title: Zygomatic fractures: Technical modifications for better aesthetic and functional results in older patients.
abstract: BACKGROUND
  The zygomaticomaxillary complex, with its intrinsically prominent convexity, is highly vulnerable to injury. In this study, we evaluated a novel combined approach to the reduction and stabilization of frontozygomatic dislocated fractures without aesthetic damage.
  
  
  METHODS
  Ten patients (mean age, 52 years) were referred for complex frontozygomatic dislocated fractures. Five patients underwent a transconjunctival approach without canthotomy in association with a transoral maxillary approach and lateral-rim skin incision, also without canthotomy. The other five patients underwent a traditional subciliary incision at the lower eyelid and a vertical lateral incision at the lateral orbital margin. Orbital floor reconstruction was achieved using two to three fixation points and autologous platelet-rich fibrin (PRF). During the 6-month follow-up, the patients were routinely evaluated using computed tomography.
  
  
  RESULTS
  Treatment was successful in all cases; there were no problems at surgery or postoperatively. During follow-up, all patients had satisfactory facial symmetry, no noticeable scar, ectropion, or lower-eyelid drop, and no functional impairment.
  
  
  CONCLUSIONS
  Aesthetic considerations are an important aspect of treatment planning in patients with orbitozygomatic fractures, because of the importance of the eye and lid areas to facial aesthetics. In our patients, good aesthetic results were achieved using a novel combined approach. In patients with a large orbital floor dislocation, the reconstructive titanium mesh can be covered by autologous PRF membranes to improve vascularization of the surgical site. By preventing aesthetic damage and functional impairment, our conservative approach is of particular utility in older individuals due to age-related tissue laxity.
authors.affiliation: Department of Medicine and Surgery, Unit of Maxillofacial Surgery, University of Salerno, Salerno, Italy. Electronic address: ancortese@unisa.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cortese
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Salerno, Italy. Electronic address: dr.mariocaggiano@gmail.com.
authors.forename: Mario
authors.initials: M
authors.lastname: Caggiano
authors.affiliation: Casa di cura Villa dei Pini, Department of Surgery, Section of Maxillofacial Surgery, Civitanova Marche, MC, Italy. Electronic address: amb.carlino@tiscali.it.
authors.forename: Franco
authors.initials: F
authors.lastname: Carlino
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy. Electronic address: giuseppepantaleo88@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pantaleo
mesh_terms: D000328:Adult; D000368:Aged; D005143:Eyelids / Q000601:surgery; D005147:Facial Bones / Q000293:injuries / Q000601:surgery*; D005260:Female; D000072039:Fracture Dislocation / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods*; D018460:Fractures, Comminuted / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009917:Orbital Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D015051:Zygomatic Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Elderly patients; Fracture; PRF; Zygoma