Late correction of orbital-zygomatic-maxillary fractures combined with orbital wall fractures.

PURPOSE: With the increasing number of patients with facial trauma, orbital-zygomatic-maxillary (OZM) fracture combined with orbital wall fracture has become common. Such fractures always induce symptoms of enophthalmos, hypoglobus, and diplopia. This study was aimed to investigate the surgical technique and operative effect of late reconstruction of OZM fractures combined with orbital wall fractures.

METHODS: A retrospective analysis of the 46 patients (46 orbits) who were treated from January 2005 to December 2008 was performed. All cases had reconstruction of OZM fractures combined with orbital wall fractures at an average of 5.3 months after injury. Various incisions were selected. According to the computer-aided design/computer-aided manufacturing design, the osteotomy, reposition, and 4-point fixation of the fractured bones were individualized performed. Titanium mesh was preshaped according to the mirroring technology and inserted into the orbit with or without high-density polyethylene (HDPE) implant material to repair the orbital wall defect and the enlarged orbital volume. All patients were followed up 1 year after surgery.

RESULTS: Forty-two of the 46 patients who had enophthalmos were completely corrected. Forty patients who had hypoglobus were corrected postoperatively. Of the 43 cases with diplopia, 20 cases were resolved.

CONCLUSIONS: Late reconstruction by osteotomy and 4-point fixation could recover midface cosmesis, correct the enophthalmos, and improve the diplopia of OZM fractures combined with orbital wall fractures. The computer-aided design/computer-aided manufacturing system and mirroring technology can help improve the outcome of surgery when repairing such fractures.