Surgeon(s): ***

‍Assistant Surgeon(s):  ***

‍Preoperative Diagnosis: ***

‍Postoperative Diagnosis: Same

‍Procedure(s): ***

‍Anesthesia: General

‍Implants: None

‍Specimen:***

‍Drains: None

‍Fluids: See anesthesia record

‍EBL: Minimal

‍Complications: None

‍Counts:  Correct x2

‍Indications: ​***

‍Findings: As expected

‍Procedure in Detail:

‍The patient was seen in the preoperative holding area with a H&P was updated, consents were verified, surgical site marked, and all questions and concerns related to the proposed procedure were discussed in detail.  The patient was transferred to the operating room by the anesthesia team.  The patient underwent general anesthesia with endotracheal intubation. Tegaderms were placed over the eyes. The patient was prepped and draped in the standard fashion for maxillofacial procedures.  A time-out was performed and the procedure began.

Local Anesthetic

***50:50 mixture of 0.5% marcaine with epi and 1% lidocaine with epi

***0.5% marcaine with epinephrine 1:200,000

***1% lidocaine with epinephrine 1:100,000

***Was used in local infiltration in the maxillary vestibule and the lateral brow of the affected side

Exposure and Approach

***Cautery was used to make a maxillary vestibular incision ~5mm from the mucogingival junction from midline to the second molar area.  Once through mucosa this incision was carried down to bone.  A periosteal elevator was used to raise a FTMP flap to expose the pyriform rim, infra orbital rim, visualizing the infra orbital nerve intact, and the zygomatic maxillary buttress.

***A 15 blade was used to make a blephroplasty incision in a skin crease > 15mm from the lash line through the skin.  Obicularis oculi was divided with cautery. Cautery was then used to carry the incision down to the supra orbital rim.  Periosteal elevator used to raise a sub periosteal flap to expose the ZF suture and fracture line.

***

Reduction

Periosteal elevator and finger pressure was used to reduce the ZM buttress, ZF suture, infra orbital rim and arch.

Fixation

All plates were adapted to fit passively and span the reduced fracture with at least two screw holes on either side of a fracture.  All plates were secured by drilling holes with a TPS drill using copious irrigation to minimize heat generation and subsequently screws were placed to finger tightness until plate was securely fixated.

L plate from ZM buttress to maxilla - *** screws

Curvilinear plate to span ZF suture - *** screws

***After initial stabilization with the two plates, intraoperative CT imaging confirmed adequate reduction of the fracture and appropriate re-establishment of the zygomatic body projection.

Closure

All fracture sites were copiously irrigated with normal saline.

***Intra oral incision closed with 3-0 chromic gut suture in simple running fashion.

***4-0 vicryl suture was used to re-approximate periosteum over the ZF suture.

***6-0 fast gut suture was used to close the skin incision over the brow.

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The patient's face was then cleaned and the posterior pharynx was suctioned. An OG tube was used to suction out the contents of the stomach. Tegaderms were removed from the eyes. Dressings were placed. The patient was then transferred back to the care of the anesthesia team for extubation and recovery.

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