Hidden incisions on the face—use of Transconjunctival approach in management of Orbito-Zygomatico-Maxillary complex fractures.

Abstract

Abstract Anatomic reduction of the Orbito-Zygomatico-Maxillary complex is necessary to reestablish facial symmetry, position of the globe and to restore normal sensations to the structures innervated by the infraorbital nerve. The face is the primary area of cosmesis, and the surgeon must balance the exposure needed for access and treatment with the esthetic demands of the patient. There are several popular incisions used to gain access to the orbito-zygomatico maxillary complex region: the infraorbital, the subciliary, and the transconjunctival incisions. The transconjunctival approach with a lateral canthotomy (swinging lid) is the workhorse of approaches to the orbit in the management of orbital trauma. This approach provides a wide exposure for treatment of floor fractures and minimizes the risk of lower lid malpositioning and most importantly avoid the perceptible scar on the face. We report a case of OZM complex fracture, in which transconjunctival approach was used to access the infraorbital and the lateral orbital rim for the fracture reduction and discuss the surgical technique and associated advantages of this approach. Abbreviations OZM-Orbito-Zygomatico-Maxillary