Optimizing the management of orbitozygomatic fractures.

Our understanding of the biomechanics and current management of orbitozygomatic fractures has evolved with the development of craniomaxillofacial surgery. Early management was minimal, with reduction alone as the uniform treatment, and the only variation was the approach used. However, a critical review of the literature using these methods revealed that many of these fractures were unstable after simple reduction alone. Using the principles of craniofacial surgery, our clinical experience, and the data presented in this article, a pragmatic algorithm for optimizing the management of orbitozygomatic fractures is presented. Our approach to this problem has been graduated, with orbitozygomatic fractures being divided into two general categories: nondisplaced and displaced. The nondisplaced orbitozygomatic fracture is treated nonoperatively, with close patient follow-up to detect signs of malunion. Displaced fractures are openly reduced and rigidly fixed internally with mini- and/or microplates. The orbit is routinely explored, especially in high-velocity injuries. The orbit is anatomically as well as volumetrically reconstructed with bone grafts, if needed, to prevent postoperative enophthalmos.