Zygomatic Fractures Research Articles

Management of Atypical M-Shaped Zygomatic Arch Fractures.

M-shaped zygomatic arch fractures can usually be treated effectively through closed reduction. It consists of 2 fracture segments: the anterior zygomatic segment and the posterior temporal bone segment. In clinical practice, atypical M-shaped fractures are often encountered, in which the anterior and posterior fracture segments are discontinuous and separated. Closed reduction usually cannot achieve the desired anatomic reduction effect for this type of fracture. The preoperative design showed that the anatomic reduction of the posterior zygomatic arch fracture segment was hindered due to bone spurs in the most concave area of the anterior zygomatic bone fracture segment. Open reduction and fixation were performed to achieve anatomic reduction and restore facial symmetry. The fracture sites were exposed through a hemicoronal incision. After the bone spurs are removed, the posterior bone segment can be anatomically reduced. Absorbable plates were used for fixation. The patient's facial appearance was restored after the surgery. The postoperative computed tomography scan showed a good alignment of the fracture. The authors believe that for patients with high requirements for facial symmetry, the presence of atypical M-shaped fractures can indicate open reduction and fixation.

Transmalar Kirshner Wire Fixation Under Ultrasound Scanning is Useful for Unstable Zygomatic Arch Fracture Combined With Zygomatic Body Fracture.

Plate fixation to zygomatic arch fractures carries the risk of facial nerve palsy and scarring of the cheek; however, without plate fixation, bone deviation or displacement may reoccur after surgery. Furthermore, zygomatic arch fractures combined with zygomatic body fractures are more postoperatively unstable than single zygomatic arch fractures. Few reports have focused on this combined fracture type, and no consensus has been reached regarding treatment. Because plate fixation for slight deviation of the zygomatic body has little advantage for stabilization, the authors, usually opt for transmalar pinning alone instead of plate fixation at the hospital. This study is a retrospective case series of 7 patients, among 100 zygomatic fractures excluding isolated zygomatic arch fractures, treated using transmalar pinning under ultrasound scanning. The reduction was performed through the oral and temporal incision as a surgical procedure. Under ultrasound observation, a Kirshner wire was inserted into the zygomatic body from the unaffected side while maintaining the reduced position. The wire was removed at an outpatient visit 2 to 3 months following surgery. In all cases, the zygomatic body was of the laterally rotated type, and postoperative morphologic evaluation showed improvement without postoperative complications. Scores were higher in middle-aged and older than in young people. Correction of zygomatic rotation also scored higher than zygomatic arch morphology. Transmalar Kirshner wire fixation under ultrasound observation is a simple and minimally invasive method for zygomatic arch fractures, which avoids the possible complications related to plate fixation.

Intraoperative Computed Tomography in the Surgical Treatment of Zygomatic Complex Fracture: A Retrospective Cohort Study.

This study aimed to assess the effectiveness of intraoperative computed tomography (ICT) in managing zygomatic complex (ZMC) fractures surgically. A total of 143 patients (84 men, 59 women; average age 37.13y) undergoing surgical treatment for ZMC fractures participated in this retrospective cohort study, with 72 in the ICT group and 71 in the control group. There were no notable differences in gender, age, time from injury to surgery, and surgical duration between the two groups. The ICT group exhibited significantly fewer surgical approaches than the control group (1.39±0.519 vs. 2.07±0.617, P<0.001). Fixation points in the ICT group (1-point: 42, 2-point: 14, 3-point: 16) significantly differed from the control group (1-point: 15, 2-point: 17, 3-point: 39), P<0.001. Symmetry of reduction was assessed through immediate postoperative images, and stability was compared between immediate postoperative images and those taken at least 3 months later. Both assessments revealed no significant differences between the 2 groups. This study indicates that ICT facilitates prompt evaluation of ZMC reduction, minimizing the necessity for incisions and internal fixation, while achieving comparable reduction efficacy and long-term stability to conventional approaches.

Feasibility of 2-Point Fixation by Absorbable Plates Using the Transoral Approach in Management of the Zygomatic Complex Fractures.

The purpose of this study was to retrospectively evaluate the feasibility of 2-point fixation using absorbable plates by the transoral approach in the management of the zygomatic complex (ZMC) fractures. Twenty-five patients (15 male and 10 female, age range 16y to 55y) with Knight and North Group Ⅲ zygomatic fractures were included in this case series. Open reduction by intraoral approach was performed on these patients, and the fractures were fixed using absorbable plates placed at the zygomaticomaxillary buttress and infraorbital rim. Postoperatively, follow-up was undertaken to evaluate the fracture healing, mouth opening, facial asymmetry, diplopia, and paresthesia. Postoperatively, all patients achieved uneventful healing; facial symmetry and wound healing were achieved, along with sensory recovery involving the infraorbital nerve. Complications such as sensory disturbances, infection, diplopia, malunion, and nonunion were not encountered in these patients. Two-point fixation using absorbable plates by transoral approach can provide sufficient stabilization for Knight and North Group III zygomatic fractures.

Profile of Facial Trauma Victims of Motorcycle Accidents: A Prospective Study.

To outline the profile of patients with facial trauma, victims of motorcycle accidents, treated at the Hospital da Restauração, Recife/PE, Brazil, from December 2020 to July 2021. The collection was carried out through questionnaire and analysis of medical records. Data were analyzed descriptively, as well as Pearson's chi-square test or Fisher's exact test. Among the patients, 88.6% were male, 47.5% were between 18 and 29 years old, and 59.6% lived in rural areas; 72.15% of the victims used the motorcycle for work and 43.52% were working at the time of the accident. Most victims did not have a national motorcycle license (62%) and were not wearing a helmet at the time of the accident (60%), with 37.6% wearing a full-face helmet, 16.5% an open helmet, and 5.9% an articulated full-face helmet. Soft tissue injuries were the most prevalent. Zygomatic complex fractures were the most common facial fractures and were significantly associated with helmet use and type. Most victims of motorcycle accidents are young adult men, without a regular driver's license and residing in rural areas. Preventive and educational actions and continuous traffic inspections are necessary to minimize these accidents.

The ‘Manchester’ method of minimal access fixation of the zygomatic arch in zygomatic complex fractures: a case series

We have introduced a minimally invasive approach for the fixation of the zygomatic arch during the surgical management of zygomatic complex fractures. Access for this technique is provided by a preauricular approach and eyelid incisions with the addition of transcutaneous stab incisions overlying the arch. These stab incisions allow transcutaneous drilling and screw placement through a size CH 20 (5.0 mm) paediatric nasopharyngeal airway (NPA). We present a case series of seven patients. In all patients the arch component was successfully reduced and fixed, and no intraoperative or postoperative complications were observed. The use of an NPA is novel. It functions as a flexible self-irrigating sleeve and protects the skin from mechanical and thermal damage. The technique uses readily available equipment, is easy to learn, and simplifies surgery to the zygomatic arch.

SPECTRUM OF ZYGOMATIC COMPLEX FRACTURE AT A TERTIARY CARE CENTER OF NEPAL

Background: Zygomatic bone is complex bilaterally located bone of face contributing to aesthetic and function. Zygomatic complex fracture is common type of facial bone fracture in young male with periorbital ecchymosis, flattening of cheek being common clinical presentation and Road Traffic Accident (RTA) being common etiology. Its treatment depends upon various factors like demographics, clinical findings, socioeconomics, fracture type and available resources. Present study is aimed to evaluate various clinical and other preoperative spectrums of ZMC fracture. Methods: This was a descriptive cross-sectional study conducted at Department of Oral and Maxillofacial Surgery in a tertiary center for 1 year, after taking consent in 86 patients. Convenience sampling was used after confirmation of ZMC fracture by CT scan. Data was collected, assembled, analyzed by SPSS and presented in table and graphs. Results: Mostly male 74(86%) of age group 20-39 years 42(48.8%) were involved in ZMC fracture. RTA was most common etiology accounting for 68.6%. Common presentations were subconjunctival hemorrhage, periorbital hematoma, trismus, flattening of cheek and orofacial laceration accounting for 90.1%, 84.9%, 54%, and 58.1% respectively. Nasal fracture was associated in 33.7% cases and extremity fracture in 20.9% cases. 84.9% cases were of displaced type and 48.8% were of tetrapodal fracture. Conclusions: This study in different preoperative parameters of ZMC fracture would be helpful in educating society regarding etiologies and precautions to be taken, for policy makers to make and enforce regulations to minimize incidences and for health workers to evaluate, diagnose and better multidisciplinary management.

Prevalence and Pattern of Zygomatic Complex Fracture in a Tertiary Care Hospital of Central Nepal

Background Zygomatic complex fracture is one of the commonest fractures of face leading to facial asymmetry. Various classification systems describing the pattern have been reported. The aim of this study was to determine the prevalence and pattern of Zygomatic maxillary complex fracture in tertiary centre hospital of Nepal based on two different classifications. MethodsA prospective observational study was conducted on College of Medical Sciences, Teaching Hospital, Chitwan from September 2021 to August 2023 with all cases of facial injuries. Computed Tomography scan of the cases were considered and 371 cases with Zygomatic maxillary complex fracture were studied. Apart from the demographic data, Knight and North classification and Zing Classification of the fractures were recorded. The data was tabulated and analysed using SPSS 20.ResultsZygomatic maxillary complex fracture was prevalent in third decayed of life with mean age of 28.45 years. Male (286) were more affected. Road traffic accident is primary cause of the fracture in our study. Type III fracture (31.35%) on Knights classification is commonest pattern followed by type VI (18.65%), type V (13.99%) and type II (14.77%). On Zing classification type B (53.89%) of Zing classifications is more prevalent followed by type C (19.69%) and type A2 (17.36%).Conclusions The study describes the demographic distribution, aetiology and pattern of Zygomatic complex fracture in a tertiary hospital.

Navigating Diagnostic Dilemmas in Subacute Subdural Hemorrhage: A Case Report

In this case report a 64-year-old male patient with recent past medical history of head injury complicated by zygomatic arc fracture and mild subarachnoid hemorrhage is studied. He had been presented to the Emergency Department because of progressive neurological symptoms and neurological deficits in the physical examination that could have been indicating subcacute subdural hemorrhage. However, the patient was reluctant to undergo diagnostic imaging due to concerns about radiation exposure. After several explanations, a CT scan was done, which revealed a bilateral subacute subdural hematoma. Neurosurgical management was initiated and intravenous corticosteroid therapy was administered to reduce local edema. The challenge of this case is based on the subtlety of symptoms that might cause patients to delay seeking medical attention. Additionally, patient reluctance to undergo diagnostic tests can complicate management, emphasizing the importance of patient education and therapeutic alliance. Multidisciplinary management involving Neurology and Neurosurgery is crucial for optimal patient care in such cases. This report underscores the significance of effective communication and collaborative decision-making between healthcare providers and patients to ensure timely and appropriate management of complex medical conditions.

A comparison of one point versus two point fixation in the management of zygomatico-maxillary complex fractures

The zygomaticomaxillary complex (ZMC) fractures are highly frequent injuries. There is a variety of operative techniques for fixation of ZMC fractures, with no consensus about the best technique. We aim to compare one-point versus two-point fixation of tripodal zygomatic fractures. This study was carried out on 34 patients admitted to the trauma unit in Sanjay Gandhi Institute of Trauma and Orthopaedics in the period from September 2022 to August 2023. Patients were divided into two groups (group 1; one-point fixation, and group 2; two- point fixation). When compared to the one-point fixation group, only 14 patients had substantial stability with a P-value of &amp;#60;0.05 being statistically significant. In contrast, nearly all patients in the two-point fixation group had higher stability. In the two-point fixation group, nearly all patients had a post-operative scar; in the one-point fixation group, however, only two patients had the same scar, and the mouth opening was also improved. In two-point fixation, paraesthesia was observed in nearly seven patients, while in one-point fixation, it was present in only two patients.The one-point fixation technique for tripodal ZMC fractures is considered effective as the two-point fixation technique; and it offers advantages of scarless operation, reduced operation time, fewer complications, and lower cost.

Major clinical and surgical approaches to treating orbitozygomatic and zygomatic maxillary complex fractures: a systematic review

Introduction: In the scenario of orbitozygomatic fractures, facial and head injuries account for half of deaths due to trauma, and thousands are left with long-term or permanent injuries. Fractures of the zygomatic-maxillary complex (ZMC) and zygomatic arch are common athletic injuries. Operative treatment is indicated in cases of significant displacement or functional disturbance. Technology such as virtual surgical planning, intraoperative navigation, and intraoperative imaging has the potential to improve the accuracy of treatment of challenging fractures. Objective: It was to develop a systematic review of the main clinical and surgical approaches to the treatment of orbitozygomatic and zygomatic maxillary complex fractures. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from October 2023 to January 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 102 articles were found, 26 articles were evaluated in full and 25 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 14 studies with a high risk of bias and 12 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=57.9%&gt;50%. A single-piece fracture of the fronto-orbito-zygomatic-maxillary bone connected to a temporoparietal bone may require additional osteotomy to achieve successful results in an acute setting. Orbital volume analysis offers a valid modality for objectively evaluating the efficiency of the management of orbitozygomatic complex fractures. The success rate of the fixation procedure at 1 point of the zygomaticomaxillary complex is high, with minimal complications. Intraoperative CT/three-dimensional imaging should be used in the treatment of ZMC fractures requiring orbital floor reconstruction, where adjacent fractures require fixation and/or when ≥ 2 axes are displaced ≥ 5 mm.

Is Gillies Temporal Incision Necessary to Successfully Reduce Zygomaticomaxillary Fracture Combined With Orbital Wall Fracture?

Gillies temporal approach has been widely used to reduce zygoma fractures. Traditionally, it is the preferred method to reduce the isolated zygomatic arch fracture. It can be combined with other approaches, such as subciliary and intraoral incisions for more complex zygomatic fractures, so-called tripod fractures. In this study, the author hypothesized that complex zygomaticomaxillary bone fracture reduction can successfully be achieved without Gillies temporal incision. The author retrospectively analyzed the medical records and 3D facial Computed Tomography (CT) scans of 80 patients who had orbitozygomaticomaxillary fractures that affected >3 sites among the frontozygomatic suture, zygomaticomaxillary buttress, zygomatic arch, and orbital walls from May 2021 to August 2023. A single surgeon performed all surgical operations. All fractures were reduced with 2 incisions, lower eyelid incisions (subciliary or subconjunctival) and intraoral incisions (gingivobuccal approach), within a week of the initial traumatic event. After sufficient exposure to fractured sites using 2 incisions, the author reduced the fracture with a bony hook at the inferior orbital rim, lateral wall, or Boise elevator at the intraoral incision. All cases were successfully corrected without any complications. In conclusion, the author can successfully reduce complex zygomaticomaxillary fracture combined with orbital wall fractures without temporal Gillies approach.

BoneTape: A novel osteosynthetic device for the stabilization of zygomatic fractures

BackgroundThe study aims to assess the safety and effectiveness of BoneTape™, a new resorbable bone fixation device, using a zygomatic fracture model in rabbits. MethodsThe study followed BoneTape™ samples and control (sham) groups over 2-, 6-, and 12-week periods post-zygomaticomaxillary (ZM) osteotomy and zygomaticofrontal (ZF) disarticulation. The osteotomized segments were analyzed for bone healing, inflammatory response, and tissue healing. µCT imaging and histological analysis were used to examine the axial alignment, offset, and quality of new bone formation. ResultsBoneTape™ samples demonstrated enhanced maintenance of the initial intraoperative positioning, reduced axial offset, and better alignment when compared with the control group, enabling stable bone healing under physiological loading conditions. Complete union was observed at 12-weeks in both groups. The BoneTape™ group experienced minimal immune and tissue reactions, classically associated with wound healing, and showed an increased number of giant cells at 6 and 12-weeks. ConclusionBoneTape™ represents a promising advancement in osteosynthesis, demonstrating efficacy in maintaining stable zygomatic reconstruction and eliciting minimal immune response in a rabbit model. This study introduces BoneTape™ as a disruptive solution specifically designed for clinical application in cranio-maxillofacial fracture fixation, with the potential to eliminate the use of over-engineered solutions while offering benefits such as ease of application and fewer biologically disruptive steps.

Modeling stability post zygomatic fracture reconstruction

Zygomaticomaxillary complex (ZMC) fracture repair is one of the most common surgical procedures performed in craniomaxillofacial trauma management. Miniplates and screws are used to stabilize the fractured bone using small local incisions, however, these procedures are not infrequently associated with hardware-related post-operative complications. The amount of fixation hardware utilized varies depending on the fracture pattern and surgical judgment, with three-point fixation being the conventionally accepted treatment. However, limited experimental testing and clinical studies have suggested that ZMC stabilization may be achieved with less than three-point fixation. In this study, we utilized a previously developed finite element modeling approach that allows for detailed bone and muscle representation to study the mechanical behavior of the fractured craniomaxillofacial skeleton (CMFS) under one, two, or three-point fixation of the ZMC. Results suggest that using a miniplate along the infraorbital rim in three-point fixation increases the amount of strain and load transfer to this region, rather than offloading the bone. Two-point (zygomaticomaxillary and zygomaticofrontal) fixation yielded strain patterns most similar to the intact CMFS. One-point (zygomaticofrontal) fixation resulted in higher tensile and compressive strains in the zygomaticofrontal region and the zygomatic arch, along with a higher tensile strain on the zygomatic body. These modeling results provide biomechanical evidence for the concept of over-engineering in the stabilization of facial fractures. Furthermore, they support previous suggestions that less than three-point fixation of ZMC fractures may be adequate to achieve uneventful healing.

Evaluation of the Relationship Between Zygomatic Arch Fracture Reduction and Mandibular Movements.

The aim of this study was to evaluate the relationship between surgical zygomatic arch fracture reduction and mandibular movements in different fracture types. Fractures were classified according to the Yamamoto classification. The extent of zygomatic arch reduction after surgery was evaluated by measuring three reference points on both fractured and normal side both before and after surgery. The selected reference points were: the most anterior (A1), the most posterior (B1) and the midpoint (C1) relative to midsagittal plane on the fracture side and the same points on the normal side (a1, b1, c1). Mouth opening, movements to right and left were recorded in these patients. The highest extent of zygomatic arch reduction was observed at the midpoint of the arch (p = 0.041). Surgery did not significantly alter other points of the zygomatic arch. The extent of reduction of the zygomatic arch was not significantly associated with mandibular movements. However, type of fracture correlated with lateral excursion to the right and left (p = 0.002 and p = 0.031, respectively). This study showed that the amount of post-surgical changes in zygomatic arch reduction was not significantly related to mandibular movements. In addition, the amount of lateral excursion two weeks after surgical correction of more severe types of zygomatic arch fractures was less compared with other fracture types. Patients with more severe fractures may need to be followed for a longer period of time in order to regain the normal mandibular movement range.

A Novel Method in Restoring Form and Function Following Malunited Isolated Zygomatic Arch Fractures- A Technical Note

Isolated zygomatic arch fractures of the facial skeleton are rare. Blunt force to the cheek can result in an isolated zygomatic arch fracture, with resulting aesthetic issues such as indendations and functional impairments such as trismus. Symptomatic or visible isolated zygomatic arch fractures are commonly treated using either the Keen (intraoral) or Gillies (temporal) approaches to reduce the fracture while avoiding visible scars. Typically, the reduced fractures are not rigidly fixated but rather held in place by the native periosteal sleeve. However, cold fractures of the zygomatic arch are difficult to treat as they require a wide area of exposure for re-osteotomy and fixation. In the present technical note, we describe a novel technique to overcome this. Through a minimally invasive approach, two osteotomies were made proximally and distally to the fracture segment, and the segment was rolled 180 degrees along the sagittal axis. The medially depressed zygomatic arch is now projected laterally and was found to give adequate prominence and relieve restrictions in mouth opening. This is a novel method for reestablishing the prominence of the zygomatic arch and aiding in mandibular function following malunion of the fractured, isolated zygomatic arch.

Zygomatic and midface fractures and post-traumatic orbital defects—primary and delayed primary treatment

Zygomatic and midface fractures and post-traumatic orbital defects—primary and delayed primary treatment

Maxillofacial trauma and its management presenting at a tertiary care hospital in Lahore during Covid-19 pandemic.

The objective of this study was to assess the patterns of maxillofacial injuries, aetiology and their management during the pandemic of Covid-19 in a tertiary care hospital in Lahore, Pakistan. This is a single center, prospective cross-sectional study. Patients from all age groups who presented at the Emergency room of Jinnah Hospital Lahore and managed by the Oral and Maxillofacial Surgery Department during 1st December 2020 till 31st January 2021 were included. Data were analyzed using IBM SPSS for Windows, Version 20.0. Total 202 patient were analyzed, 161 (79.7%) were male and 41 (20.3%) were females. Male to female ratio was 4:1. About fifty three percent of patients belonged to the age group 15-35 years. The most common cause was road traffic accidents (RTA), followed by fall. Eighty-three (41.1%) had only soft tissue injuries without any bony fracture and 119 (58.9%) had facial bones fractures. Zygomatic bone fracture was most common (53.8%) followed by mandible fracture (31.1%). Sixty-one out of 119 patients with fractures were treated with Open Reduction Internal Fixation (ORIF). Three patients had complete loss of vision because of facial trauma. Only 56 (28%) patients were managed under General Anaesthesia. During the initial pandemic era, a large majority of patients presenting with maxillofacial injuries were young male adults. The most common cause of maxillofacial trauma was RTAs. Soft tissue injuries were predominant followed by facial bone fractures and zygomatic bone was more frequent among the fracture cases. Covid-19 pandemic increased the difficulties faced in the management of maxillofacial trauma patients.

ANALYSIS OF HARDWARE REMOVAL IN MAXILLOFACIAL TRAUMA: A RETROSPECTIVE STUDY IN A MILITARY HOSPITAL IN SANA'A, YEMEN

Background and objective: Dental trauma is a significant problem for total dental health in terms of expenses, frequency, and age (young patients). Collaboration between various professionals, including oral surgeons, maxillofacial surgeons, dentists, orthodontists, and periodontists, frequently results in the treatment process. Surgical treatment may entail placing plates for fractures and shattered bones for long or permanent periods, and may require their removal for many reasons. Therefore, this study sought to ascertain the reasons for plate removal in individuals referred to the Department of Oral and Maxillofacial Surgery at Military Hospital in Sana'a, Yemen during a period of 3 years. Method: The study included 57 Yemeni patients who visited the Department of Oral and Maxillofacial Surgery at the Military Hospital in Sana’a during the period 2021-2023. Cases of hardware removal were extracted from the medical records to include sex, age, medical history, accident history, type of fracture, primary complaint, period from the date of the first operation, approach to the operation, tooth in the fracture line, and extracted tooth. Results: Gunshot injuries (40.4%) and explosive injuries (31.6%) were the most common causes of maxillofacial fractures. Mandibular fractures (68.4%) were the most frequent, followed by orbital and zygomatic fractures (12.3% each). The main reason for hardware removal was infections (29.8%), followed by patient preference (22.8%) and visible exposed hardware (15.8%). Mini-plates (68.4%) were the most commonly removed hardware, and the extra-oral approach (56.1%) was the most frequently used for removal. There was a significant association between orbital fractures and the incidence of positive discharge, as well as between reconstructive plates and the incidence of positive discharge. Longer plate usage, exceeding 24 months, increased the probability of positive discharge. Tooth involvement and extraction were minimal. Conclusion: Gunshot and explosive injuries were the main causes of maxillofacial fractures, while infections, patient preferences, visible exposed devices, and pain and discomfort were the main reasons for removal of devices. Mandibular fractures were the most common and orbital fractures carry a higher risk of infection, while small plates have shown lower rates of infection. Prolonged panel use beyond 24 months increased the probability of positive discharge. Peer Review History: Received: 25 October 2023; Revised: 18 November; Accepted: 24 December, Available online: 15 January 2024 Academic Editor: Dr. Gehan Fawzy Abdel Raoof Kandeel, Pharmacognosy Department, National Research Centre, Dokki, 12622, Giza, Egypt, gehankandeel9@yahoo.com Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com Dr. Hasniza Zaman Huri, University of Malaya Medical Centre, Kuala Lumpur, hasnizazh@ummc.edu.my

Orbital Fat Herniation Through Inferior Orbital Fissure and Persistent Diplopia Caused by Facial Trauma.

Orbital fat herniation is often accompanied by orbital floor fractures. Furthermore, herniation through the inferior orbital fissure (IOF) is rare, and its pathophysiology remains largely unknown. Here, the authors report a case of a patient with IOF herniation and diplopia caused by orbital trauma. The patient was a 58-year-old male who had undergone reduction of a left zygomatic fracture 15 years previously; however, reduction of the lateral orbital wall displacement was not performed at that time. The patient presented with refractory diplopia following a sports-related orbital injury. Although no new facial fractures occurred, an asymmetric IOF herniation was observed in the left orbital fissure, which caused persistent diplopia. Surgical repair of the orbital fat herniation was performed 46 days after injury. Two months after the surgery, the herniation of the orbital fat and diplopia completely disappeared. Surgery for an IOF herniation should be considered when ocular symptoms persist after orbital trauma.