Zygomatic fractures: Technical modifications for better aesthetic and functional results in older patients

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• 作者：Antonio Cortese^a ; ^{ancortese@unisa.it" class="auth_mail" title="E-mail the corresponding author} ; Mario Caggiano^b ; ^{dr.mariocaggiano@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Franco Carlino^c ; ^{amb.carlino@tiscali.it" class="auth_mail" title="E-mail the corresponding author} ; Giuseppe Pantaleo^d ; ^{giuseppepantaleo88@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Fracture ; Zygoma ; PRF ; Elderly patients
• 刊名：International Journal of Surgery
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：33
• 期：supp_S1
• 页码：S9-S15
• 全文大小：967 K

文摘

The zygomaticomaxillary complex, with its intrinsically prominent convexity, is highly vulnerable to injury. In this study, we evaluated a novel combined approach to the reduction and stabilization of frontozygomatic dislocated fractures without aesthetic damage.

Materials and Methods

Ten patients (mean age, 52 years) were referred for complex frontozygomatic dislocated fractures. Five patients underwent a transconjunctival approach without canthotomy in association with a transoral maxillary approach and lateral-rim skin incision, also without canthotomy. The other five patients underwent a traditional subciliary incision at the lower eyelid and a vertical lateral incision at the lateral orbital margin. Orbital floor reconstruction was achieved using two to three fixation points and autologous platelet-rich fibrin (PRF). During the 6-month follow-up, the patients were routinely evaluated using computed tomography.

Results

Treatment was successful in all cases; there were no problems at surgery or postoperatively. During follow-up, all patients had satisfactory facial symmetry, no noticeable scar, ectropion, or lower-eyelid drop, and no functional impairment.

Discussion

Aesthetic considerations are an important aspect of treatment planning in patients with orbitozygomatic fractures, because of the importance of the eye and lid areas to facial aesthetics. In our patients, good aesthetic results were achieved using a novel combined approach. In patients with a large orbital floor dislocation, the reconstructive titanium mesh can be covered by autologous PRF membranes to improve vascularization of the surgical site. By preventing aesthetic damage and functional impairment, our conservative approach is of particular utility in older individuals due to age-related tissue laxity.