title: Criteria for selective management of the orbital rim and floor in zygomatic complex and midface fractures.
abstract: OBJECTIVE
  To develop objective criteria with which to identify patients with zygomatic complex (ZMC) or midface fractures who require a surgical exploration and treatment of the orbital component of their fracture to prevent postoperative enophthalmos, diplopia, or malar depression.
  
  
  METHODS
  Nonrandomized, prospective management of facial trauma patients.
  
  
  METHODS
  Urban, university referral center.
  
  
  METHODS
  Ninety-seven patients with facial fractures (72 with ZMC fractures and 25 with midface fractures) who presented to the maxillofacial and oculoplastics trauma teams at the University of Cincinnati, Cincinnati, Ohio, for management.
  
  
  METHODS
  The decision whether to include an orbital exploration as part of the management plan was made based on a specific set of physical and radiological criteria that are detailed in the text.
  
  
  METHODS
  Patients were evaluated postoperatively for possible complications related to the orbital and periorbital portions of their fractures.
  
  
  RESULTS
  Thirty-four percent of the study patients (30% of the patients with ZMC fractures and 44% of the patients with midface fractures) underwent orbital rim exposure and orbital floor exploration as part of their fracture management. Sixt-six percent of these patients (70% of the patients with ZMC fractures and 56% of the patients with midface fractures) were managed without orbital exploration. Postoperatively, none of the patients who did not undergo exploration experienced diplopia or enophthalmos and only 1 patient had a residual malar depression.
  
  
  CONCLUSIONS
  The criteria reported herein allow surgeons to identify the minority of patients with midfacial and ZMC fractures who require an orbital exploration for optimal fracture management. Orbital exploration, and its potential complications, can be avoided in the majority of patients with ZMC and midface fractures without significantly increasing the risk of morbidity related to the orbital component of their fractures.
authors.affiliation: Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Shumrick
authors.forename: R C
authors.initials: RC
authors.lastname: Kersten
authors.forename: D R
authors.initials: DR
authors.lastname: Kulwin
authors.forename: C P
authors.initials: CP
authors.lastname: Smith
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D009915:Orbit / Q000000981:diagnostic imaging / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D015050:Zygoma / Q000000981:diagnostic imaging / Q000293:injuries*