How to improve ZMC fracture reconstruction due to severe enophthalmos

Abstract

Introduction and importance: Zygomaticomaxillary (ZMC) fractures are common, often resulting from traffic accidents, and account for 17 % of facial fractures. These fractures can lead to issues such as enophthalmos, flattened cheeks, diplopia, maxillary hypoesthesia. If the reduction is inadequate to restore facial structure, long term-functional and aesthetic complications may arise. In such cases a computed tomography (CT) scan with 3-dimensional (3D) reconstruction is valuable to assessing the fracture and planning surgery, with current technological advancements, 3D printing can now be utilized for this purpose.

Presentation of case: A 24-year-old male, after a motorcycle accident and initial surgery for maxillofacial fractures, experienced persistent diplopia and facial numbness. Physical examination showed malpositioning of the right eye, and a CT scan with 3D reconstruction revealed multiple fractures and prior internal fixation. A 3D-printed model was created to plan a second surgery using rib cartilage and a silicone orbital base for orbital rim reconstruction. Post-surgery, the patient reported minimal pain and no diplopia or blurred vision in the primary gaze position.

Clinical discussions: 3D printing is beneficial in facial reconstruction, aiding in surgical planning by allowing precise measurement and design of graft. Rib cartilage can serve as an alternative for orbital rim reconstruction, and 3D printing facilitates accurate harvesting of the rib.

Conclusion: In cases of severe ZMC fracture, 3D printing was utilized as a guide during surgical preparation to achieve improved outcomes.

Keywords: 3-Dimensional printing; Inferior orbital; Orbital rim reconstruction; Rib cartilage; Rib graft.

Fig. 1

(A) CT scan showed multiple fractures were seen on the maxillofacial region with orbital mesh and multiple plate and screws (B) plasticine was used to estimate the size of graft needed and (C) rib cartilage graft used for zygomaticomaxillary reconstruction; (D) simulation for graft placement in 3D models.

Fig. 2

Intraoperative showed the placement of rib cartilage graft in the right zygomaticomaxillary.

Fig. 3

Pre-operative (left) and post-operative (right) assessment.