1 C J Mieny, U Mennen: Principles of Surgical Patient Care - Volume ...

an infraorbital margin fracture. A cranio-facial fixation, with additional stabilization of thenaso-ethmoidal complex, is seldom indicated.Medial Orbital Blow-Out FractureA medio-supero-orbital (Lynch) incision approach will allow sufficient access to thefracture region. A small defect may be bridged by a lyophilized dura transplant, whereas alarge defect requires a thin bone transplant. In cases where a pre-trauma chronic sinusitis ofthe ethmoid sinuses was present, one has to supply additional drainage from the sinus to thenasal cavity.Le Fort II FractureThe involved mid-facial region has to be reduced and fixated in the anterior andsuperior direction, because the mid-face has been displaced posteriorly and inferiorly. As inthe case of a Le Fort I fracture, the treatment is chosen according to the four different"availabilities of occlusion and a stable mandible".Arcus FractureThe displaced bony fragments must be repositioned to their original location. Differentareas of approach, such as the temporal, supraorbital and intraoral approaches, but no directapproach, are available for this repositioning procedure.Inferior Orbital Blow-Out FractureAn infra-orbital approach is usually sufficient for the repositioning of the prolapsedorbital content. Lyophilized dura or fascia lata may be placed over a small defect, but a largedefect requires a bony transplant (fig. 5.3.11). In some cases, especially where there is a largecomminuted fracture of the orbital floor, an antral pack in the maxillary sinus is necessaryto support the orbital floor, an antral pack in the maxillary sinus is necessary to support theorbital floor inferiorly.Zygomatic Bone FractureThe basic principle in the treatment of a zygomatic bone fracture is the correctrepositioning and stabilization of the zygoma.The reduction may be achieved by a direct approach using a malar hook, or by atemporal or supraorbital elevation. Fixation is mostly done at the fronto-zygomatic fractureline and in some cases additionally at the infraorbital margin and/or at the malar process.When the zygomatic bone fracture is comminuted, an antral pack is imperative for thesupport of the comminuted lateral wall.34