Q: Dr. Eppley, I met with a facial trauma seven months before and doctor have to put plates on my right zygoma bone and maxillary sinus and eye socket with 14 screws. But now I feel a lot of pain under my eye and cheek. So can removal of plates help me from getting an infection? What can be the right time to remove them? What can be complications in future? Will my bones have an adverse effect of it or they will remain healthy?
A: As a general rule, fixation hardware (plates and screws) are not removed after facial fracture repair unless there is a distinct problem. Such problems could be pain from device loosening or palpability or cold temperature transmission (usually around the eye area) Most facial plates and screws today are made of titanium which is very biocompatible and does not have any long-term issues such as corrosion or degradation. Because of the trauma of additional surgery, one therefore should have a compelling reason for removal. Should removal be necessary, they can safely be removed six months after the original repair surgery. Facial bones heal quickly and are very stable at that time.
Dr. Barry Eppley
Q: Dr. Eppley, I was in an accident that fractured my nose, eye socket, cheekbone and jaw. I had 1 reconstructive surgery to place the bones back in place. After the surgery, months past and I was hoping for my face to begin to look the same as before. It has almost been a year and I hate how I look. Afraid of what the world has to think or say, I cover my face with sunglasses. I hate how I look and since then I’ve had a very low self esteem. I want to look for answers. Can my face be fixed? Or will I ever look the same or close to it? I can provide pictures of my face to determine if my face is at all repairable or if it’s just too late. Thank you.
A: Thank you for sending your pictures. I can see that you have a classic post-traumatic facial deformity, known as zygomatico-orbital displacement on your right side. While your initial facial fractures may have been surgically treated, they did not properly place your orbital and cheek (zygomatic) bones back into anatomic position or there were not supported well after reduction. Either way, your right ZMC complex is displaced downward showing the visible problems of orbital dystopia (eyeball in lower position than the other side) and the cheek bone being displaced downward and outward with increased midfacial width.
Your facial problems can be improved by a revision or re-do of your original facial fracture repair. This would be a zygomatico-orbital osteotomy with bone grafts to lift the eye back up and reshape the cheek area. Before considering this surgery, you need to have a 3-D CT scan to confirm this diagnosis and provide a detailed assessment of these and the surrounding facial bones.
Dr. Barry Eppley