repair surgeries, where a nasolabial fistula may develop.
• Functional Impairment Patients may experience functional issues, such as difficulties with feeding, speech, or nasal airflow, necessitating surgical intervention to restore normal function.
• Aesthetic Concerns The presence of a nasolabial fistula can lead to significant aesthetic concerns for patients, prompting the need for repair to improve facial appearance.

2. Procedure

The procedure for repairing a nasolabial fistula involves several critical steps, each designed to ensure effective closure and restoration of normal anatomy:

• Step 1: Exposure of the Fistula The surgical process begins with the careful division of the intraoral aspect of the lip. This step is crucial as it allows the surgeon to gain access to the nasolabial fistula, which is the abnormal opening between the upper lip and the nose.
• Step 2: Elevation of Nasal Mucosa Once the fistula is exposed, the next step involves elevating the nasal mucosa. This is the lining of the nasal cavity, and elevating it is essential for preparing the edges of the fistula for closure.
• Step 3: Trimming and Approximating Edges The mucosal edges of the fistula are then trimmed to create clean edges that can be approximated. This step is vital for ensuring a proper fit and alignment of the tissue during closure.
• Step 4: Flap Elevation and Rotation A flap of mucosa is elevated from the area adjacent to the labial aspect of the fistula. This flap is then rotated over the defect to provide adequate coverage and support for the closure.
• Step 5: Closure of the Defect Finally, the defect is closed with sutures. This step secures the flap in place and promotes healing, ultimately restoring the normal anatomy of the lip and nasal area.

3. Post-Procedure

After the repair of a nasolabial fistula, patients can expect specific post-procedure care and considerations. It is essential to monitor the surgical site for any signs of infection or complications. Patients may be advised to follow a soft diet to minimize strain on the surgical area during the initial healing phase. Additionally, proper oral hygiene should be maintained to prevent any contamination of the surgical site. Follow-up appointments will be necessary to assess healing and ensure that the repair is successful. The expected recovery time may vary depending on individual healing processes, but patients should be informed about the importance of adhering to post-operative instructions to achieve optimal outcomes.