# Need help with surgery code orbital zygomatic fx



## chughes04

codes that I picked are: 21356 and 21387 or 21365 not sure which one I should use

DX:  Left orbital blowout fracture.  Displaced zygomatic fracture with extension to the anterior walls, comminuted


Procedure:  Open reduction and internal fixation of a left orbital blowout fracture and displacedzygomatic fracture with extension to the anterior walls, communuted with mini plate and antral balloon and silastic sheath insertion


Initially, an incision was made over the anterior orbital rim after injection with Xylocaine and epinephrine transection the skin.  the orbital muscles down into the periosteum of the infraorbital area.  Th ebone in question was noted and there was a fracture of the rim extending into the anterior wall with possible inujury of the infraorbital nerve.  The periosteum was dissected more posteriorly and using a Freer elevator the displaced orbital floor bone fracture was replace in its original position.  Considering the fact that this was a floating bone I elected to use a silastic sheath instead of a mesh.  The silastic was fashioned to a adequate sie and placed under the globe with the piece of bone in entrapment at this juncture.  Prior to the close the frontozygomatic fracture was reduced and a mini plate was inserted.  A manipulator was also inserted infraorbitally after reduction of the zygomatic malar area.  We directed our attention in investigating the alar wall by making an incision at the gingival sulcus area with use of a #15 knife blade.  the superior flap was then dissected up until the lateral and medial wall of the maxillary sinus was noted.  There was a comminuted fx in this area that was minimally displaced.  Due to the natureof the fx of the anterior wall it was decided that an antral balloon be inserted in the following fashion.   The inferior turbinates were then infractured and antrostomy opening was created at the inferior meatus.  A #24 foley catheter was then inserted into the antral cavity with the use of a ureteral guide.  


Any help would be appreciated,   Cathy


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