Clinical Characteristics of Olfactory Dysfunction

Abstract

Ohio) School of Medicine, and coworkers presented a discussion of their experience with orbital rim fixation and orbital floor explorations. Dr. Shumrick reported that in their experience the majority of zygomatic-maxillary complex fracture complications arise from the exploration of the orbital rim and floor. The majority of zygomatic-maxillary complex fractures are currently being repaired with fixation of the orbital rim and exploration of the orbital floor. This provides two-to four-point fixation and does not address the zygomaticomaxillary buttress suture. It does require an incision on the lower eyelid, which may lead to ectropion. Dr. Shumrick advocates using miniplate fixation on the zygomaticomaxillary buttress and wire fixation of the zygomaticofrontal suture.The first part of a two-part study was a retrospective study analyzing 33 patients. The second part was a prospective study involving 24 patients in whom the fractures were handled using plating of the zygomaticomaxillary buttress suture and wire fixation of the frontal zygomatic suture line. The decision to explore the orbital floor was based on rigid criteria and was not made indiscriminately. Dr Shumrick's criteria for performing orbital floor explo¬ ration was presence of diplopia, a forced-duction test with positive results, presence of enophthalmos, rim step-offs, or roentgenographic confirmation of blowout fractures. In both groups there were no orbital floor fractures present roentgenographically in over 50% of patients. In the part I study, 92% of patients underwent an approach to the orbital rim. Of the 92% of patients in the part I study, 88% had the orbital rims wired. In the part II study, 32% of patients un¬ derwent orbital rim exploration and 12% had fixation per¬ formed. Of the 92% of patients in the part I study who un¬ der orbital rim exploration, 70% of those had no significant pathologic findings on the orbital floor. Of the 32% of patients in the part II study who underwent orbital rim ex¬ ploration, explorations of the orbital floor did not show negative results. In the part I group, four patients presented with persistent depression of their zygomaticmaxillary complex fracture, and no patients in the part II group had persistent depression of the fracture. Patients in part I had six complications, ranging from chemosis, persistent lid edema, and ectropion, whereas patients in part II had two complications that were considered mild.In conclusion, Dr Shumrick stated that 65% to 70% of explorations currently being performed for orbital floor fractures are unnecessary in isolated zygomatic fractures, and that patients who do require orbital floor exploration can be selectively identified with preoperative evaluations properly performed.-EUGENIO A. AGUILAR III, Houston, Tex