CPT® Code 68550

1. Indications

The excision of a lacrimal gland tumor, as described by CPT® Code 68550, is indicated for various conditions affecting the lacrimal gland. These include:

• Inflammatory Lesions These may include conditions such as dacryoadenitis, sarcoidosis, and orbital inflammatory pseudotumor, which can cause swelling and dysfunction of the lacrimal gland.
• Benign Neoplastic Lesions Tumors such as pleomorphic adenoma, benign reactive lymphoid hyperplasia, and oncocytomas may necessitate excision to prevent complications or further growth.
• Malignant Neoplastic Lesions The presence of malignant tumors, including adenoid cystic carcinoma, squamous cell carcinoma, adenocarcinoma, mucoepidermoid carcinoma, and malignant lymphomas, requires surgical intervention to remove cancerous tissue and prevent metastasis.

2. Procedure

The procedure for excising a lacrimal gland tumor under CPT® Code 68550 involves several critical steps:

• Step 1: Anesthesia and Preparation The patient is positioned appropriately, and local or general anesthesia is administered to ensure comfort during the procedure. The surgical area is then prepared and draped to maintain a sterile environment.
• Step 2: Incision and Exposure An incision is made over the crease of the upper eyelid, similar to the approach used in CPT® Code 68540. The soft tissues are carefully dissected to expose the lacrimal gland, ensuring minimal trauma to surrounding structures.
• Step 3: Tumor Dissection and Excision The lacrimal gland is meticulously dissected free from surrounding tissues. In this procedure, any tumor present within the gland is excised. Additionally, if the tumor involves the adjacent bone, that bone is also removed using a bone saw or osteotome to ensure complete resection of the tumor.
• Step 4: Margin Evaluation Frozen sections of the excised tissue are sent for pathological evaluation to determine if the surgical margins are clear of tumor cells. If the margins are not clean, further surrounding tissue is excised until clear margins are achieved.
• Step 5: Closure Once the tumor and any involved bone have been removed, the surgical wound is closed in layers, ensuring proper alignment of the tissues and minimizing scarring.

3. Post-Procedure

After the excision of the lacrimal gland tumor, patients may require monitoring for any complications such as infection or excessive bleeding. Post-operative care typically includes pain management and instructions for wound care. Patients may also be advised on activity restrictions to promote healing. Follow-up appointments are essential to assess recovery and ensure that there are no signs of recurrence or complications related to the surgery.