Orbital floor reconstruction in zygomatic-orbital-maxillary fracture with a fractured maxillary sinus wall segment as useful bone graft material

The anterior maxillary sinus wall is a suitable and useful bone donor site for reconstructive bone graft material for blowout fractures in zygomatic-orbital-maxillary complex fracture surgery. A 51-year-old male patient was referred to the Division of Oral and Maxillofacial Surgery of Kagawa Prefectural Central Hospital after slipping down and bumping the right cheek against a rock at a hot spring on the previous night. The patient presented with complaints of diplopia and acute throbbing pain, and had a right midfacial concave deformity. Computed tomography revealed that the right midfacial deformity was due to comminuted fractures of the maxillo-zygomatico-orbital floor, a large orbital bone defect measuring 25 mm × 28 mm, and blowout of the orbital contents, which appeared to be the cause of the diplopia and ophthalmic dysfunction. Clinical examination by an ophthalmologist resulted in diagnoses of diplopia and enophthalmos. Open reduction and internal fixation of the maxillary-zygomatic segment, together with an orbital floor reconstruction with a bone graft taken from the fractured one-piece segment of anterior maxillary sinus wall at the intraoral reduction of the zygomatic-orbital-maxillary segment, were performed via a transconjunctival approach. The postoperative clinical course was successful with good bony reduction of the midface and full recovery of ophthalmological function. Use of the anterior maxillary sinus wall in the operative series of zygomatic-orbital-maxillary complex fracture open reduction surgery may be recommended as an effective and simple reconstruction material, shortening the surgery time for orbital reconstruction.