Clinical Criteria for Selective Exploration of Orbital Floor in Zygomaticomaxillary Complex Fractures

Abstract

Purpose: Exposing the orbital floor requires a surgical procedure that has its own challenges. Despite the meticulous clinical examination followed by sophisticated imaging modalities, orbital floor defects associated with zygomaticomaxillary complex (ZMC) fractures may evade diagnosis and appropriate management. If surgeons can decide about the need for orbital floor exploration in patients with ZMC fracture, the chance of a postoperative eyelid deformity can be prevented. The aim of this article is to assess whether an association exists between the pattern of fracture line and the need for exploration of the orbital floor in ZMC fracture. Materials and Methods: A retrospective study of 94 patients with isolated, unilateral ZMC fractures who were treated at our unit by open reduction of the ZMC complex with internal orbital exploration from January 2016 to January 2018. The records of all patients were reviewed and specific data related to fracture pattern and orbital floor defect were registered and assessed. Results: Of the 94 cases with isolated, unilateral ZMC fractures, in 80 cases the fracture line propagated to the orbital floor, which required exploration but did not required any reconstruction and only the infraorbital rim was addressed; 14 of them required orbital floor reconstruction. Among the cases which required orbital floor reconstruction, the majority of the cases where those with fracture involving medial side of infraorbital foramen (n = 10) followed by lateral side (n = 3) and through the foramen (n = 0) and lastly bilateral side of the foramen (n = 1). Conclusion: The present study highlights the pattern of fracture line at the level of infraorbital rim can predict the need for orbital floor exploration while treating ZMC fractures for purpose of orbital floor reconstruction. Based on the results and a review of the records, authors strongly recommend the need for exploration of orbital floor when the fracture line passes medial to the infraorbital foramen.

Critical Degree of Orbital Floor Displacement Drives Operative Repair of Zygomaticomaxillary Complex Fractures: Findings from a 10-Year Retrospective Study

“…14 Based on a retrospective review examining fracture patterns in 94 patients with isolated unilateral ZMC fractures managed surgically, Anehosur et al advocated for exploration of the orbital floor when the fracture line passes medial to the infraorbital foramen. 15 Even so, very few studies have critically sought to determine a "cutoff" displacement for which operative intervention is recommended. In our study, the average displacement of the orbital floor was 5.7 AE 3.2 mm in groups undergoing surgery, versus 2.9 AE 1.5 mm in the observation group (p ¼ 0.001).…”

Application of Computer-Aided Design and Individualized Templates for Bilateral Zygomaticomaxillary Complex Fractures

“…8 Therefore, it is a great challenge to restore not only masticatory function, but also facial symmetry. 9,10 At present, various studies on the treatment of ZMC fractures mainly focus on unilateral fractures, but there are few studies on bilateral ZMC fractures. Compared with unilateral ZMC fracture, bilateral ZMC fractures are usually more complicated and serious, which further increases the difficulty of surgery.…”

“…It can also cause limitation of mouth opening, enophthalmos and diplopia 8 . Therefore, it is a great challenge to restore not only masticatory function, but also facial symmetry 9,10 …”