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CHAPTER 4: Midfacial Trauma
Resident Manual of Trauma to the Face, Head, and Neck
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2. Zygomatic Fractures
Zygomatic fractures may be another cause of globe dysfunction/
malposition, because of the contribution of the zygoma to the orbital
structure. More commonly, however, a displaced zygoma, particularly a
depressed arch, may lead to impingement on the temporalis muscle,
causing trismus and/or painful mouth opening and difficulty with
mastication. More commonly, however, zygomatic fractures are
reduced for cosmetic reasons. It is also common for patients to refuse
repair, when the problem is only cosmetic.
3. Maxillary Fractures
Le Fort fractures can affect the position of the dentition and result in
significant malocclusion. Because this will interfere with chewing, repair
is very important.
F. Approaches to Repairing Midfacial Trauma
1. Orbital Fractures
A number of different options can be used when approaching orbital
fractures, and each has its proponents and detractors. It is important to
protect the cornea from trauma when utilizing these approaches. The
common approaches to the orbital floor include:
a. Lower Lid Approaches
i. Subciliary Incision
This transcutaneous approach is generally placed 1–2 millimeters (mm)
below and parallel to the lash line (Figure 4.4). The incision can be
made through skin and muscle, and dissection can be carried out under
the muscle to the inferior orbital rim. Alternatively, the incision can be
made through skin, carried inferiorly for several mm, whereupon the
orbicularis muscle is dissected away from the orbital septum, exposing
the inferior orbital rim. Care must be taken to avoid damaging the thin
Figure 4.4
Illustration depicting the subciliary
transcutaneous approach.
Source:
Kellman and Marentette, Figure 3-45.