Which of the following condition is not indicated for surgical exposure of orbital floor in ZMC fracture?
Correct Answer: Oedema
Description: The decision to intervene should be based on signs, symptoms, and functional impairment. The decision need not be made hastily because ZMC fractures are not emergencies and treatment can be delayed, if necessary. However, during the first week following trauma, the soft tissue undergoes changes consistent with the usual sequence of wound healing. The form that they will ultimately take depends on the underlying bony architecture. Optimally, fractures are treated before the onset of edema from the traumatic incident. In practice, however, such timing of treatment is rarely possible.
When edema is moderate to severe, postponement of surgery for several days makes thorough examination and surgical treatment reliable and much easier tasks. Therefore, postponement of the decision to operate until facial edema resolves is recommended when the necessity for intervention is questionable. This approach may be used in fractures that are minimally displaced, when radiographic examination of the internal orbit shows no major defects. However, if the radiographic findings are so dramatic that intervention is definitely necessary, it may be advantageous to perform the surgery regardless of the facial edema present, because the final soft tissue contour may be superior to that which may occur when surgery is postponed. If the surgeon decides not to intervene, the patient should be observed for 2 to 3 weeks and a soft diet should be prescribed.
One should always remember that if a force is sufficient to produce a fracture of the zygoma, it is also sufficient to produce intracranial injuries. ZMC fractures are not life-threatening injuries and should not be given priority over more acute problems. Treatment need not be hastened if the neurologic state of the patient is in question because zygomatic fractures can be satisfactorily treated in several days, after the facial edema has resolved.
Ref: Fonseca 4th ed page no 363
Category:
Surgery
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