Precise repair of orbital maxillary zygomatic fractures

To demonstrate the techniques, advantages, indications, and potential pitfalls of the transconjunctival approach with lateral canthotomy, sublabial approach, and coronal approach in the treatment of complex trimalar fracture with associated blow-out fractures.

All patients diagnosed as having complex trimalar fractures with or without blow-out treated by either of us over a 2-year period were included. Follow-up ranged from a minimum of 6 months to 2 years.

All patients were treated with December 1989 to December 1991 at either Louisiana State University Medical Center, Shreveport, or University of Kansas Medical Center, Kansas City.

Eighteen patients with complex trimalar fractures were included in this study. Eight patients had associated orbital blow-out fractures. Simple isolated arch fractures were excluded.

All subjects underwent a transconjunctival approach with lateral canthotomy. Seven subjects also had associated sublabial flaps. Five patients required hemicoronal or coronal approaches.

There were seven minor complications. Ninety-three percent (14/15 [three didn't respond to the survey]) of patients surveyed were either very satisfied or satisfied with their functional and cosmetic results.

The management of complex trimalar fracture with blow-outs is greatly facilitated by the rational application of the described techniques.