Management of Orbito-zygomaticomaxillary Fractures by Hisham Marwan & Yoh Sawatari & Michael Peleg

Author:Hisham Marwan & Yoh Sawatari & Michael Peleg
Language: eng
Format: epub
ISBN: 9783030426453
Publisher: Springer International Publishing

For all midface fractures, it is very common to use monocortical plates; therefore, the 5 mm screw length is common along with 1.0 to 1.5 mm diameter screw diameters. It is always ideal to place three screws on each side of the fracture; however, if the placement of three screws requires excessive dissection, excessive retraction, and potential iatrogenic injury, then two screws are more than adequate for midface fracture fixation.

Specific to the OZM fracture, the strategy concerning the reduction and fixation of the OZM is variable. On a minimally displaced fracture, only one or two local approaches may be necessary. The intraoral vestibular approach provides visualization and access to reduce the OZM with a focus on the zygomaticomaxillary junction which includes the orbital rim and the maxillary buttress. Although the vestibular approach does allow for fixation of the infraorbital rim, significant tension of the infraorbital nerve and tissue is required to place screws in a perpendicular manner. However, the right angle screwdriver can be used to achieve proper fixation via an intraoral approach. More importantly, the vestibular access will provide adequate visualization to confirm an appropriate reduction of the complex to the stable bone. In addition to the reduction of the zygomaticomaxillary junction, the zygomaticofrontal and the zygomaticotemporal junctions may be palpated during the reduction to assure the lack of noticeable steps and continuity defects.

For fractures that are more displaced or comminuted, more than one junction will require access, and in general, the combination of the zygomaticofrontal and the intraoral and periorbital access to the zygomaticomaxillary junction provides the adequate access for appropriate reduction. In the combination of local approaches, the only component which remains inaccessible is the zygomaticotemporal junction. If the fracture is comminuted or severely displaced, the coronal provides generous access to the zygomaticotemporal and zygomaticofrontal junctions.

The main objective concerning the OZM is to reduce the complex against stable bone. As described, there are varying access options to expose the necessary junctions to reduce and fixate the complex to its original preinjury position. Once the appropriate access is gained, the next step involves the manipulation of the complex. Again there are varying strategies involved to gain control of the complex. One strategy is the utilization of the Carroll-Girard screw. Much of the literature describes an extraoral incision to fixate the screw and manipulate the complex to the appropriate reduction point. Ideally, however, any additional extraoral incisions should be avoided. The Carroll-Girard screw can be utilized from an intraoral approach. This approach is obviously more difficult due to access but also because the commissure of the lip prevents complete freedom of movement of the complex. To circumvent this limitation, the Carroll-Girard screw should be applied in a vector creating an acute angle against the complex. This allows additional lateral rotation without being limited by the lip. When consideration is given to the common mechanism and resultant medial displacement of the complex, the general vector of reduction would be a lateral rotation of the complex. Care should be taken during

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