• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.3
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• pp.324-331
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• 1991

Ocular injuries often accompany midfacial trauma Blindness related to indirect optic nerve injury in midfacial fractures is an uncommon and usually permanent complication. Opic nerve blindness is secondary to an indirect optic nerve injury due to the skeletal distortion that occurs in a facial fracture and almost all are caused by frontal, nasoethmoido-frontal or Le Fort III type fractures. When the loss of vision following midfacial fractures is complete and immediate, the prognosis is poor in spite of treatment. Computed tomography revealed compressin of the optic nerve by bony fragments. And so if injury to the optic nerve is suspected, a CT-scan must be performed and massive steroid therapy must be started as soon as possible. Surgery must be performed if there are hematoma or bony fragments injuring the nerve. The following report concerns two patients who suffered immediate and total loss of vision due to a midfacial fracture with no improvement after massive steroid therapy and surgial decompression.

• Archives of Craniofacial Surgery
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• v.24 no.3
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• pp.117-123
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• 2023

Background: Midfacial fractures frequently involve the maxillary sinus, leading to maxillary sinus pathology. We aimed to examine the incidence and contributing factors of maxillary sinus pathology in patients who underwent open reduction and internal fixation (ORIF) for midfacial fractures. Methods: A retrospective analysis was conducted on patients who underwent ORIF for midfacial fractures at our department over the past 10 years. The incidence of maxillary sinus pathology was identified clinically and/or by computed tomography findings. Factors that significantly influenced the groups with and without maxillary sinus pathology were examined. Results: The incidence of maxillary sinus pathology in patients who underwent ORIF for midfacial fractures was found to be 11.27%, with sinusitis being the most common pathology. Maxillary sinus pathology was significantly associated with the presence of a blowout fracture involving both the medial and the inferior orbital walls. Factors such as sex, age, diabetes mellitus, hypertension, smoking, inflammatory disease, follow-up period, use of absorbable plates, and use of titanium plates did not have a significant impact on the development of maxillary sinus pathology. Conclusion: The incidence of maxillary sinus pathology in patients who underwent ORIF for midfacial fractures was relatively low, and in most cases, it resolved without the need for specific treatment. Consequently, there may not be a significant need for concern regarding postoperative maxillary sinus pathology.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.1
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• pp.83-89
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• 2008

Purpose: Different patterns in the causes of maxillofacial injury are thought to correlate with socioeconomic status and regional environment. This study investigated maxillofacial fractures in order to analyze maxillofacial trauma characteristics and the relationship between the causes and injury patterns in Korea. Material and methods: A total of 518 patients with maxillofacial fractures who were treated at the Seoul National University Boramae Hospital between 1996 and 2004 were retrospectively analyzed. Data were obtained from the patients' medical records and radiographs. The male to female ratio in the patient group was 2.78:1, and the mean age was 32.3 years. Results: Midfacial fractures were the most common location of injury (46.1%). The most common etiologic factor was an activity associated with daily life (42.6%) including falls, stumbling, and collisions. The second most common cause was assault (32.4%), followed by traffic accidents (13.7%). In the case of midfacial fractures and mandibular fractures, assault was the most common etiologic factor, whereas in the case of alveolar bone fractures, activities associated with daily life were the most common cause. With regard to age groups, assault was the most common cause for patients between 10 and 39 years old and an activity associated with daily life was the most common cause in those under 10 years and over 40 years. Conclusions: This study concluded that activities associated with daily life and assault causes a large proportion of Korean maxillofacial injuries and that preventive measures should be implemented in order to minimize these risks.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.43-47
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• 2011

Purpose: Sensory impairment in infraorbital nerve is common symptom following mid-facial fractures. The purpose of this study is to document the incidence of sensory impairment in infraorbital nerve following midfacial fractures and its recovery. Methods: Three hundreds fourteen patients with midfacial fracture were included involving emergence areas of infraorbital nerve. Fractures were classified into zygoma fracture, maxilla fracture, complex comminuted fracture and pure blow out fracture. Neurosensory function was assessed with clinical symptoms and light touch test in infraorbital nerve regions. Patients were followed and sensory function was evaluated immediately, 1, 3 and 6 months after trauma. Results: The total series consisted of 198 zygoma fractures, 19 maxilla fractures, 30 complex comminuted fractures and 67 pure blow out fractures. The incidence of sensory impairment was 60% (63% in zygoma fractures, 84% in maxilla fractures, 93% in complex comminuted fractures, 31% in pure blow out fractures). Persistent sensory impairments were remained in 32% (33% in zygoma fractures, 47% in maxilla fractures, 73% in complex comminuted fractures, 6% in pure blow out fractures) 6 months after trauma. Younger patients had better prognosis than older patients in recovery of infraorbital nerve function ($p$ <0.05, $x^2$-test). Mean recovery time was 11 weeks. Conclusion: The incidence of post-traumatic sensory impairment was different according to fracture types. Age of patients and fracture type were important factors that influence to recovery of sensory impairment. Complex comminuted fracture had poor prognosis, and pure blow out fractures had better prognosis than other fractures.

• Archives of Craniofacial Surgery
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• v.17 no.4
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• pp.206-210
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• 2016

Background: Zygoma is a major buttress of the midfacial skeleton, which is frequently injured because of its prominent location. Zygoma fractures are classified according to Knight and North based on the direction of anatomic displacement and the pattern created by the fracture. In zygomaticomaxillary complex (ZMC) fracture many incisions (lateral eyebrow, lateral upper blepharoplasty, transconjunctival, subciliary, subtarsal, intraoral, direct percutaneous approach) are useful. We reviewed various approaches for the treatment of ZMC fractures and discussed about incisions and fixation methods. Methods: A retrospective review was conducted of patients with ZMC fracture at a single institution from January 2005 to December 2014. Patients with single zygomatic arch fracture were excluded. Results: The identified 694 patients who were admitted for zygomatic fractures from which 192 patients with simple arch fractures were excluded. The remaining 502 patients consisted of 439 males and 63 females, and total 532 zygomatic bone was operated. Orbital fracture was the most common associated fracture. According to the Knight and North classification the most frequent fracture was Group IV. Most fractures were fixated at two points (73%). Conclusion: We reviewed our cases over 10 years according to fracture type and fixation methods. In conclusion, minimal incision, familiar approach and fixation methods of the surgeon are recommended.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.4
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• pp.615-620
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• 1996

The coronal approach is a versatile surgical technique. This method becomes particulary useful for exposure and internal fixation of midfacial fractures and the harvest of calvarial bone graft to manage the complex facial bone fractures. The rectrospective clinical study on the use of this technique in 10 patients was performed. The result shows that this technique provides the excellent exposure of fractures site, the ability to reduce the fragment accurately and good cosmetic results in incision area. We discussed with literatures review that anatomy, technique, indications, and potential complications of the coronal approach.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.3
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• pp.239-245
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• 1994

When the midfacial fractures involve the upper maxilla (LeFort I, II, III), there is a chance that the nasolacrimal duck may have been injured. When this suspected, We must observe the presence of epiphora carefully. If the epiphora was not improved following conservative treatment, dacryocystorhinostomy would be the treatment of choice. We performed two cases of DCR and got the favorable results.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.43 no.1
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• pp.53-56
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• 2017

Malocclusion is a serious complication of open reduction surgery for facial fractures. It is often caused by the lack of adequate consideration for the occlusal relationship before the trauma and intermaxillary fixation during the operation. This is a case report of postoperative malocclusion that occurred in a patient with a midfacial complex fracture.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.19 no.4
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• pp.367-376
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• 1997

The 234 patients who received treatment of midfacial fractures at the Department of Oral and Maxillofacial Surgery of Chonnam University Hospital from Jan. 1, 1992 to Dec. 31, 1996 were analyzed clinicostastically. Results obtained were as follows ; Male predominated over females by a ratio of 5.3 to 1. The frequently developing age groups were first 3rd (25%), 4th (21%) and the 2nd (18%) decade on succession. The peakest month was the August (16%), and May (11%), September (9%), October (9%). When it comes to the reasons for in-patients, traffic accident was predominant to 38%. In the 234 cases of midfacial fractures, zygomaticomaxillary complex fracture was the most by 37%. The most common with injury show that facial laceration marked by 49%, neurologic injury 24%, and mandibular fracture 20% each by each. About the time from injury onset to operation, 55% of cases were less than a week while the others (45%) more than a week. 3 plates were used for operation : 2 for zygoma or maxilla fracture and 3 for zygomatiomaxillary complex fracture. especially 4 for Le Fort I fracture, 5.5 for Le Fort I, II ; I, III ; II, III fracture, 7 for Le Fort I,II,III fracture were used. 20 patients (8%) appealed their complication and the most common was reported as infection. Above results suggest that early diagnosis and treatment of fracture site, systemic condition and associated injuries are necessary, and coorperative treatment with medical department should be performed.

• Archives of Plastic Surgery
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• v.38 no.2
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• pp.161-165
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• 2011

Purpose: Zygomaticomaxillary complex (ZMC) fracture is one of the most common facial injuries after facial trauma. As ZMC composes major facial buttress, it is a key element of the facial contour. So, when we treat these fractures, the operator should have a concern with the symmetry to restore normal appearance and function. But sometimes, unfavorable results may occur. The aim of this study is to analyze the unsatisfied midfacial contour after ZMC fractures reduction retrospectively and to point out the notandum. Methods: 369 patients, treated for fractures of the ZMC were included in the study. After the operation, such as open reduction and internal fixation (ORIF with titanium or absorbable materials), open reduction, and closed reduction, midfacial contour was evaluated with plain films and 3-dimensional computed tomography. And unfavorable asymmetric midfacial contours were correcterd by secondary correction and re-evaluated. Gross photographs were obtained at outpatient clinic. Results: Total of 38 patients had got a facial asymmetry and among of them 24 patients were treated secondary revisional ORIF operations for correction of unfavorable result of after primary reduction. Two of them had received tertiary operations, three patients had got osteotomy more than after one year and six patients had got minor procedures. The etiology of asymmetry were lateral displaced simple fracture of arch (n=2), lateral displaced comminuted fracture of arch (n=6), comminuted arch fracture combined posterior root fracture (n=9), and communited arch and body fracture (n=12), severely contused soft tissue (n=9). After the manipulations outcomes were acceptable. Conclusion: To prevent the asymmetry in ZMC fracture reduction, complete analysis of fracture, choice of appropriate operation technique, consider soft tissue, and secure of zygoma position are important. Especially, we should be more careful about communited fracture of zygomatic body and lateral displacement, root fracture of zygomatic arch. Because they are commom causes that make facial asymmetry. To get optimal result, ensure the definite bony reduction.