Middle third of face fractures – management in a major trauma centre in London

Aims : Zygomatico-orbital–maxillary complex (ZOMC) fractures are the second most common facial fracture following nasal fractures. We present a comprehensive retrospective analysis of the management of 226 patients treated for midface fractures in our unit during January 2012–December 2012 including demographics, timing of surgery, surgical access, reconstructive materials and factors affecting post-operative hospital stay.

Methods : All patients were initially assessed following hospital attendance or referral from other centers and their records were obtained retrospectively. Multivariate analysis of standard variables, relating to epidemiological and surgical data, against the length of stay was implemented.

Results : Total of 226 patients were operated: male to female ratio (6.5:1); age range14–80. Two-thirds of the operations were carried out in the afternoon. This along with associated other bodily injuries (23%) were the most important factors in determining the length of hospital stay. No plates were removed due to infection. The incisions used were transconjuctival (33.5%), temporal incision (27%), buccal–vestibular (26%), upper blepheroplasty (8%) and coronal (5%). Most of our patients (72%) had internal fixation. A pre-bent titanium plate was the most commonly (76%) used material for orbital floor and medial wall reconstruction. The commonest area of plating was the zygomatic buttress (28%), followed by infra-orbital rim (21%), orbital-floor (20%), fronto-zygomatic suture (17%), zygomatic arch (6.4%) and other areas (7.6%). Length of operation varied from 5 min to 305 min (Mode = 60 min). Excluding the patients with other serious injuries, the length of hospital stay was 0 nights (48.5%), 1 night (44.4%), 2 nights (7.1%). Patients with four or more plates in situ and those with a coronal flap access were more likely to stay for a minimum of two nights.

Conclusion : Midface fracture surgery management is essentially guided by surgeon’s experience. Complications in our unit were related to poor positioning rather than infection. Our experience shows that ZOMC fracture surgeries can be performed as day case if operated early in the day.

Key words : zygomatic; orbital floor; midface fractures management; hospital stay

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Jan 20, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Middle third of face fractures – management in a major trauma centre in London
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