Existing lacerations may also be used.

Remove sutures from skin after approximately 5 days if nonresorbable sutures have been used.Apply ice packs (may be effective in a short term to minimize edema).Avoid sun exposure and tanning to skin incisions for several months. The first step is to obtain proper 3-D reduction of the zygoma using an elevator, hook, screw, or Carroll-Girard type device to mobilize the zygoma into its proper position. In the illustration we can see that there is a comminuted segment of the lateral column. The presence of the arch bars or elastics makes this a more difficult procedure. When using the fan-shaped plate, the outer circumference of the mesh is widest in the area of the infraorbital rim.

Some surgeons prefer it.

December 3-6, 2020, The lateral orbital wall can be approached via the lower eyelid incision (transconjunctival or transcutaneous), or the. Superior orbital fissure lies between the lesser and the greater wing of sphenoid. (For a discussion on isolated orbital floor fractures, please click here.).

It can only be used if there is no comminution of the lateral wall of the orbit. —The zygomatic bone is generally described as ossifying from three centers—one for the malar and two for the orbital portion; these appear about the eighth week and fuse about the fifth month of fetal life. The use of the following perioperative medication is controversial. … all sharp edges of the plate are trimmed off to protect the soft tissues (note the shape of the fan has only a minimum number of screw holes), …, … and contoured to achieve the required shape, and accommodate key anatomical structures (nasolacrimal duct, infraorbital nerve, and optic nerve). Problems of dentition and dental sensation, Problems of the temporomandibular joint (TMJ), (lack of range of motion, pain), Type and stability of fixation (including palatal splints).

A soft toothbrush (dipped in warm water to make it softer) should be used to clean the surfaces of the teeth and arch bars. A general principle is to begin with the reference points that are least comminuted. The following signs and symptoms are usually evaluated: Note: In case of postoperative double vision, ophthalmological assessment has to clarify the cause. However, this CT scan nicely shows contour differences at the lateral orbital wall area.

The final two screws in the zygomaticofrontal plate should be placed at the end of the intervention.

Clinical follow-up depends on the complexity of the surgery, and whether the patient has any postoperative problems. This requires the alignment of the greater wing of the sphenoid and the zygoma.

It is possible that the periorbital contents may have been affected by the reduction of the zygomatic-complex fracture. It is important that the leg of the L-plate be placed on the most lateral portion of the lateral maxillary buttress, where the bone is fairly thick.It is similarly important that the foot of the L-plate is placed along the alveolar bone in a manner that the screws will not be placed into the dental roots. We recommend that lower profile plates are used at the zygomaticofrontal suture and the infraorbital rim.

Prior to securing this plate, make sure that the reference point of the lateral orbital wall, the inferior orbital rim, and the lateral maxillary buttress are properly reduced. It is controversial whether this cold sensitivity is a result of the plate, a result of nerve injury from the original trauma, or from nerve injury due to trauma of the surgery. Here, it is a plate-like bone forming the lower margin of the orbit and much of the side of the face. An exception may be made for centers capable of intraoperative imaging.Especially in fractures involving the alveolar area, orthopantomograms (OPG) are helpful. The use of the following perioperative medication is controversial. It should be noted that the zygomatic arch is not a true arch and is often relatively straight in its central portion. Reconfirm that the lateral orbital wall (greater wing of the sphenoid and zygoma) has been properly reduced prior to placing this plate. This article incorporates text in the public domain from page 164 of the 20th edition of Gray's Anatomy (1918), Side view of the teeth and jaws (zygomatic visible in center), https://en.wikipedia.org/w/index.php?title=Zygomatic_bone&oldid=979515450#Processes, Wikipedia articles incorporating text from the 20th edition of Gray's Anatomy (1918), Creative Commons Attribution-ShareAlike License, This page was last edited on 21 September 2020, at 06:07.

Whenever possible the surgeon should try to achieve a perfect reduction of the lateral wall of the orbit. Each process of the zygomatic bone forms important structures of the skull. Bone graftThe advantage of bone graft is that the material is inexpensive. Isolated lateral orbital wall fractures are rare and only occur after isolated trauma to this anatomical structure.

When using the fan-shaped plate, the outer circumference of the mesh is widest in the area of the infraorbital rim. This bone is considered key in the determination of general traits of the skull, as in the case of creatures, such as dinosaurs in paleontology, whose entire skull has not been found. If the lateral wall of the orbit is not comminuted, this reference point is still singularly the most important landmark to determine whether a proper reduction has been performed. The zygomatic arch may be an excellent reference as to whether the proper AP projection of the midface has been restored. At the same time it is important to have wide exposure of all the reference points, and to recheck the reduction of each reference point as each new plate is placed.

The postero-inferior or zygomatic border affords attachment by its rough edge to the masseter. Reconstruction of the orbital floor should be performed after the zygoma has been reduced and fixated. Lateral orbital wall plateSome surgeons recommend placement of a plate to reduce and fixate the lateral wall of the orbit between the greater wing of the sphenoid and the zygoma. Readmission might be indicated if long term stability of the orbital volume has not been maintained. Three approaches are required for this procedure.

The illustration on the left represents a zygomatic arch fracture, where the posterior fracture extends to the temporal bone. The following signs and symptoms are usually evaluated: Note: In case of postoperative double vision, ophthalmological assessment has to clarify the cause.

Correct anatomical reduction is required to reproduce the original structure of the zygomaticomaxillary complex and the proper alignment of the orbital walls. Keeping the patient’s head in an upright position both preoperatively and postoperatively may significantly improve periorbital edema and pain. In this instance using a longer L-plate with multiple screw holes may be ideal.

The intraoral maxillary vestibular approach facilitates the exposure of the lateral buttress of the midface. There is little evidence to make strong recommendations for postoperative care.

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