PMC5526466_01
Computed tomography scan showing fractures in the zygomatic bone, maxilla and mandible after trauma.
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After this period, healing of the facial fractures had already progressed substantially (Fig. 1) and the patient was referred to the oral and maxillofacial sector of the hospital.
Frontal view of the patient one year after the first surgical intervention. Note the presence of enophthalmos, dystopia and deficient projection of the zygomatic bone.
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Physical examination revealed the presence of enophthalmos, dystopia, deficient projection of the zygomatic bone, facial nerve damage and amaurosis, which resulted in a perceptible esthetic defect and discomfort to the patient (Fig. 2).
Surgical planning using titanium plates and meshes.
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A mirror image was produced with the Invesalius 3 Beta 4 software, dividing the image in the midline of the face and reproducing the healthy side to obtain a perfect and symmetric model of the face. After image editing, a prototype was printed in resin that reliably reflected the bone structure of the patient (Fig. 3). Next, surgical planning aimed at sectioning and correct repositioning of the zygomatic bone was performed, including pre-shaping of the plates and fixation in the model (Fig. 3).
Computed tomography scan obtained after the second surgical intervention.
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A system of 2.0-mm titanium plates with monocortical screws was applied (Fig. 4).
Frontal view of the patient 40 days after surgery.
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The postoperative outcomes were satisfactory, permitting functional and esthetic rehabilitation of the patient (Fig. 5).