This is a 33-year-old male patient from Siliguri. He met with an accident about three months ago. He underwent emergent treatment at a nearby local hospital. He realized that the accident had left him with a left sided double vision. He underwent three surgeries for his double vision, but this persisted. A depressed fracture of his left eyebrow and maxilla had left him with facial asymmetry.
None of these issues were set right by the three surgeries. The oral surgeon who operated on him referred him to our hospital. He told the patient that all his problems would be set right.
He presented for consultation. Dr SM Balaji examined him and recommended a 3D CT scan. This revealed a malunited zygomaticomaxillary complex fracture. The treatment plan was then explained to the patient. This would involve the use of a costochondral bone graft.
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- Pre-operative view showing depressed left maxilla, prominent left zygoma
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- Pre-operative view showing depressed left eyebrow and increased width of the right nasal bone
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- Malunited zygomaticomaxillary complex and naso-orbital bone
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- Costochondral rib and cartilage graft harvested
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- Lateral wall of orbit and orbital floor reconstruction with Titan medpor
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- Left eyebrow defect augmentation done with cc bone graft
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- Left maxillary depression augmented using cc bone graft
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- Lateral Osteotomy done on right side of the nose
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- The left side zygomatic arch was refractured intraorally and pushed back
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- Immediately after suturing showing corrected left eyebrow defect
A costochondral bone graft was first harvested from the sixth intercostal rib. Reconstruction of the lateral wall of orbit and orbital floor was then done with a Titan Medpor mesh. This corrected the diplopia and enophthalmos. The left zygomatic arch was then refractured and pushed inwards. Attention then turned to the left maxillary defect and depression in the left eyebrow.
This was by using a costochondral bone graft, which was then fixed using titanium screws. The deviated left nasal bridge was then corrected using lateral osteotomy. The patient was very satisfied with the results of the surgery.
