Remarkable Facial Reconstruction Surgery

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Facial reconstruction of severe facial asymmetry due to orbital floor blowout fractures

A 21-year-old male suffered skull and facial fractures and frontal anterior cranial vault injuries because of a high-energy motorcycle incident. He was hospitalised at a local trauma centre and immediate neurosurgical intervention was performed for reducing the high intracranial pressure level. Part of the left parietal and temporal bones was also removed temporarily, including the more comminuted bone fragments from the left orbital rim and roof.

A second surgical intervention was performed once the patient was stabilised to practice the cranioplasty. The previously removed cranial vault was reapplied and the supraorbital rim comminuted fracture was reconstructed with homologous cadaveric frozen bone, to reduce the frontal bone and zygomatic fracture. The orbital floor defect was sealed and the maxillo-zygomatic process was reduced on the left side. In addition, on the right side, orbital floor and medial orbital wall reconstruction and reduction of frontal bone and zygomatic fracture were also performed.

However, despite the treatment, left orbital deformity, severe mid-facial asymmetry and ocular dystopia remained because of the presence of a wide missing bone defect and lack of left orbital floor bone.

CT 3D rendering after first surgical stage showing the orbital floor defect, mid-facial asymmetry and orbital deformity 

Orbital floor reconstruction

6 months later, a new surgical intervention was performed to solve the left diplopia and mid-facial asymmetry. The facial asymmetry was remarkably reduced and resolution of diplopia for distance vision was obtained. Low rpm drilling was used to hand-shape 1.5 cm length and 1, 2 cm deep iliac crest homologous graft bone following the shape of a silicon mould and fixed to the titanium mesh plate with titanium screws and was fixed to the orbital floor rim.

iliac crest homologous bone graft hand shaping and its fixation to the infraorbital rim with titanium mesh

The facial asymmetry was remarkably reduced after surgery. Post-op CT scan confirmed good results and eighteen months after surgery, vertical diplopia was present on extreme downgaze only.

References

Orbital Floor Reconstruction in Facial Asymmetry: A Clinical Case https://clinmedjournals.org/articles/tcr/trauma-cases-and-reviews-tcr-1-016.php?jid=tcr

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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