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Restoration of the facial shape and mandibular function, with an additional focus on the restoration of sensory nerves (infraorbital nerve) and, not least, eye function. If enophthalmia is present, it should also be corrected without delay
Surgical fracture management is the treatment of choice in all dislocated fractures and in the presence of impaired ocular function and/or sensitivity.
Surgical therapy may include the following measures:
Repositioning using a single-prong hook
Insertion of the single-prong hook
- Insertion of the single-prong hook below the zygomatic bone #pic#
- Repositioning, infraorbital step control
- Step control
- The single-prong hook is safely inserted under the zygomatic bone/arch for repositioning
- CAUTION: soft-tissue trauma
- Stable results within 23 days; if later, use additional plate fixation
Need for osteosynthesis after repositioning by a single-prong hook
- If the zygomatic bone is unstable
- If the fracture is grossly dislocated, involving functional deficits
- Stabilization of the lateral orbital margin (zygomatico-frontal suture)
Incision in the eyebrow. (Caution: Do not shave eyebrow!)
Incision must not extend beyond the extended palpebral fissure. (Caution: facial nerve!)
- Stabilization through an intraoral access
Intraoral incision from center to tuber
single-prong hook repositioning, adaptation of a 2.0 plate, fixation, verification of fragment repositioning, rinsing of maxillary sinus (if indicated), suturing. Inspection of infraorbital foramen and, if indicated, decomminution.
- Infraorbital stabilization with orbital floor reconstruction
In cases of extremely mobile zygomatic bone fractures or comminuted fractures, the infraorbital border may have to be additionally stabilized.
- Comminuted fracture
If the zygomatic bone and arch are comminuted: coronal incision with complete exposure and reconstruction, but intraoral access is also an option.