Management of the orbital rim and floor in zygoma and midface fractures: criteria for selective exploration.

The management of zygomaticomaxillary and midface fractures has been revolutionized in the past decade as a result of improved surgical access, rigid plating systems, and high-resolution computed tomography. Previously, virtually all midface fractures underwent mandatory orbital exploration to aid in reduction and stabilization. This article emphasizes the importance of reducing and fixating the facial buttresses involved in zygomatic complex fractures, and recommends orbital exploration on a selective basis. Criteria are given to decide which patients require orbital rim and floor exploration. If a patient's fracture does not meet these criteria, the fracture is managed by exposing, reducing, and stabilizing the major facial buttresses involved without performing an orbital exploration. Ninety-seven patients with zygomatic complex fractures were examined and treated with selective orbital rim and floor explorations. Most patients could be managed without the need for orbital exploration, and all were felt to have good fracture reduction and stability. We feel the selection criteria reliably identify patients who do require an orbital exploration and allow the treating surgeon to direct surgical treatment to the site of injury.