Q: Dr. Eppley, I had fracture of my cheekbone and eyesocket and four plates with eight screw were implant in my face…………..I want to ask can I remove these plates once if my fracture got healed??……Will there be any problem of refracture or any another problem after plate removal??
A: It sounds like you have a very typical zygomatico-orbital complex fracture which required three/four point fixation for anatomic realignment.There should be no problem with removing your fixation hardware 6 to 12 months after your original facial fracture repair. Facial bones generally heal completely by 6 months after surgery so removing them should not be a problem. Barring any future facial trauma, removing your plates and screws will cause the bones to collapse or refracture. Given the re-entry operative trauma to remove your hardware, there should be compelling reasons to do so such as uncomfortable palpability, cold temperature transmission or plate and screw loosening.
Dr. Barry Eppley
Q: Dr. Eppley, several weeks ago I had surgery to repair a cheekbone fracture. However, I am not satisfied with the results. The cheek bone fracture was repaired through an incision in my temple hair. I was told by the surgeon the fracture couldn’t be accurately aligned and fixed together without significant scarring so this was the best way to do it. Is this possible for you to do? Is it too late? I have attached a picture of how I look now so you can see that my cheek is flat but the side of my face is wider than before.
A: Your history and picture are very helpful in understanding what type of zygomatic fracture that you have.It appears you have a classic ZMC fracture with inward rotation of the cheekbone complex into the maxillary sinus. This is the classic direction that it rotates when displaced, down and in. That explains the orbital rim-zygomatic flattening with the lateral facial widening (bowing out of the zygomatic arch) that you have.
I wonder why a Gilles approach as used for your repair that as that would never work. The Gilles approach is for an isolated zygoimatic ARCH fracture not a body fracture. Your cheekbone fracture repair could be fixed by either an intraoral incision alone or combined with a lower eyelid approach. The bones could be realigned and then secured by plate and screw fixation. That would not result in any significant scarring. That is the classic and best approach with hat appears to be your zygomatic fracture.
Dr. Barry Eppley