Trends in Concurrent Orbital Floor Repair During Zygomaticomaxillary Complex Fracture Repair

Abstract

scores, 4 vs 8; 95% CI, 0.01 to 7.99; P = .049). The Terzis score for the open mouth smile significantly increased (mean, 2.5 vs 3.85; 95% CI, 0.12-1.34; P = .02) as did the smile index (mean, 7.5 vs 5.6; 95% CI, −3.47 to −0.34, P = .02). Masseter function was normal in all cases. These data are summarized in the Table and the clinical outcomes in 1 case are illustrated in the Figure . Discussion | This study has demonstrated that smile excursion can be substantially improved when the masseteric nerve is used to selectively neurotize preoperatively selected muscles as a means of customizing the smile vector. Initial concerns regarding the feasibility of the masseteric nerve as a donor nerve were addressed in the present cohort by careful clinical, electromyographic, and magnetic resonance imaging assessment of the masseter muscle. 2 In addition, harvesting the masseteric nerve at a more distal point likely minimizes the risk of denervating the masseter muscle because in 90% of cases, the muscle has more than 1 branch at this level. 3 The additional advantage of the masseteric nerve over other nerve sources is its richer axonal content, which has been shown to account for increased muscle excursion 4 and a more selective and synergistic action than the hypoglossal neural supercharge. 5 In the case of weak facial muscles, direct neurotization preserves functioning facial nerve branches, allowing for dual innervation of facial muscles and the maximum amount of neural input possible for excursion. The other benefit is the flexibility to target different muscle groups, depending on the requirements of the patient (multivectorial facial reanimation). Just as multivectorial free-tissue transfers are the new gold standard for irreversible muscle paralysis, 6 selective neurotization is our preferred option for improving the weak smile.

Titanium Nickelide in Midface Fractures Treatment

“…Wilde et al in their study showed that only two of 19 (10%) zygomaticomaxillary complex fractures required orbital floor reconstruction, according to intraoperative computed tomography findings after zygomatic bone reduction [ 23 ]. Flynn and colleagues demonstrated that, of 1396 patients who underwent operative reduction, 23% of these patients underwent concomitant orbital floor repair [ 24 ].…”

Management of Posttraumatic Enophthalmos Including Complex Secondary Deficits

“…17 As a result, there has been a growing trend towards nonoperative management in concurrent orbital floor repair during zygomaticomaxillary complex fracture repair. 18 Orbital displacement is a complex process that is not only affected by increases in orbital volume, but also by atrophy of orbital contents which include fat, muscles, ligaments, and the globe itself. Volume loss from ischemic liponecrosis of endo-orbital fat plays a major role in GMP and PE.…”

Bone reconstruction surgery of complex craniomaxillofacial deformities using additive manufacturing customized implants - a case report

“…In these cases, there are objectives beyond the orbital reconstruction, restoring neighboring bones, for example, the superior lateral of zygoma, which forms the inside, floor and outside of the orbital wall or the superior border of the maxilla, etc. (Flynn et al , 2019; Kanthak, 1940; Scholz et al , 2007).…”