Midface Fractures I

Abstract

Facial fractures are a common source of emergency department consultations for the plastic surgeon. A working understanding of evaluation, assessment, management, and prevention of further injury when dealing with these fractures is vital. This two-part series detailing the management of midface fractures serves as a guide for the appropriate workup and management of the wide variety of fracture patterns that are commonly encountered.

Risk of Lower Eyelids Malposition in Subciliary Compared to Transconjunctival Approach in Maxillofacial Fractures Management: A Systematic Review and Meta-Analysis

“…As shown in Figure 2, incidence of ectropion between subciliary and transconjunctival approach were 7.0% and 1.5%, respectively. Based on fixed effect model with low heterogeneity (I2 = 0%; χ 2 = 0.34; p = 0.99), pooled risk ratio between subciliary and transconjunctival approach on ectropion incidence was 4.64 (p = 0.003; 95% CI: 1.68-12.81).…”

“…The possible underlying mechanism of postoperative ectropion and entropion is scarring at the anterior and middle lamella of the eyelid after a subciliary incision while post-operative scar of the posterior lamella can occur after the transconjunctival incision. By the time the scar becomes mature, it can create the outward retraction in the former and the inward retraction in the latter [1], [2], [5].…”

“…The transconjunctival approach doesn’t emphasise in the involvement of the lower eyelid skin and orbicularis oculi muscle so that reduced the risk for postoperative lower eyelid retraction, scleral show, and ectropion. In this review, most studies performed transconjunctival incision with lateral canthotomy to get enough exposure and visibility [2]. Despite its cosmetic advantages, the main disadvantages of this approach are its technique sensitivity, a relatively limited exposure when used alone but relatively higher rates of lower eyelid malposition when combined with a lateral canthotomy [3].…”

“…Despite the impact on physiologic function, maxillofacial fractures may also have an unfavourable effect on facial aesthetics of the trauma victim. Challenges in the comprehensive management of facial bone fractures are not only how to achieve a physiologic union of the bones, but also to manage all of the effects caused by the broken bones [1], [2].…”

Nasal and Naso-orbito-ethmoid Fractures

“…NOE fractures involve the lateral nose, inferior orbital rim, medial orbital wall, nasomaxillary buttress, and frontal process of the maxilla. 5 The medial canthal tendon (MCT) inserts around the lacrimal fossa and acts as a pump for the lacrimal sac. 6 Thus, NOE fractures can result in dysregulation of tear film clearance and resultant epiphora.…”