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Precise repair of orbital maxillary zygomatic fractures.

OBJECTIVE: To demonstrate the techniques, advantages, indications, and potential pitfalls of the transconjunctival approach with lateral canthotomy, sublabial approach, and coronal approach in the treatment of complex trimalar fracture with associated blow-out fractures.

DESIGN: All patients diagnosed as having complex trimalar fractures with or without blow-out treated by either of us over a 2-year period were included. Follow-up ranged from a minimum of 6 months to 2 years.

SETTING: All patients were treated with December 1989 to December 1991 at either Louisiana State University Medical Center, Shreveport, or University of Kansas Medical Center, Kansas City.

PATIENTS: Eighteen patients with complex trimalar fractures were included in this study. Eight patients had associated orbital blow-out fractures. Simple isolated arch fractures were excluded.

INTERVENTION: All subjects underwent a transconjunctival approach with lateral canthotomy. Seven subjects also had associated sublabial flaps. Five patients required hemicoronal or coronal approaches.

RESULTS: There were seven minor complications. Ninety-three percent (14/15 [three didn't respond to the survey]) of patients surveyed were either very satisfied or satisfied with their functional and cosmetic results.

CONCLUSION: The management of complex trimalar fracture with blow-outs is greatly facilitated by the rational application of the described techniques.

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