Zygomatic Orbital Fracture Follow-up
- Author: Stuart Seiff, MD, FACS; Chief Editor: Hampton Roy, Sr, MD more...
Further Outpatient Care
Follow-up care is essential for the evaluation of surgical success. Masticatory function, globe position, and restoration of normal facial anatomy are all important elements that need to be critically addressed in the postoperative period.
Inpatient & Outpatient Medications
Most surgeons place patients on oral antibiotics and oral pain medications; they often order a short course of oral steroids as well.
The complications of an inadequately or unreduced zygomatic fracture are very difficult to correct secondarily. Malunion is the most common complication of zygomatic fractures and is the result of improper reduction and fixation, resulting in malocclusion, facial asymmetry, and enophthalmos.
Extraocular muscle entrapment, although usually attributable to the initial fractures, also can occur secondary to fracture repair. The rare complication of sudden onset blindness resulting from retrobulbar hemorrhage following reduction of even simple zygomatic fractures means that, in some instances, this procedure may be unsuitable for outpatient surgery. This serious complication, although rare (0.3% of treated zygomatic fractures), is potentially reversible upon early recognition of the symptoms and signs of retrobulbar hemorrhage (eg, pain, proptosis, loss of vision, decreased motility). If the surgeon suspects a retrobulbar hemorrhage, a lateral canthotomy and cantholysis should be performed as soon as possible. This should be completed at the bedside if the patient has visual compromise and is not near the operating suite.
Indicators of favorable outcome include bony union, absence of skeletal or soft tissue deformity, and a normal range of mandibular movement.
Advise patients to avoid nose blowing for fear of orbital emphysema and potential blindness. Also, warn them of the signs and symptoms of orbital/retrobulbar hemorrhage. Advise patients to call the surgeon at any time if orbital bleeding is suspected.
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