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Published on: September 16, 2022
Quantitative comparison of open reduction and internal fixation versus the Gillies method in the treatment of
Marcin Czerwinski1, Mark Martin, Chen Lee
1Division of Plastic Surgery, Montreal General Hospital, Montreal, Canada.
Background:
Precise repair of orbitozygomatic complex fractures is essential for proper re-establishment of facial symmetry, ocular globe position, and infraorbital nerve function. Controversy regarding the optimal treatment method remains.
Methods:
To compare uniform study groups, only patients without previous craniofacial injuries or operations who had sustained moderate-energy orbitozygomatic complex fractures, based on preoperative computed tomography scans, and who were treated using the Gillies repair or open reduction and internal fixation were selected. Quantifiable end-points, including orbitozygomatic complex position, ocular globe projection, and infraorbital nerve function, were measured to objectively compare the accuracy of repair produced by the Gillies procedure and open reduction and internal fixation. Negative sequelae resulting from cutaneous access were tabulated.
Results:
Overall, 12 patients treated using the Gillies repair and 12 treated with open reduction and internal fixation were examined. The results demonstrated that the open reduction and internal fixation technique produces superior realignment of the orbitozygomatic complex, that is, a smaller difference in the position of the orbitozygomatic complex between the injured and noninjured sides of the face. The differences in orbitozygomatic complex projection, height, and lateral position were 1.4 mm, 1.4 mm, and 1.6 mm, respectively, in the open reduction and internal fixation group and 7.5 mm, 5.6 mm, and 4.1 mm in the Gillies group. The p values were 0.0003, 0.01, and 0.06, respectively. Visible cutaneous scarring was present in four patients and lower lid shortening was seen in three patients treated using open reduction and internal fixation.
Conclusions:
To the authors' knowledge, this is the first study to objectively show that the open reduction and internal fixation technique results in superior positioning of the orbitozygomatic complex in moderate-energy orbitozygomatic complex fractures compared with the Gillies repair. Although negative sequelae from surgical access were substantial, recently introduced transconjunctival and upper lid blepharoplasty incisions will minimize these drawbacks.
