The significance of orbital floor exploration during open reduction of zygomaticomaxillary complex fractures

Krasadakis, Christos; Igoumenakis, Dimosthenis; Mourouzis, Constantinos; Rallis, Georgios

doi:10.22540/jrpms-01-045

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…Retrospective analysis of patients’ data by Krasadakis 4 confirmed that a considerable percentage (28 of the 82 or 34, 1%) of ZMC fractures were associated with orbital floor defects that had not been detected preoperatively and were only diagnosed upon intraoperative exploration of the orbital floor following open reduction.…”

Section: Discussionmentioning

confidence: 97%

“…3 Some studies show that it is not always possible to detect the orbital floor fractures preoperatively and can only be diagnosed upon intraoperative exploration of the orbital floor following open reduction. 4 The big question, however, is how does one decides about the need for orbital floor exploration when a patient presents with a ZMC fracture?…”

Section: Introductionmentioning

confidence: 99%

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

Anehosur

Nathani

Nagraj

et al. 2020

Craniomaxillofacial Trauma & Reconstruction

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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.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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

Anehosur

Nathani

Nagraj

et al. 2020

Craniomaxillofacial Trauma & Reconstruction

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Surgical management of isolated orbital floor and zygomaticomaxillary complex fractures with focus on surgical approaches and complications

Schneider

Besmens

Luo

et al. 2020

Journal of Plastic Surgery and Hand Surgery

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Does More Invasive Surgery Result in Higher Patient Satisfaction? A Long-Term Follow-Up of 136 Zygomaticomaxillary Complex Fractures

Rahbin,

Sunnergren,

McBride

et al. 2024

Craniomaxillofacial Trauma & Reconstruction

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Study Design Retrospective with follow-up. Objective To evaluate the long-term satisfaction of surgically treated patients with zygomaticomaxillary complex (ZMC) fractures in relation to the use of internal fixation, number of fixation points, and orbital floor (OF) reconstruction. Secondary objectives were to describe the use of antibiotics and post-operative infections. Methods Patients with unilateral ZMC fractures between 2007-2018 and treatment with either open reduction and internal fixation (ORIF) or closed reduction (CR) were identified from medical records and invited to follow-ups between 2018-2020. Patients were examined, photographed, and completed a questionnaire. A review panel of 3 experienced surgeons evaluated photographs and computed tomography (CT) scans pre- and post-surgery. Results The study sample consisted of 136 patients (108 ORIF, 28 CR) with a median follow-up time of 76 months. Patient satisfaction of surgical outcome was high (97.8%), with no significant differences in relation to the use of internal fixation, number of fixation points, or OF reconstruction. Dissatisfaction was primarily related to hypoesthesia. On post-operative CT scans, malar asymmetry was more often predicted in patients with 1-point fixations. On questionnaires and photographs, malar asymmetry was more common in patients with 3-point fixations. Prophylactic antibiotics had no effect on the rate of post-operative infections. Conclusions Patient satisfaction was not influenced by internal fixation, number of fixation points, or OF reconstruction. Selected ZMC fractures can be treated with less invasive approaches. Caution should be observed when predicting long-term malar asymmetry on post-operative CT scans. The findings of this study highlight the importance of a rational and ethical use of surgery.

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The significance of orbital floor exploration during open reduction of zygomaticomaxillary complex fractures

Cited by 3 publications

References 18 publications

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

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

Surgical management of isolated orbital floor and zygomaticomaxillary complex fractures with focus on surgical approaches and complications

Does More Invasive Surgery Result in Higher Patient Satisfaction? A Long-Term Follow-Up of 136 Zygomaticomaxillary Complex Fractures

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