left zmc # is the most common fracture encountrered, here is a brief overrview

1. Enbloc left ZMC #

2. Demographic details:
• Patient’s name: Ghulam Malik
• Age/sex: 55years/Male
• Residence:
• Opd no.
• Telephone number: 9419510213

3. Chief complaint:
• Patient gives an alleged history of trauma to face due to fall from
height 2 days back.

4. History of present illness:
• Patient was apparently alright 2 days back then he fell from a height
of 3 feet which led to trauma to his face. Patient gives a brief history
of loss of consciousness for 10 minutes. History of bleeding from nose
and mouth. History of multiple teeth avulsion. No history of vomiting.
Patient visited a primary centre initially where nasal pack was placed
and was later refered to omfs casuality.

5. Past medical and dental history
• Not significant.

6. General examination:
• Patient is conscious, cooperative and well oriented to time, place and
person.
• GCS score: 15/15

7. Local examination:
• Inspection:
• Abrasions present over left supraorbital and malar region.
• Edematous upper lip.
• Abrasions present over philtrum region
• Laceration present over upper lip and upper labial mucosa.
• Avulsion seen with 31 32 41 42 11 21 22
• Nasal pack is in place
• Interrupted Sutures present over upper labial mucosa

8. • Bilateral periorbital ecchymosis present
• Oedematous left side of face.
• Telecanthus and depressed nasal bridge present.
• Palpation:
All inspectory findings are confirmed.
Tenderness present over left infraorbital rim and left lateral orbital wall.
Tender anteriomedial wall of maxillary sinus
Step deformity seen in left infraorbital rim region.
Mouth opening: restricted.

9. Radiographic examination:
• On NCCT face,
Coronal section:
Infraorbital rim #
Orbital volume has increased
Left orbital wall
Clouding of left maxillary sinus.

10. • Axial section :
• # sz suture
• Anteriomedial and posterolateral wall of max sinus#
• Fractured left lateral pterygoid plate
• Lt zygomatic arch #
• Bilateral nasal bone fracture

11. Final diagnosis:
• Enbloc zygomaticomaxillary complex fracture.

12. Treatment plan
• Open reduction internal fixation

13. Instrument tray:
• Instruments for sterilization of the surgical field:
• Instruments for incision:
• BP handle
*Instruments for dissection:
Periosteal elevators
hemostat: curved and straight

14. • Instruments for retraction:
• Langenbeck retractor
• Cats paw retractor
• Skin hook
• Instruments for reduction:
• Bristows elevator
• Rowes elevator
• Carroll girard screw

15. • Instruments for fixation:
• Trauma kit
• 1.5 mm titanium miniplates
• Screws
• Straight handpiece
• micromotor

16. • Instruments for closure:
• Needle holder
• Adsons toothed and non toothed forcep
• Suture cutting scissiors
• Resorbable and non resorbable sutures

17. Choice of anesthesia
• Oral endotracheal intubation

18. Fixation:
• 3 point fixation
• Infraorbital rim
• FZ
• Zygomaticomaxillary buttress

19. Approaches:
• For Infraorbital rim:
• Infraorbital incision
• Subciliary
• Subtarsal
• transconjunctival

20. • For zm buttress:
• Maxillary degloving vestibular incision
• For FZ:
• Left lateral brow incision