Q: Dr. Eppley, I had a shotgun injury to my face over two years ago with a lot of remaining metal pellets around my face. I had some fractures of the cheek bone and eye and these were initially fixed with metal plates and screws. I got an infection after surgery around my eyelid incision and cheek which then needed to be drained. Afterwards my eyelid was pulling down. I have a lot of residual problems from this injury and the subsequent surgery to fix it including a lot of pain from the plates, a down pulled eyelid and the movement of the metal pellets that are retained is quite uncomfortable. I am going to have another reconstructive surgery done. The doctor plans to use implants to replace the titanium mesh to build my orbital floor. He also wants to use an implant for my cheek as I have lost part of my cheek bone. A scar revision for my cheek will be done too. He says all this can be achieved in one surgery. What do you think about this treatment plan?
A: While much can be accomplished in another reconstructive surgery, it is important to do three things during your surgery. First, all currently indwelling hardare that is loose or easily palpable should be removed. This also applied to anmy remaining metal pellets in our face that can be identifed as easily accessible, palpable and known to be painful. Second the anatomy of the displaced bones should be fully exposed so the floor of the orbit and the cheek bone can be seen as to how much displacement they have. The debate is to whether these defects should be reconstructed with facial implants or bone grafts. Given your history of infection, I would be concerned about any implant that has exposure to your maxillary sinus. For this reason, I would lean towards using bone grafts when possible. Lastly, the lower eyelid ectropion can be released and resuspended. All of these procedures could be and should be done in a single operative session.
Dr. Barry Eppley