Delayed reconstruction of posttraumatic facial deformities

Article information

J Korean Med Assoc. 2018;61(12):740-748

Publication date (electronic) : 2018 December 17

doi : https://doi.org/10.5124/jkma.2018.61.12.740

Yong Ha Kim, MD

Department of Plastic & Reconstructive Surgery, Yeungnam University Hospital, Daegu, Korea

Corresponding author: Yong Ha Kim E-mail: kimyon@ynu.ac.kr

Received 2018 November 21; Accepted 2018 December 06.

Abstract

Posttraumatic facial deformities (PTFDs) are very difficult to correct, and if they do occur, their impact can be devastating. It may sometimes be impossible for patients to return to normal life. The aim of surgical treatment is to restore the deformed bone structure and soft tissue to create symmetry between the affected side and the opposite side. In the process of managing PTFD, correcting enophthalmos is one of the most challenging aspects for surgeons because of difficulties in overcoming the scar tissue and danger of injuring to the optic nerve. In this article, surgical options for reconstruction of the medial wall, floor, lateral wall, and roof of the orbit are described. To optimize aesthetic improvement, additional cosmetic procedures such as facial contouring surgery, blepharoplasty and rhinoplasty can be used. Plastic surgeons should join emergency trauma teams to implement an overall treatment plan containing rational strategies to avoid or minimize PTFD.

Keywords: Orbital fractures; Facial bones; Enophthalmos

Figure 1.

(A,B) Preoperative view of the patient. He showed 3 mm enophthalmos, 2 mm hypoophthal-mos, pseudoptosis, supratarsal fold deepening, mid face widening and retrusion, and cheek drooping. (C,D) Postoperative view after 6 months of surgery. Improvement facial deformities. Informed consent was obtained from the patient.

Figure 2.

(A) Preoperative view of the patient. This 12-year-old female patient was observed to have posttraumatic exotropia, hypotropia, and strabismus on the right eye. (B) Postoperative view after 12 months of surgery. (C) Postoperative view after 12 years of surgery (From Kim YH et al. J Craniofac Surg 2012;23:1005-1009, with permission from LWW Journals) [11].

Figure 3.

(A) Preoperative view of the patient. The distance of midline to medial canthus was 22 mm on the affected side and 35 mm on the other side. B. Postoperative view after 9 months of surgery. Telecanthus on the affected side was improved (From Kim TG et al. Ann Plast Surg 2014;72:164-168, with permission from LWW Journals) [46].

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