Resident Manual of Trauma to the Face, Head and Neck

CHAPTER 4: Midfacial Trauma

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.

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Resident Manual of Trauma to the Face, Head, and Neck