This nerve lies very close to the periosteum of the zygomatic arch.A smaller plate is recommended for the infraorbital rim. The first step is to obtain proper 3-D reduction of the zygoma using an elevator, hook, screw, or Carroll-Girard type device to mobilize the zygoma into its proper position. Issues of cold sensitivity generally improve or resolve with time without removal of the hardware. The first step should be the placement of a plate or wire at the frontozygomatic suture. A general principle is to begin with the reference points that are least comminuted. Make sure that the fracture is adequately spanned so that each screw is placed in solid bone. The lateral maxillary vestibular approach can also be used to help reposition the depressed zygoma. Note: Restoration of normal orbital anatomy can only be accomplished by the proper placement of these preformed implants. The plate should be properly adapted. Mall describes it as being ossified from one center which appears just … Here, it is a plate-like bone forming the lower margin of the orbit and much of the side of the face. A smaller plate is recommended for the infraorbital rim. However, this CT scan nicely shows contour differences at the lateral orbital wall area. Clinical examination of the lateral orbital wall area is camouflaged by the overlying soft tissues. In some cases where long-term MMF may be recommended, the surgeon may choose to leave the patient out of MMF immediately postoperatively because of concerns of edema, postoperative sedation, and airway. Chlorhexidine oral rinses should be prescribed and used at least 3 times a day to help sanitize the mouth.For larger debris, a 1:1 mixture of hydrogen peroxide/chlorhexidine can be used. The antero-superior or orbital border is smooth, concave, and forms a considerable part of the circumference of the orbit. It can also be approached via a coronal incision (if a coronal incision is otherwise required). It is possible that this may be requested by patients if the implant becomes palpable or visible. Remove sutures from skin after approximately 5 days if nonresorbable sutures have been used.Apply ice packs (may be effective in a short term to minimize edema).Avoid sun exposure and tanning to skin incisions for several months. It is important that the leg of the L-plate be placed on the most lateral portion of the lateral maxillary buttress, where the bone is fairly thick.It is similarly important that the foot of the L-plate is placed along the alveolar bone in a manner that the screws will not be placed into the dental roots. However, this CT scan nicely shows contour differences at the lateral orbital wall area. The aim is to restore the proper orbital volume and to restore proper width, AP projection, and height of the midface. Each process of the zygomatic bone forms important structures of the skull. A Waterpik® is a very useful tool to help remove debris from the wires. Implant removal is rarely required. Join from wherever you are in the world. Use a minimum of a 5-hole plate with the extra hole spanning the fracture line. Isolated lateral orbital wall fractures are rare and only occur after isolated trauma to this anatomical structure. In a zygomatic fracture that requires orbital floor reconstruction, after exposing the zygoma and orbital floor, the zygoma should be disimpacted prior to dissecting herniated orbital soft tissues from the maxillary sinus.In a fracture of this nature, the reduction and fixation of the zygoma should be performed first. The temporal surface, directed posteriorly and medially, is concave, presenting medially a rough, triangular area, for articulation with the maxilla (articular surface), and laterally a smooth, concave surface, the upper part of which forms the anterior boundary of the temporal fossa, the lower a part of the infratemporal fossa. No aspirin or nonsteroidal antiinflammatory drugs (NSAIDs) for 7 days, Antibiotics (many surgeons use perioperative antibiotics. The bone is similarly reduced in birds. When the lateral wall is comminuted, the lateral wall is not so reliable as a landmark in determining the proper reduction of the zygoma. Vision (except for alveolar ridge fracture, palatal fracture), Extraocular motion (motility) (except alveolar ridge fracture, palatal fracture), Diplopia (except Le Fort I, alveolar ridge fracture, palatal fracture), Globe position (except Le Fort I, alveolar ridge fracture, palatal fracture), Perimetric examination (except Le Fort I, alveolar ridge fracture, palatal fracture). The surgeon may chose to use one or more of the holes on the fan plate for fixation of the fan-shaped plate to the orbital rim or orbital floor (as illustrated). The 4-point technique is unique from the 3-point technique in that the surgeon has visualization of the zygomatic arch. Some ointments have been found to cause significant conjunctival irritation. (See description of second plate application). On it are seen the orifices of two canals, the zygomatico-orbital foramina; one of these canals opens into the temporal fossa, the other on the malar surface of the bone; the former transmits the zygomaticotemporal, the latter the zygomaticofacial nerve.
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