Complex Orbital Zygomatic Fracture
It is not often that Maxillofacial Surgeon is called for a patient who is unable to open his eye. Probably all other consults were done (Neurology & Opthalmology) and the problem was still unresolved. Finally this 20year old gentleman was referred by Neurosurgery Colleagues for Maxillofacial Opinion.
CT scan showed displaced frontal bone fracture in Supraorbital Rim region along with zygomatic fracture of Right side. Opthalmic consults were already done and neurological damage was ruled out. It was a clear case of Mechanical obstruction causing levator Palpebrae superioris imbalance. Check out the CT scan image for stark difference in orbital outline.
Other possibilities considered and ruled out were hematoma in the upper lid, Superior orbital fissure syndrome. A plan for ORIF of the Supraorbital rim (frontal bone) & Zygoma was proposed to the patient. Access was achieved thorugh the existing laceration and ORIF done under General Anesthesia. No CSF leak was noted intraoperatively or postoperatively. Postoperative period was uneventful and wound healing very nicely. By the 4th Postop day eye opening was already improving. At 2 weeks,Normal eye opening and vision was restored. Don’t forget to Check the Postop PNS xray for unexpectedly nice orbital contour achieved by reduction.