I'm looking for some surgeons in the Europe or USA who have great experience in the osteotomy of that bone. I wonder how many incision and where are needed in that kind of procedure ? - in order to have reposition of the bone to the original place - eye looks like it isn't sunken or no more than 1mm - hard to say - no cheek prominence - little flattened side of the head due to flattened zygomatic arch - infraorbital canal and nerve issue - 80% of normal feeling what about scars and risks ?
Overlooked Zygomatic Fracture (3 Years Ago) - How Many Incisions Needed to Have Reposition of the Whole Bone? (photo)
Doctor Answers 4
Osteotomy to fix old zygoma fracture
The surgical treatment of an old zygomatic fracture can either be designed around an ostotomy to cut the bone and move it and anchor it in place if the deformity is severe, or to do lesser procedures to camoflague the problem. The full correction usually involves large scalp inscisions plus others in the mouth and eyelid but others may also be needed depending on the injury. Only go to an experienced craniofacial surgeon for evaluation. This is much harder than you think.
Revision Open Repair of Midface Fracture vs. Cheek Implant
Thank you for this interesting question and for posting your films. Typically, repair of the zygoma/orbital rim requires a minimum of 2 incisions. Generally, one of these can be placed inside the mouth (and thus is hidden) while the other can be made in near the eye in a couple of different places, depending on the nature of the frature. This can be a lower eyelid incision, an upper brow incision, etc. In your case, with a delayed cosmetic deformity, treatment would require osteotomies (controlled fractures) and plating (rigid fixation). This is a complicated process with a risk or unacceptable cosmetic outcome. A less-invasive option is a cheek implant and/or orbital rim implant to restore aesthetic proportions and contours. This can be performed, in most cases, with less sot tissue retraction (less swelling) and often through an incision inside the mouth only. A board certified facial surgeon can help you make the right decision for your case.
Zygoma and maxillary fractures can be treated with a unilateral custom carved silastic implant placed on the effected side. The sunken cheek is built up to match the opposite normal side. The implant is placed thru an intra-oral approach and placed directly over the depressed bone after it has been custom carved to fit the defect
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Overlooked Zygomatic Fracture (3 Years Ago) - How Many Incisions Needed to Have Reposition of the Whole Bone?
I agree with Dr. Rand's comments on craniofacial reconstruction. Another, more straight-forward option that your question did not touch on is a custom cheek implant. These implants are fabricated based on a 3 dimensional CT scan similar to the images that you've posted. The implant creates perfect bony symmetry by creating a mirror image of the uninjured side. This is a straight-forward lifelong improvement without the need for extensive craniofacial procedures and the resulting downtime. I hope this information is helpful.
Stephen Weber MD, FACS
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