Trauma and Fractures of Periorbital Region

Article Outline

• Statement
• Materials and Methods
• Method of Data Analysis
• Results
• Conclusion
• References
• Copyright

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Statement 

The management of periorbital fractures has evolved from closed reduction, maxillary fixation, and cranial suspension wires to extended access approaches with precise open reduction and rigid internal fixation using miniplates. These fractures include maxilloorbital fractures, zygomaticoorbital fractures and associated orbital fractures. The use of CT for accurate diagnosis and surgical planning has been invaluable in the development of treatment for these injuries.

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Materials and Methods 

We studied 15 patients with periorbital fractures. All of them had fractures of zygomaticoorbital complex, Le Fort trauma and associated orbital lesions.

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Method of Data Analysis 

We analyzed medical history, CT, Xray and surgical treatment which was done by us.

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Results 

An ophthalmologist and maxillofacial surgeon treated all patients. For all patients we made osteosynthes with titanium plates of fractured fragments and reconstruction of orbital floor with titanium through maxillary sinus and transconjunctival approach. Indications for this treatment were: a) persistent diplopia, b) cosmetically significant and clinically apparent enopthalmos, c) radiological evidence of significant comminution and/or displacement of the orbital rim and greater than 50% of the orbital floor with herniation of soft tissue in maxillary sinus, d) combined orbital floor, body of zygoma and medial wall defects with soft tissue displacement, e) physical-radiological evidence of exopthalmos or orbital content impingement caused by displaced periorbital fractures.

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Conclusion 

The management of periorbital fractures has advanced with accurate diagnosis by CT, extended access approaches via concealed incisions, and open reduction and fixation with plates and screws. Evaluation of involved buttresses in the facial skeleton allows operative planning for repair. With early, accurate repair of these injuries more patients will be returned to their pretraumatic state.

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References 

1. Barry CP, Ryan WJ, Stassen LF. Anatomical study of factors contributing to zygomatic complex fracture instability in human cadavers. Plast Reconstr Surg. 2007 Feb;119(2):637–640discussion 641
2. Carinci F, Zollino I, Brunelli G, Cenzi R. Orbital Fractures: A New Classification and Staging of 190 Patients. J Craniofac Surg. 2006 Nov;17(6):1040–1044