DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left orbital zygomatic complex fracture with orbital floor blow-out fracture.
POSTOPERATIVE DIAGNOSIS: Left orbital zygomatic complex fracture with orbital floor blow-out fracture.
OPERATION PERFORMED: ORIF of orbital zygomatic, left, complex fracture with exploration without reconstruction of left orbital floor blow-out fracture.
SURGEON: John Doe, MD
ANESTHESIA: General.
FLUIDS: Crystalloids.
ESTIMATED BLOOD LOSS: About 25 mL.
DESCRIPTION OF OPERATION: The patient was brought to the operating suite and given general endotracheal anesthesia. Marcaine 0.5% with epinephrine was infiltrated into the areas where incision was made, which included the left upper buccal sulcus and the left lower eyelid. The patient was then prepped and draped in the usual sterile manner.
The left upper buccal incision was made with electrocautery. Dissection was carried through the mucosa down to the underlying periosteum of the maxilla. A Joseph periosteal elevator was then used to dissect up to the inferior orbital rim. Fractures were noted along the anterior maxillary sinus as well as the zygomaticomaxillary buttress. After getting exposure, we then went to make the subciliary incision. Incision was made just below the eyelashes on the lower lid, on the left side. Dissection was carried with scissors from the lateral to medial direction. The underlying muscle was identified and divided in the direction of its fibers.
Dissection was then carried just superficial to the septum orbitale. We went down to the inferior orbital rim and incised the periosteum. The Joseph periosteal elevator was then used to expose the fracture. The fracture was one of protrusion of the inferior orbital rim. This exposure was obtained. We went ahead and reduced the fracture by elevating the zygomatic prominence through the oral incision with an elevator. The inferior orbital rim protrusion was nice and flat and anatomically correct. Due to the comminution along the zygomaticomaxillary buttress, we placed the plate along the inferior orbital rim first. The Lorenz system was used for the fixation. Along the inferior orbital rim, an 8-hole plate was placed.
Multiple 3 mm screws were placed into the fracture and just medial and lateral to it. The plate was a 1.0 mm plate. We then went to the zygomaticomaxillary buttress and reduced the butterfly fragment along this fracture line and then placed a 1.5 plate; this was a 6-hole plate. Multiple 5 mm screws were placed along the fracture line. A 1.0 plate was then placed right along the side of that as there were some fragments along the anterior maxillary area that we wanted to reduce and fix anatomically. This was a 1.0 plate, 6-hole, and 3 mm screws used for the fixation.
The wounds were then irrigated. Hemostasis obtained. Wound closure was performed along the buccal sulcus with 3-0 chromic. The subciliary incision approximated with 6-0 fast-absorbing gut. The patient was then awakened, extubated, and taken to the recovery room in satisfactory condition having tolerated the procedure well.
