s, non healing of the fracture, and significant residual deformities. The treatment of zygomatic fractures has dramatically progressed over the past several decades to the more aggressive open repair using rigid mini-plates of technetium to stabilize a fracture and align the bones in their appropriate position (open reduction). The floor of the orbit (eye socket) is routinely explored and reconstructed, if needed. More Facial Trauma & Facial Reconstructive Surgery Facts...
MaxillaThe maxilla is the largest part of the middle third of the facial skeleton. Fractures of the maxilla occur less frequently than those of the mandible or because of the strong structural support of this bone. The midface consists of alternating thick and thin sections of bone that are capable of resisting high amounts of force. This structurally strong bone provides protection for the eye socket and brain, projection of the midface, and support for the upper bite.
Maxillary fractures today are often the result of motor vehicle accidents. These high-velocity injuries are diagnosed by computerized tomographic (CT) scans. Once again, the more recent development of 3-D reconstructions have aided greatly in the diagnosis, classification, and preoperative planning of these complex maxillary fractures.
Maxillary fractures are treated by realignment and immobilization of the bones that make up the maxilla. Establishment of pre-injury bite and midface alignment provides the foundation for this treatment. Early placement of the patient in Internal Maxillary Fixation (IMF) will decrease the chance of Internal Soft tissue deformities. IMF is established by securing wire arch bars to the upper and lower set of teeth. The appropriate occlusion of the teeth (or bite) is then determined and the maxillary and mandibular (jaw bone) arch bars are secured together. This is one of the simplest and most effective forms of treatment.
Recent advances in the treatment of maxillary fractures include the use of open-repair and realignment (open reduction) techniques using rigid plate and screw fixation of the facial bones. Bone grafts have been used to replace missing or severely fractured bones. This more aggressive surgical approach has dramatically improved the aesthetic results now obtainable with fewer secondary deformities. More Facial Trauma & Facial Reconstructive Surgery Facts...
Nasoethmoid Orbital SkeletonTrauma to the central midface frequently results in fractures of the nasoethmoid orbital (NOE) skeleton. This complex area consists of a union of bones from the nose, orbits, maxilla, and cranium. These fractures may be the most difficult and challenging of all facial fractures to diagnose and treat. To the inexperienced examiner, NOE fractures may be misdiagnosed as simple nasal fractures, and a high degree of suspicion is necessary to make the diagnosis. These fractures may occur as isolated injuries or as part of more complex (LeFort) facial fractures. Failure to diagnose these injuries or inadequate treatment will result in both functional and cosmetic deformities that are very difficult to correct secondarily.
The best results of the NOE fracture are obtained with early diagnosis and aggressive surgical treatment. Complications result when this injury has been misdiagnosed or inadequately treated. Successful surgical treatment of these complex injuries consist of early open reduction and stabilization of bone fragments. Bone grafts are used to restore contour and support to areas of severely fractured or missing bone. Unstable or displaced fractures that are left untreated result in permanent deformities once healed. Late reconstruction is a difficult task that requires repositioning of both bone and soft tissue. Although late reconstruction of these deformities is possible, in general, the best aesthetic results are obtained with definitive repair at the time of injury, avoiding the common pitfalls.
To repair severe fractures around the nasal bone (A), an incision is made into the patient's skin at the top of the head (B). The skin is pulled off the face 