CPT® Code 21395

1. Indications

The open treatment of an orbital floor blowout fracture using a periorbital approach with a bone graft is indicated for the following conditions:

• Orbital Floor Fracture: This procedure is performed when there is a fracture of the orbital floor, typically resulting from trauma to the mid-facial region.
• Extraocular Muscle Entrapment: Indications include cases where the fracture has led to entrapment of the extraocular muscles, causing impaired eye movement.
• Aesthetic Facial Deformity: The procedure is also indicated for patients who present with aesthetic deformities due to the fracture, necessitating surgical correction.

2. Procedure

The procedure for the open treatment of an orbital floor blowout fracture involves several critical steps:

• Step 1: The surgical process begins with an incision made across the length of the lower eyelid, just below the base of the tarsus. This incision allows for direct access to the orbital area.
• Step 2: Traction sutures are then placed to facilitate the surgical field. The conjunctiva is carefully pulled superiorly to protect the cornea during the procedure.
• Step 3: The surgeon proceeds to bluntly dissect the plane between the orbital septum and the orbicularis muscle, extending the dissection to the orbital rim to gain adequate access to the fracture site.
• Step 4: Once access is achieved, the periosteum is opened and elevated off the orbital floor, exposing the fracture and any herniated orbital tissue.
• Step 5: The herniated tissue is either removed or repositioned back into the orbit to restore normal anatomy.
• Step 6: The fracture is then reduced, and an autogenous bone graft is harvested from a suitable donor site, such as the maxillary wall, calvaria, iliac crest, rib, or fibula. This graft is shaped to match the contour of the bony deficit in the orbital floor.
• Step 7: The shaped bone graft is inserted into the orbital space to provide structural support and restore the integrity of the orbital floor.
• Step 8: After ensuring hemostasis, the traction sutures are cut, and the conjunctiva is repositioned. Finally, the incision is closed with sutures to complete the procedure.

3. Post-Procedure

Post-procedure care following the open treatment of an orbital floor blowout fracture includes monitoring for any complications such as infection or hematoma formation. Patients are typically advised to avoid activities that may increase intraocular pressure or strain on the surgical site. Follow-up appointments are essential to assess healing and ensure that the eye movement and aesthetic appearance are returning to normal. Pain management and instructions for wound care are also provided to facilitate recovery.