Freihofer H P, van Damme P A
J Craniomaxillofac Surg. 1987 Aug;15(4):183-7. doi: 10.1016/s1010-5182(87)80046-x.
Over a 6 year period 20 patients presented for secondary corrections of the periorbital region after trauma. Corrections after isolated fracture of the zygoma were necessary in 6 cases, mainly comprising re-osteotomies and contour corrections. A tertiary correction was needed only once (17%). Secondary treatment was indicated in 6 patients after fracture of the midface, necessitating mainly re-osteotomies of the zygoma, corrections of the nose and canthopexies. Tertiary corrections were performed in 3 cases (50%). In 8 patients the results of treatment of fronto-orbito-nasal fractures required further improvement. Again, osteotomies of the zygoma, corrections of the nose as well as corrections of scars and bony contours were often indicated. Four cases (50%) needed tertiary surgery. It is concluded that the more serious the primary trauma the greater the necessity for further secondary surgery. Independently of the kind of primary trauma the indication for secondary treatment was, in most cases, aesthetic. Not only was the number of re-osteotomies and nasal corrections high, but also the number of tertiary revisions. While this might not be very surprising for the nose, it is for the zygoma and proves the difficulties which arise for perfect positioning when there are no clear landmarks. Forty percent of all patients underwent tertiary and one patient needs a quaternary correction.
在6年的时间里，20例患者因外伤后眶周区域的二次修复前来就诊。6例患者因孤立性颧骨骨折后需要进行修复，主要包括再次截骨术和轮廓矫正。仅1例（17%）需要进行三次修复。6例患者因面中部骨折后需要进行二次治疗，主要需要对颧骨进行再次截骨术、矫正鼻部和内眦固定术。3例（50%）进行了三次修复。8例患者额眶鼻骨折的治疗结果需要进一步改善。同样，颧骨截骨术、鼻部矫正以及瘢痕和骨轮廓的矫正也经常需要进行。4例（50%）需要进行三次手术。得出的结论是，原发创伤越严重，进一步进行二次手术的必要性就越大。无论原发创伤的类型如何，二次治疗的指征在大多数情况下都是美学方面的。不仅再次截骨术和鼻部矫正的数量很多，三次修复的数量也很多。虽然这对鼻子来说可能并不十分令人惊讶，但对颧骨来说却是如此，这证明了在没有明确标志时实现完美定位所产生的困难。所有患者中有40%接受了三次修复，1例患者需要进行四次修复。
