Zygomatico-Orbito-Cranial Fractures

Fig. 12.22  Panfacial fracture (cranio-frontal-fracture, Le FortIII, left Le Fort-II and sagittal-maxillary fracture, mandibular fracture). (a) Internal osteosynthesis with multiple 2.0-mm mini-

plates after craniotomy, skull base exploration and reconstruction of the frontofacial bandeau. (b) Result 1 year postoperatively

12.4  Zygomatico-Orbito-Cranial

Fractures

Zygomatico-orbito-cranial fractures comprise ­complex lateral midface fractures with additional ­involvement of the cranial skeleton, the naso-ethmoidal complex and the maxilla. These fractures should always be treated primarily to avoid late functional and aesthetic disturbances (Chuong and Kaban 1986). Orbital reconstruction is preferentially carried out using available bony fragments.

Calvarial bone grafts should be used for primary reconstruction in cases of extensive orbital wall defects (Fonseca and Walker 1991) (Fig. 12.24).

Delayed surgical treatment of these complex fractures is much more complicated and correct reduction of the zygomatico-orbital complex is not always possible. Secondary corrections of zygomatico-orbital malpositions usually require extensive osteotomies and CT-based navigation (Gellrich et al. 2003).

An additional (unilateral) transfrontal craniotomy may be necessary in the following situations:

Fig. 12.23  Burst trauma of the midface after severe suicidal gun shot from submental through the midface. First row: posttraumatic situation with partial destruction of the central midface and loss of the lower central midfacial structures including

the palate. Middle row: situation after debridment and reconstruction of the palate with microvascular bone graft (arrow). Lower row: after reconstruction of the mandible with 3.0/2.4-mm locking reconstruction plates