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Case Report

Management of Mid-Facial Fracture with Ophthalmic Injury

Jessica Weynata,Seto Adiantoro,Abel Tasman Yuza,Faturrachman Faturrachman.

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Background: Trauma affecting mid-face often leads to lesions of soft tissues, teeth and bone, damaging the integrity of the orbital skeletons, and is frequently complicated by ophthalmic injury. Careful injury assessment and its complications are important to make optimal treatment decision. The aim of this paper is to present a case of mid-facial fracture with a brief review of the risk of ophthalmic injury and its surgical management preferred by the authors.
Case Report: A 19 year-old man was brought to the emergency room with swelling and multiple wounds at facial region after he was involved in a motorcycle accident 30 minutes earlier. Primary survey performed according to Advanced Trauma Live Support (ATLS) showed no live threatening condition. There was asymmetrical face with edema at left cheek and eye. We found no wound intra-orally and teeth occlusion was not possible. After careful physical examinations, we assessed his condition with the following injuries: mid-facial fracture with suspect muscle entrapment of his left eyeball. Laboratory and radiographic imaging were taken to support the diagnostic. The surgical reposition and fixation of the fracture were performed under general anesthesia by an oral maxillofacial surgeon and an ophthalmologist. Reduction using interdental wiring and fixation using plate and screw at facial buttress successfully returned the patient facial contour to its former condition and occlusion was achieved. A catheter balloon was inserted to his left maxillary sinus to obtain normal sinus volume and hold his eyeball to its position. Then the patient was followed up at 1 day, 1 week, and 1 month.
Discussion: Treatment of mid-facial fracture focuses on reductions to achieve exact orbital rim alignment, preserve ophthalmic function and normal dental occlusion. Immobilization of fracture requires various combinations of interdental wiring, inter-maxillary fixation, and open reduction with internal fixation.
Conclusion: Dealing with mid-facial fracture needs a sharp investigation to produce proper diagnosis. Ophthalmic injury is one of the common injuries accompanying mid-facial injury. Early surgical treatment is preferred to reduce risk of irreversible globe injury and maximizes the functional and cosmetic results.

Key words: Maxillofacial fracture, ophthalmic injury

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