PMC3222451_01
Preoperative clinical appearance.
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F1
The patient is a 41-year-old man who presented to the emergency department with a 12-cm vertically oriented left facial laceration resulting from a chainsaw (Fig 1). The laceration extended from the height of the left cupid bow on the upper lip, through the left alar base, to the left superior eyelid as seen in Figure 1.
Computed tomography scan demonstrating injury pattern (a) axial view with unilateral nasal orbital ethmoid (NOE) segment rotated 180  into ectopic position, (b) coronal view demonstrating the ectopic bone from left nasal piriform rotated posteriorly, (c) 3D reconstruction of the bony injury left maxilla, and (d) red indicates the 22-mm segment of bone rotated posteriorly into the orbit. This ectopic bone was interposed between the inferior oblique and the medial rectus muscles of the left globe.
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F2
This 22-mm segment was rotated approximately 180  about the craniocaudal axis (Figs 2a and 2b).
Postoperative maxillofacial computed tomographic scan with 3D reconstruction (a) axial view, (b) anteroposterior 3D view, (c) oblique 3D view.
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F3
Postoperative computed tomographic scan obtained on the following day showed reduction of the bone fragment with no residual foreign body in the globe or evidence muscle impingement (Figs 3a-3c).
(a) Two weeks following injury the patient has shown good healing without orbital dystopia or early enopthalmus. (b) Lateral view demonstrates appropriate orbital position (tarsal plate sutures are still present at the eyelid margins).
eplasty11e44_fig4.jpg
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F4
Subsequent follow-up in clinic 2 weeks postoperatively demonstrated an acceptable aesthetic result without orbital dystopia or enophthalmos (Figs 4a and 4b).