CPT® Code 42509

1. Indications

The bilateral parotid duct diversion procedure, as described by CPT® Code 42509, is indicated for patients experiencing excessive salivation, or sialorrhea, which can lead to uncontrolled drooling. This condition is often a result of neurological deficits, including but not limited to:

• Cerebral Palsy A neurological disorder that affects movement and muscle coordination, often leading to difficulties in managing saliva.
• Head Injury Trauma to the brain that can disrupt normal salivary control mechanisms, resulting in increased saliva production.

2. Procedure

The procedure for bilateral parotid duct diversion with excision of both submandibular glands involves several critical steps to ensure successful outcomes. Each step is designed to address the underlying issues contributing to sialorrhea.

• Step 1: Incision Bilateral incisions are made in the upper aspect of the neck, just below the mandible. This access point is crucial for the subsequent dissection and removal of the submandibular glands.
• Step 2: Dissection of Submandibular Glands The surgeon carefully exposes and dissects the submandibular glands from the surrounding tissue. During this step, it is essential to protect the marginal mandibular branch of the facial nerve to prevent any postoperative complications related to facial movement.
• Step 3: Excision of Glands Once adequately dissected, both submandibular glands are removed from their anatomical locations. This excision is a critical component of the procedure, as it directly contributes to the reduction of saliva production.
• Step 4: Drain Placement After the glands are excised, a drain is placed in the surgical wound. This is important for preventing fluid accumulation and promoting proper healing.
• Step 5: Closure of Incision The incision is then closed around the drain, ensuring that the surgical site is secure while allowing for drainage as needed.

3. Post-Procedure

Post-procedure care following a bilateral parotid duct diversion with excision of both submandibular glands includes monitoring for any signs of complications, such as infection or excessive bleeding. Patients may require pain management and should be advised on wound care to promote healing. Follow-up appointments are essential to assess recovery and ensure that the desired outcomes of reduced salivation are achieved. Additionally, patients may need guidance on dietary modifications and oral hygiene practices to accommodate changes resulting from the surgery.