Quantitative analysis of soft tissue sagging after lateral midface fractures: A 10-year retrospective study.

BACKGROUND: Lateral midface fractures occasionally require open reduction and internal fixation to restore function and facial symmetry. However, some patients retain facial asymmetry despite undergoing surgery due to hard tissue displacement or soft tissue sagging. This study aimed to determine the influence of soft tissue sagging on the postoperative facial symmetry. METHODS: We examined the medical records of 590 patients who underwent planned plate removal after lateral midface or zygomatic bone fractures. After applying the inclusion and exclusion criteria, we analyzed 106 cases of lateral midface fractures for hard tissue displacement and soft tissue sagging using pre- and postoperative radiological imaging and postoperative face scanning. RESULTS: We observed significantly larger soft tissue sagging (p < 0.001) and hard tissue displacement (p = 0.006) on the fractured side than on the non-fractured side. There was no correlation between differences in the soft tissue sagging and those in the hard tissue displacement (|rho|=0). Linear regression analysis showed no statistical influence of sex or age group on the soft tissue sagging and hard tissue displacement. CONCLUSION: Therefore, we recommend treating soft tissue sagging as a discrete aspect of midfacial fracture treatment to achieve optimal postoperative facial symmetry. From a clinical perspective, we recommend better soft tissue management during open fracture treatment than focusing mainly on the reduction of bony hard tissues.

Zygomatic complex fractures in the emergency department: diagnosis and management.

Falls, assaults, road traffic accidents and sporting injuries are some of the common causes of facial bone fractures. Fractures to the zygomatic complex, or cheekbone, are one of the most common fractures to the facial skeleton. These fractures can be easily missed on assessment and examination and thus left undiagnosed. This can lead to aesthetic deformities to the facial region and, rarely, orbital compartment syndrome due to a retrobulbar haemorrhage or other ocular complications. Emergency department advanced nurse practitioners are usually the clinicians responsible for ensuring that patients with zygomatic complex fractures are screened, investigated and escalated appropriately. The aim of this article is to inform readers of the strategies and methods for diagnosing and managing patients with zygomatic complex fractures, including when these types of injuries need to be referred to the oral and maxillofacial team.

Abordagens cirúrgicas em fraturas do complexo zigomático: revisão de literatura / Surgical approaches in fractures of the zygomatic complex: literature review

Introdução: O complexo zigomático é de grande importância no estudo da traumatologia devido a sua posição anatômica muito suscetível a traumas. Devido a sua interação direta com a órbita, o osso zigomático é uma importante proteção do globo ocular, assim como um dos responsáveis pela dissipação e transmissão de forças mastigatórias. Objetivo: O presente estudo objetiva revisar as formas de diagnóstico, exames complementares e as principais abordagens cirúrgicas bem como as possíveis complicações. Metodologia: Os dados selecionados foram obtidos através do acesso as bases de dados eletrônicos Medline, PubMed e Science direct. Foram selecionados 1 livro e 15 artigos publicados entre 2013 e 2019. Resultados: Diversas abordagens cirúrgicas podem ser utilizadas em fraturas do complexo zigomático dependendo da extensão e localização da fratura. As cirurgias são consideradas procedimentos seguros, com baixos níveis de complicações e sem problemas maiores no pósoperatório. Com a tecnologia 3D, o diagnóstico e planejamento dos casos se torna facilitado e mais preciso, levando a um procedimento mais seguro e previsível. Conclusão: O diagnóstico de fraturas no osso zigomático deve ser minucioso, envolvendo aspectos clínicos e exames complementares, o tratamento deve ser realizado de forma a preservar não só a função bem como a aparência, visto que erros no reposicionamento pós-trauma do processo zigomático pode causar simetria facial evidente no paciente, assim como o afundamento do globo ocular, diplopia, fissura orbital superior e hemorragia retrobulbar(AU)

Introduction: The zygomatic complex is of great importance in the study of traumatology due to its anatomical position very susceptible to trauma. Due to its direct interaction with the orbit, the zygomatic bone is an important protection of the eyeball, as well as one of those responsible for the dissipation and transmission of masticatory forces. Objective: This study aims to review the forms of diagnosis, complementary exams and the main surgical approaches as well as possible complications. Methodology: The selected data were obtained through access to the electronic databases Medline, PubMed and Science direct. One book and 15 articles published between 2013 and 2019 were selected. Results: Several surgical approaches can be used in fractures of the zygomatic complex depending on the extent and location of the fracture. The surgeries are considered safe procedures, with low levels of complications and without major problems in the postoperative period. With 3D technology, diagnosis and planning of cases becomes easier and more accurate, leading to a safer and more predictable procedure. Conclusion: The diagnosis of fractures in the zygomatic bone must be thorough, involving clinical aspects and complementary exams, the treatment must be carried out in order to preserve not only function but also appearance, since errors in the post-trauma repositioning of the zygomatic process can cause facial symmetry evident in the patient, as well as sinking of the eyeball, diplopia, upper orbital fissure and retrobulbar hemorrhage(AU)

Underdiagnosis of Nasoorbitoethmoid Fractures in Patients with Zygoma Injury.

BACKGROUND: Nasoorbitoethmoid fractures commonly accompany midface fractures and may be underdiagnosed, resulting in incomplete reconstruction or inadequate treatment following facial trauma. To better understand the nasoorbitoethmoid fracture diagnosis and treatment tendencies, the authors analyzed concomitant nasoorbitoethmoid injuries in the setting of zygoma fractures. METHODS: The facial trauma database at a level I trauma center was evaluated. All patients with diagnosed zygoma fractures from June of 2011 to March of 2016 were assessed for a concomitant nasoorbitoethmoid injury. Documentation of these fractures in radiology, plastic surgery, and operative notes was recorded, as was the rate of nasoorbitoethmoid fracture surgical repair. RESULTS: The authors identified 339 eligible patients and completed retrospective analysis of computed tomographic images for their 356 zygoma fractures. The incidence of concomitant nasoorbitoethmoid fractures was 30.6 percent (109 of 356). Documentation rates of nasoorbitoethmoid fractures were 0 percent, 3.7 percent, and 8.3 percent in radiology, plastic surgery, and operative notes, respectively. The rate of surgical correction of nasoorbitoethmoid injuries was 22.9 percent (25 of 109). Of those fractures identified, 44.9 percent (49 of 109) were minimally displaced or nondisplaced. Subset analysis of only significantly displaced fractures yielded an incidence of 16.8 percent (60 of 356). Of significantly displaced fractures, documentation rates were 0 percent, 6.7 percent, and 16.8 percent in radiology, plastic surgery, and operative notes, respectively. The surgical repair rate of significantly displaced fractures was 31.7 percent (19 of 60). CONCLUSIONS: These findings suggest a high concomitance rate of nasoorbitoethmoid fractures with zygoma fractures and identify a tendency to underdocument and undertreat this injury pattern. Clinicians managing patients with midface trauma should have a high suspicion for nasoorbitoethmoid trauma. Plastic surgeons and radiologists should be better trained in identifying the nasoorbitoethmoid fracture pattern.

Feasibility of a craniometry in a comminuted zygomaticomaxillary complex fracture.

Few studies have reported on using craniometry for comminuted zygomaticomaxillary complex (ZMC) fracture management. We present our experiences with this procedure and a review of the related literature.From September 2011 to October 2018, 43 patients with comminuted ZMC fracture receiving open reduction internal fixation under coronal incision were enrolled. Data on gender, age, operation time, hospital stay, duration of follow-up, vertical/horizontal differences, and complications were collected. Between-group differences (C-arm imaging vs craniometry) were evaluated using nonparametric Mann-Whitney test for continuous data and chi-square test for categorical data.No significant difference were found between the groups regarding gender, age, hospital duration, follow-up duration, and postoperative complications, except for operation time. The averaged operation time was significantly shorter in the C-arm imaging group (4.217 h) than in the craniometry group (6.193 h). The C-arm imaging group had two cases with horizontal differences >3 mm and one case with vertical differences >3 mm. The craniometry group had four cases with horizontal differences >3 mm and four cases with vertical differences >3 mm. There were no significant differences between the two groups in horizontal differences and vertical differences.Craniometry may achieve the same outcomes as C-arm imaging in comminuted ZMC fracture management; however, the former requires more time than the latter.

Three-Dimensional Computed Tomography Analysis of Stability Following Two- and Three-Point Fixation With Biodegradable Plates Among Patients With Zygomatic Fracture.

BACKGROUND: Open reduction followed by internal fixation has been regarded as the most effective technique for the surgical repair of zygomatic fractures. However, the ideal number and locations of internal fixation points to maintain stable reduction remain controversial. Using 3-dimensional computed tomography, we aimed to compare the stability of 2-point and 3-point fixation among patients who had undergone surgical repair of zygomatic bone fractures. METHODS: The study included 22 patients (17 men, 5 women) with unilateral zygomatic bone fractures who had undergone open reduction with 2-point or three-point fixation using biodegradable materials (11 patients in each group). The authors measured the lateral projection and height of the zygoma at 2 landmark points (zygomaticofacial foramen and frontozygomatic suture). In each group, bony displacement was analyzed between the preoperative and immediate postoperative phases, and between the preoperative and follow-up phases. Differences in stability between the 2 groups were analyzed by comparing values between the immediate postoperative and follow-up phases. RESULTS: The 2-point group exhibited a lower rate of complex fractures at the frontozygomatic suture than the 3-point group (18.2%, 63.6%, respectively). In both groups, the authors observed significant differences in the lateral projection of the zygomaticofacial foramen between the preoperative and immediate postoperative phases, and between the preoperative and follow-up phases. No significant differences in stability were observed between the groups. CONCLUSION: Our findings demonstrated that 2-point fixation of the zygoma with biodegradable materials is as stable as 3-point fixation. It could be initially considered when open reduction of frontozygomatic suture was not essential.

Reliability of Ultrasound-Guided One-Point Fixation for Zygomaticomaxillary Complex Fractures.

This study aimed to analyze the precision and postoperative stability of ultrasound guided 1-point fixation on the zygomaticomaxillary buttress for the treatment of zygomaticomaxillary complex (ZMC) fractures. The authors analyzed 24 consecutive patients who underwent ultrasound-guided 1-point fixation for ZMC fractures without separation of the fracture at the frontal process of the zygomatic bone. The authors used titanium plates in the first 6 cases, and biodegradable plates in the remaining 18 cases. The authors obtained computed tomography images preoperatively, and again the first day after surgery (T1) and 6 months after the surgery (T2). The authors calculated vertical change (VC) and horizontal change (HC) of the zygoma on computed tomography. Precision was evaluated with T1 images. Stability was evaluated from T1 to T2, and titanium and biodegradable plates were compared. From T1 images, the mean VC and HC was 0.22° (range, 1.60°-1.08°) and 0.33° (range, 1.86°-1.03°), respectively. From T1 to T2, the mean VC and HC was 0.08° and 0.28°, respectively. Comparing the types of plates, the mean HC in the biodegradable plate group was 0.39°, which was significantly greater than that in the titanium plate group (mean -0.10°). However, as the degree of change was relatively small, this did not pose any clinical problems. Our findings suggest that ultrasound-guided 1-point fixation on the zygomaticomaxillary buttress provides accurate reduction on ZMC fractures without the separation of the frontal process of the zygomatic bone fracture. Sufficient stability was obtained, even with the use of biodegradable plates.

Assessment of Infraorbital Hypesthesia Following Orbital Floor and Zygomaticomaxillary Complex Fractures Using a Novel Sensory Grading System.

PURPOSE: Introduction of a novel sensory grading system to assess the incidence and long-term recovery of infraorbital hypesthesia following orbital floor and inferior orbital rim fractures. METHODS: Patients who presented for evaluation of orbital floor and/or zygomaticomaxillary complex (ZMC) fractures between January 2015 and April 2016 were analyzed. Two-point subjective infraorbital sensory grading in 5 discrete anatomic areas was performed. Fractures were repaired based on traditional criteria; hypesthesia was not an indication for surgery. The sensory grading system was repeated a mean 21.7 months (range 18-28) after initial fracture. RESULTS: Sixty-two patients (mean 41.8 years) participated in the initial symptom grading, and 42 patients (67.7%) completed the 2-year follow-up. Overall, 20 of 42 patients (47.6%) had some infraorbital hypesthesia. There were fewer with isolated orbital floor fractures versus ZMC fractures (31.8% vs. 68.4%; p = 0.019). Two years postinjury, 9.1% and 40.0% with isolated floor and ZMC fractures, respectively, had persistent sensory disturbance (p = 0.0188). Of patients with sensory disturbance on presentation, 71.4% with isolated floor fractures and 38.5% with ZMC fractures experienced complete sensory recovery (p = 0.1596). Patients with isolated floor fractures had improved recovery after surgery (100% vs. 33.3% recovery; p = 0.0410). Patients with ZMC fractures showed no difference in sensory prognosis between those repaired and observed. CONCLUSIONS: In this pilot study, isolated orbital floor fractures carried a good infraorbital sensory prognosis, further improved by surgical repair. Zygomaticomaxillary complex fractures portended a worse long-term sensory outcome, unaffected by management strategy. This study validates the novel sensory grading system in post-fracture analysis.

Redução de fratura de arco zigomático sob anestesia local ­ relato de caso / Reduction of zygomatic arch fracture under local anesthesia ­ case report

As fraturas do arco zigomático são geralmente causadas por trauma direto e refletem prejuízos estéticos e funcionais, devendo ser realizado o correto diagnóstico por meio de exame clínico e radiográfico para realizar o tratamento adequado e evitar a presença de sequelas pós-traumáticas. O objetivo desse trabalho é relatar um caso de fratura isolada de arco zigomático, descrever os meios de diagnóstico e tratamento fechado desse tipo de fratura. Paciente HVS, gênero masculino, 38 anos, vítima de agressão física compareceu ao serviço de Cirurgia e Traumatologia Bucomaxilofacial da UFBA/OSID por meio da emergência do Hospital Geral do estado (Salvador/BA) há aproximadamente uma hora após o trauma. Foi realizada a antissepsia com iodo tópico, anestesia local superficial e incisão cutânea com lamina de bisturi nº 15. Após o acesso, realizou-se a introdução do gancho de Barros e redução fechada da fratura. Paralelamente ao relato, foi realizada uma pesquisa na literatura científica para embasar os métodos e técnicas utilizados no diagnóstico e tratamento. Observou-se, então, a partir do caso clínico que é possível reduzir fraturas isoladas de arco zigomático sob anestesia local com acesso próximo à fratura para redução fechada a fim de evitar aumento da morbidade de procedimentos e reduzir a oneração ao serviço público (AU).

Fractures of the zygomatic arch are usually caused by direct trauma and reflect aesthetic and functional damages, and the correct diagnosis must be made by means of clinical and radiographic examination in order to carry out the appropriate treatment and avoid the presence of post-traumatic sequelae. The objective of this work is to report a case of isolated fracture of the zygomatic arch, to describe the means of diagnosis and closed treatment of this type of fracture. Patient HVS, male gender, 38 years old, victim of physical aggression attended the Service of Oral and Maxillofacial Surgery and Traumatology of UFBA/OSID through the emergency of the state general hospital (Salvador/Bahia) approximately one hour after the trauma. Antissepsis was performed with topical iodine, superficial local anesthesia, and cutaneous incision with scalpel blade nº 15. After the access was performed the introduction of the Barros hook and closed reduction of the fracture. Parallel to the report, it has done a research in the scientific literature to support the methods and techniques used in diagnosis and treatment. It is observed from the clinical case that it is possible to reduce zygomatic arch fractures isolated under local anesthesia with close access to closed reduction fracture in order to avoid increased morbidity of procedures and reduce the burden on the public service (AU).

Pediatric Zygomaticomaxillary Complex Fracture Repair: Location and Number of Fixation Sites in Growing Children.

BACKGROUND: Relatively few reports have been published investigating the operative management of pediatric zygomaticomaxillary complex fractures. The purpose of this study was to assess pediatric zygomaticomaxillary complex fracture management and associated complications, and potentially describe a standard treatment paradigm for these cases. METHODS: A retrospective cohort review was performed of all patients younger than 15 years presenting to a single institution with zygomaticomaxillary complex fractures from 1990 to 2010. Patient demographics, concomitant injuries, management details, and complications were recorded. Complications were compared among patients by dentition stage, number of fixation points, and identity of fixation sites. RESULTS: A total of 36 patients with 44 unique zygomaticomaxillary complex fractures met the authors' inclusion criteria. Thirty-two fractures exhibited at least 2.0 mm of diastasis along at least one buttress (73 percent), and all but one of these were managed operatively. Among operatively managed patients with deciduous dentition, two-point fixation was associated with a lower overall complication rate compared with one- and three-point fixation (0 percent versus 75 percent and 75 percent; p = 0.01). Furthermore, rigid plate-and-screw fixation at the zygomaticomaxillary buttress was not associated with an increased complication rate in operatively managed patients with deciduous dentition (40 percent versus 50 percent; p = 0.76). CONCLUSIONS: The authors' results suggest that two-point fixation is an effective management strategy for repair of displaced zygomaticomaxillary complex fractures in children. In addition, rigid plate-and-screw fixation at the zygomaticomaxillary buttress in children with deciduous dentition appears to be safe and effective when performed. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Fractura de malar. Presentación de caso / Fracture of malar. Presentation of case

Actualmente, los traumatismos faciales en la población joven, producto de: agresiones físicas, accidentes de tráfico, y laborales, adquieren protagonismo. Los huesos faciales sufren, debido a su ubicación prominente, cerca de los ojos. El paciente con fractura del complejo cigomático maxilar presenta: dolor regional, diplopía al mirar hacia arriba, y disminución de la agudeza visual. Cuando cumple con el tratamiento, dentro de los 10 días siguientes al trauma, se obtienen los mejores resultados. Se presentó un paciente masculino, de 50 años de edad, que acudió a consulta de estomatología del Policlínico Pedro Díaz Coello, luego de haber sufrido un accidente de tránsito que le provocó: edema facial, hematoma, dificultad para ingerir alimentos, y debilidad visual en el ojo de la zona comprometida. Al observar sus características clínicas y radiográficas, se le diagnosticó fractura de malar. Se remitió, inmediatamente, a los servicios de Cirugía máxilo- facial, y se trató quirúrgicamente para reducir la fractura, sin complicación.(AU)

Young people´s facial traumatisms are increasing. Most common causes are physical aggression, traffic and occupational accidents. Facial bones are exposed to injuries, due to their location next to eyes. A patient with zygomatico-maxillary fracture presents: regional pain, double vision with upper movement of the head, and poor visual acuity. An effective treatment within the 10 days following to trauma, is the best way for good results. A 50-year-old male attended hospital, right after having a traffic accident. The consequences: facial edema, hematoma, visual weakness in the committed eye, and difficulty to move his head up. He was diagnose with maxillary fracture based clinical and radiographic characteristics. He was transferred immediately to facial surgery service, and he was operated for shortening the fracture, without complication.(AU)

A clinical decision rule to predict zygomatico-maxillary fractures.

Patients presenting with periorbital trauma require clinical assessment to exclude zygomatico-maxillary fractures. A single-centre pilot investigation was undertaken at a general hospital in the United Kingdom. The sample was composed of 229 adult patients attending our emergency department with periorbital injuries. Findings from 17 signs or symptoms of facial injury were recorded on a validated tool. The relationship between clinical presentation and displaced zygomatico-maxillary fracture was assessed using diagnostic test parameters and tests for correlation. A decision-making rule was derived. The presence of a) palpable bony step, b) bony asymmetry, c) lateral sub-conjunctival haemorrhage with no posterior limit, d) anaesthesia or paraesthesia to lip/cheek or side of nose and e) palpable emphysema were all specific features of radiographically displaced zygomatico-maxillary fracture (specificity all >75.0 %, p value for correlation all <0.001). A decision-making rule based on the presence of any one of features (a),(c),(d) or (e) identified all patients with displaced zygomatico-maxillary fractures in this sample (sensitivity 100% (95% CI 93.4%-100.0%), specificity 72.6% (95% CI 65.3%-79.0%). Implementation of this clinical decision-making rule would identify all patients with displaced fractures at the triage stage whilst reducing radiographic exposures by 55% in this sample.

Is Surgical Navigation Useful for Treating Zygomatic Arch Fractures?

OBJECTIVE: To report the case of a 58-year-old man with a zygomatic arch fracture, which was well localized and reduced using a surgical navigation system. METHODS: In this clinical report, the authors suggest intraoperative surgical navigation systems are useful diagnostically and for localizing sites of zygomatic arch fractures. RESULTS: The patient underwent successful closed reduction of zygomatic arch fractures using a surgical navigation system. CONCLUSIONS: Surgical navigation is a useful tool for identifying the locations of zygomatic arch fractures and for guiding closed reduction. Surgical navigation is recommended for localizing the sites of zygomatic fractures.

Zygomaticomaxillary complex fractures: diagnosis and treatment.

PURPOSE OF REVIEW: To provide an overview of zygomaticomaxillary complex (ZMC) fractures and their treatment. Aspects of anatomy, diagnosis, and treatment objectives of these common fractures will be reviewed including recent literature. RECENT FINDINGS: Advances in technology such as guided surgery have allowed for better outcomes and a reduction in surgeon variability with regard to postoperative results. The use of titanium and bioresorbable mini screws and plates have expanded the ability to achieve stable and predictable results. There are many different challenges and techniques that are acceptable to treat zygoma fractures. Surgeon preference and training dictate these methods that vary among specialties. SUMMARY: ZMC fractures are commonly encountered in the trauma setting. Although there is a multitude of treatment methods available, the ultimate goal for any surgeon should be to reproduce premorbid form and function. The availability of techniques such as 3D navigation, contralateral mirroring, and advances in fixation technology have shown promise for better outcomes, particularly in severely comminuted or displaced fractures.

Maxillofacial and Mandibular Fractures in Sports.

Sports account for 3% to 29% of facial injuries and 10% to 42% of facial fractures. Fractures of the facial skeleton most commonly occur owing to interpersonal violence or motor vehicle crashes. Facial fractures from sporting activities has clearly decreased over time owing to better preventive measures. However, this decreasing trend is offset by the emergence of more dangerous sports activities, or "pushing the envelope" of traditional sports activities. Fractures can occur from contact between athletes, and between athletes and their surroundings. Football, soccer, hockey, and baseball most frequently are involved in sports-related cases of facial bone fracture.

Management of Zygomatic Fractures in Young Patients: Technical Modifications for Aesthetic and Functional Results.

INTRODUCTION: The zygomaticomaxillary complex is very vulnerable to injury because of its intrinsically prominent convexity. There are 2 different surgical approaches for the therapy of these fractures: closed reduction and open reduction. In the open reduction 2 or 3 fixation points with related incisions are usually necessary in dislocated fractures: osteosynthesis must be performed starting from zygomaticofrontal suture when dislocated at this site, followed by zygomatic body fixation on the anterior sinus wall, anterior orbital floor margin fixation, and finally orbital floor reconstruction in case of eye globe dislocation with diplopia. AIM: This study evaluated the combination of the transconjunctival (TC) approach without canthotomy in association with the transoral maxillary approach and lateral rim skin incision (SI) without canthotomy for frontozygomatic dislocated fractures to achieve proper reduction and stabilization without any aesthetic decay in young patients. A less invasive and more aesthetic technique is shown for treating dislocated zygomaticomaxillary complex fractures with 2 or 3 fixation points and platelet-rich fibrin (PRF) use to promote tissue healing. MATERIALS AND METHODS: Ten patients (mean age: 32) were referred for dislocated zygomaticomaxillary complex fracture. Five patients were treated by TC approach without canthotomy in association with the transoral maxillary approach and, when needed, eyebrow SI without canthotomy for frontozygomatic dislocated fractures (group 1). Five more patients were treated by traditional subciliar incision at lower eyelid and vertical lateral incision at lateral margin of the orbit (group 2). Autologous PRF for orbital floor reconstruction was used. The follow-up period was 6 months long. Follow-up radiographs (TC) and photos were routinely used to evaluate the adequacy of reduction and lower eyelid right position or retraction. RESULTS: All cases were successful; there were no problems at surgery and postoperative time. During the 6-month follow-up, all 5 patients of group 1 showed satisfactory facial symmetry, no noticeable scarring, no ectropion or lower eyelid significant droop, and no functional impairment. Mean difference for lower eyelid droop between the 2 groups of patients was 1.4 mm at T1 and 1.2 mm at T2. DISCUSSION: Aesthetic result is a priority in the treatment planning of orbitozygomatic fractures because of the fundamental role of the eye and lid area in the aesthetic of the face. In our experience best aesthetic results were achieved through a latero cantal horizontal SI combined to a vertical periosteal incision at the frontozygomatic rim without canthotomy, thus performing a different double-layer incision. In the patients with large orbital floor dislocation, reconstructive titanium mesh was covered by autologous PRF membranes, which can improve the vascularization of the surgical site, by promoting neoangiogenesis. CONCLUSIONS: In young patients these techniques are indicated because of the need of better aesthetic results that can be achieved by preventing postoperative functional impairment with lower eyelid droop and unnatural aesthetic asymmetry of the 2 lower lids. This more conservative technique resulted in better aesthetic results, avoiding most common complications.

Predicting late enophthalmos: Differences between medial and inferior orbital wall fractures.

INTRODUCTION: The purpose of this study was to compare the strength of the relationships between predictors and late-onset enophthalmos in medial and inferior orbital wall fractures and to determine the most significant predictive factor of enophthalmos in medial or inferior orbital wall fracture. METHODS: Sixty-three adult patients with unilateral medial or inferior orbital wall fracture who had been left untreated for more than two months were enrolled in this study. Patients who had accompanying multiple orbital wall fractures and those with orbital-zygomatic fractures were excluded. Orbital defect area and herniated muscle and fat volumes were evaluated using computed tomography. The degree of enophthalmos was measured using a Hertel exophthalmometer. RESULTS: Herniated muscle and fat volumes were positively correlated with defect area in the medial orbital wall fracture but showed no positive correlation with inferior orbital wall fracture. In the medial orbital wall fracture group, enophthalmos was positively correlated with defect area and herniated muscle and fat volumes. Defect area was more highly related to enophthalmos than other analyzed metrics. The defect area predictive of enophthalmos was 1.98 cm2. However, enophthalmos was positively correlated only with herniated fat volume in inferior orbital wall fracture. The herniated fat volume predictive of enophthalmos was 343.50 mm3. CONCLUSION: Orbital defect area in medial orbital wall fracture and herniated fat volume in inferior orbital wall fracture were the most significant predictors of late-onset enophthalmos.

Preoperative Use of Radiopaque Materials on Fractured Zygomatic Arch.

Fractures of the zygoma are relatively frequent and their management has been extensively described. Above all, isolated zygomatic arch fractures comprise about 10% of all zygomatic fractures. Temporal approach is common surgical method, Gillies approach, but it has the limitation of blinded surgical approach. So, the mobile intraoperative fluoroscan is used famously for more suitable reduction, but it needs an additional man to control the machine and increases irradiation doses. The authors got the simple idea, but so helpful tool, and it has been performed since 2012. The authors have gotten good surgical results, so introduce this idea that favors the surgery on isolated zygomatic arch fracture.