CRITERIA FOR SELECTIVE MANAGEMENT OF THE ORBITAL RIM AND FLOOR IN ZYGOMATIC COMPLEX AND MIDFACE FRACTURES

Objective: To develop objective criteria with which to identify patien ts with zygomatic complex (ZMC) or midface fractures who require a sur gical exploration and treatment of the orbital component of their frac ture to prevent postoperative enophthalmos, diplopia, or malar depress ion. Design: Nonrandomized, prospective management of facial trauma pa tients. Setting: Urban, university referral center. Participants: Nine ty-seven patients with facial fractures (72 with ZMC fractures and 25 with midface fractures) who presented to the maxillofacial and oculopl astics trauma trams at the University of Cincinnati, Cincinnati, Ohio, for management. Intervention: The decision whether to include an orbi tal exploration as part of the management plan was made based on a spe cific set of physical and radiological criteria that are detailed in t he text. Outcome Measure: Patients were evaluated postoperatively for possible complications related to the orbital and periorbital portions of their fractures. Results: Thirty-four percent of the study patient s (30% of the patients with ZMC fractures and 44% of the patients with midface fractures) underwent orbital rim exposure and orbital floor e xploration as part of their fracture management. Sixty-six percent of these patients (70% of the patients with ZMC fractures and 56% of the patients with midface fractures) were managed without orbital explorat ion. Postoperatively, none of the patients who did not undergo explora tion experienced diplopia or enophthalmos and only 1 patient had a res idual malar depression. Conclusions: The criteria reported herein allo w surgeons to identify the minority of patients with midfacial and ZMC fractures who require an orbital exploration for optimal fracture man agement. Orbital exploration, and its potential complications, can he avoided in the majority of patients with ZMC and midface fractures wit hout significantly increasing the risk of morbidity related to the orb ital component of their fractures.