Clinical Implications of Orbital Volume Change in the Management of Isolated and Zygomaticomaxillary Complex–Associated Orbital Floor Injuries

Tahernia, Amir; Erdmann, Detlev; Follmar, Keith E.; Mukundan, Srinivasan; Grimes, Jason; Marcus, Jeffrey R.

doi:10.1097/prs.0b013e318199f486

Cited by 47 publications

(36 citation statements)

References 14 publications

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“…Traditional teaching states that fracture involving greater than 50% of the orbital floor or defects measuring 1 to 2 cm 2 should be explored and repaired. [43][44][45][46][47] Tahernia et al determined that a change in orbital volume of 20% results in a perceptible deformity, and the 50% rule may be too conservative. 44 They advise to explore and reconstruct the orbital floor with 1 cm or more of inferolateral displacement of the ZMC, as this results in an orbital volume change of 20%.…”

Section: Discussionmentioning

confidence: 99%

“…[43][44][45][46][47] Tahernia et al determined that a change in orbital volume of 20% results in a perceptible deformity, and the 50% rule may be too conservative. 44 They advise to explore and reconstruct the orbital floor with 1 cm or more of inferolateral displacement of the ZMC, as this results in an orbital volume change of 20%. Shape and position of the inferior rectus muscle has been found to be the most predictive indicator for enophthalmos.…”

Section: Discussionmentioning

confidence: 99%

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Current Management of Zygomaticomaxillary Complex Fractures: A Multidisciplinary Survey and Literature Review

Farber

Nguyen

Skolnick

et al. 2016

Craniomaxillofacial Trauma & Reconstruction

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The prominence of the zygomaticomaxillary complex (ZMC) convexity along the anterolateral portions of the face makes it vulnerable to traumatic injury. While there is debate as to what part of the facial skeleton is most commonly injured, ZMC fractures comprise up to 40% of facial fractures. 1,2Common etiologies include motor vehicle accidents, assault, falls, and sports-related injuries.1,3 The complex three-dimensional aspect of the zygoma contributes both to facial aesthetics and function. It forms the malar eminence, providing cheek projection, and the lateral and inferior portions of the orbit. Reestablishing preinjury form is the goal of all ZMC fracture treatments, regardless of the approach utilized.As surgical technique and technology have improved through the past century, management opinions have evolved.4-7 Standard treatment mostly involves internal fixation with plates and screws, but there is much debate Keywords ► orbital fractures ► zygomatic fractures ► facial injuries AbstractDespite the prevalence of zygomaticomaxillary complex (ZMC) fractures, there is no consensus regarding the best approach to management. The aim of this study is to determine differences in ZMC fracture treatment among various surgical specialties. A survey was conducted regarding treatment of patients with different ZMC fractures that included a minimally displaced fracture (Case 1), a displaced fracture without diplopia (Case 2), a displaced fracture with diplopia (Case 3), and a complex comminuted fracture (Case 4). The survey was distributed to members of plastic surgery, oral maxillofacial surgery, and otolaryngology societies. The rates of surgical treatment, exploration of the orbital floor, and plating three or more buttresses were analyzed among the specialties. A total of 173 surgeons participated (46 plastic and reconstructive surgeons, 25 oral and maxillofacial surgeons, and 102 otolaryngologists). In Case 1, a significantly higher percentage of plastic surgeons recommend an operation (p < 0.01) compared with other specialties. More than 90% of surgeons would perform an operation on Case 2. Plastic surgeons explored the orbital floor (p < 0.01) and also fixated three or more buttresses more frequently (p < 0.01). More than 93% of surgeons would operate on Case 3, with plastic surgeons having the greatest proportion who fixed three or more buttresses (p < 0.01). In Case 4, there was no difference in treatment patterns between specialties. Across the specialties, more fixation was placed by surgeons with fewer years in practice (<10 years). Conclusion There is no consensus on standard treatment of ZMC fractures, as made evident by the survey. Significant variability in fracture type warrants an individualized approach to management. A thorough review on ZMC fracture management is provided.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Current Management of Zygomaticomaxillary Complex Fractures: A Multidisciplinary Survey and Literature Review

Farber

Nguyen

Skolnick

et al. 2016

Craniomaxillofacial Trauma & Reconstruction

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“…Operative intervention is also indicated in the presence of trismus or orbital apex involvement [7]. Isolated nondisplaced zygomatic arch fractures infrequently undergo repair, whereas closed reduction is implemented for displaced arch fractures, invariably producing favorable outcomes [22].…”

Section: D Ct Of Posttraumatic Defects Of the Orbital Skeleton Aftementioning

confidence: 99%

Postoperative CT of the Orbital Skeleton After Trauma: Review of Normal Appearances and Common Complications

Reiter

Schwope

Theler

2016

American Journal of Roentgenology

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The goal of surgery is to restore the preinjury orbital anatomy to improve function and prevent enophthalmos. Radiologists need to be cognizant of the more frequently encountered operative procedures used for orbital fracture repair, the desired goals of treatment, and common complications. This will permit accurate interpretation of postoperative CT and provide surgeons with clinically useful results.

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“…Fractures of the four orbital walls, occurring isolated or jointly with other midface fractures, have to be restored properly to prevent enophthalmos, hypoglobus, or resulting diplopia. 13,14 Fractures of the lateral orbital wall along the zygomaticosphenoidal suture typically occur in zygomatic bone or Le Fort III fractures. This wall is flat and lends itself to an assessment of a correct realignment.…”

Section: Orbital Wall Fracturesmentioning

confidence: 99%

Maxillofacial Fractures: Midface and Internal Orbit—Part II: Principles and Surgical Treatment

et al. 2015

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Current clinical assessment and imaging techniques were described in part 1, and this article presents a systematic review of the surgical treatment principles in the management of midface and internal orbit fractures from initial care to definitive treatment, including illustrative case examples. New developments enabled limited surgical approaches by standardization of osteosynthesis principles regarding three-dimensional buttress reconstruction, by newly developed individualized implants such as titanium meshes and, especially for complex fracture patterns, by critical assessment of anatomical reconstruction through intraoperative endoscopy, as well as intra- and postoperative imaging. Resorbable soft tissue anchors can be used both for ligament and soft tissue resuspension to reduce ptosis effects in the cheeks and nasolabial area and to achieve facial aesthetics similar to those prior to the injury.

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Clinical Implications of Orbital Volume Change in the Management of Isolated and Zygomaticomaxillary Complex–Associated Orbital Floor Injuries

Cited by 47 publications

References 14 publications

Current Management of Zygomaticomaxillary Complex Fractures: A Multidisciplinary Survey and Literature Review

Current Management of Zygomaticomaxillary Complex Fractures: A Multidisciplinary Survey and Literature Review

Postoperative CT of the Orbital Skeleton After Trauma: Review of Normal Appearances and Common Complications

Maxillofacial Fractures: Midface and Internal Orbit—Part II: Principles and Surgical Treatment

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