Eski Muhitdin, Sengezer Mustafa, Turegun Murat, Deveci Mustafa, Isik Selcuk
Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.
J Craniofac Surg. 2007 May;18(3):520-5. doi: 10.1097/scs.0b013e318053432c.
Inappropriate treatment or untreated fractures of the zygomaticoorbital area results in secondary deformities such as loss of malar projection, enophthalmos, and dystopia. Secondary deformities can be corrected with osteotomies, contour restoration, or a combination of both. Contour restoration can be performed with using onlay grafting with autogenous material or alloplastic implants. In this study, mild to moderate secondary deformities of zygomaticoorbital fractures were corrected with porous a polyethylene implant, which is a highly biocompatible, durable, and stable material. The number of patients who have no surgical treatment at the time of their initial injury was 15, whereas the number of patients who have an initial treatment that resulted in secondary deformities was seven. Twelve of 15 patients had only loss of cheek projection and three of the 15 patients had dystopia and loss of cheek projection. The remaining seven patients had secondary deformities resulting from skeletal surface contour abnormality as a result of comminuted fractures. In 17 of the patients, we used a subciliary approach while using the old incision scar for access in the remainder. In 22 patients, 24 implants were used. Porous polyethylene implant was carved outside in according to the existing contour deficit and was placed in the subperiosteal plane and fixed with titanium screws. The mean follow-up period was 13 months (range, 6-24 months). In this follow-up period, there was no implant extrusion, exposition, infection, or any complication resulting from subciliary incision. Patients were satisfied with the results. The best result can be achieved with porous polyethylene implant in contour restoration of mild to moderate secondary deformities of zygomaticoorbital fractures. The use of this implant in the zygomaticoorbital area is safe and has minimal morbidity.
颧骨眶区骨折治疗不当或未治疗会导致继发性畸形，如颧突丧失、眼球内陷和移位。继发性畸形可通过截骨术、轮廓修复或两者结合来矫正。轮廓修复可采用自体材料或异体植入物进行覆盖移植。在本研究中，采用具有高度生物相容性、耐用性和稳定性的多孔聚乙烯植入物矫正颧骨眶骨折的轻至中度继发性畸形。初次受伤时未接受手术治疗的患者有15例，而初次治疗后导致继发性畸形的患者有7例。15例患者中有12例仅存在面颊部突出丧失，15例患者中有3例存在移位和面颊部突出丧失。其余7例患者因粉碎性骨折导致骨骼表面轮廓异常而出现继发性畸形。17例患者采用睑缘下切口，其余患者利用原手术切口瘢痕进行手术入路。22例患者共使用了24枚植入物。根据现有的轮廓缺损在体外雕刻多孔聚乙烯植入物，将其置于骨膜下平面并用钛钉固定。平均随访期为13个月（范围6 - 24个月）。在此随访期内，未出现植入物挤出、外露、感染或睑缘下切口引起的任何并发症。患者对结果满意。在颧骨眶骨折轻至中度继发性畸形的轮廓修复中，多孔聚乙烯植入物可取得最佳效果。在颧骨眶区使用这种植入物是安全的，发病率极低。
