Prophylactic Midface Lift in Midfacial Trauma

Abstract

The objective was to review our favorable experience in the use of prophylactic midface lifts in the setting of severe midfacial trauma. A retrospective review of a consecutive series of patients undergoing prophylactic midface lifts at the time of definitive fracture repair in a County Hospital Level 1 trauma center was done. All patients undergoing midface lifts at the time of fracture repair by the senior author from July 1998 to July 2012 were included in this review. A total of 72 patients (58 males, 14 females, average age: 36.2 years) were available for review. Sixty-three patients had a minimal follow-up of at least 3 months. No complications felt to be related to the midfacial suspension were noted. There were no instances of frontal nerve paralysis or palsy. There were no patients with ectropion. Patient midfacial symmetry was evaluated by two blinded facial plastic surgeons. It was felt to be excellent in 53 patients, good in 9, fair in 1, and poor in none. The force of trauma necessary to elicit a severe midfacial fracture and the subsequent subperiosteal dissection required to expose the fractures for rigid fixation result in severe laxity of the midfacial soft tissue envelope. Failure to suspend and support these soft tissues will result in significant facial asymmetry. Prophylactic endoscopic midface suspension appears to be a safe and effective method of largely eliminating this problem and should be considered in the setting of severe midfacial fractures.

Keywords

midface lift - maxilla fractures - facial trauma - facial deformity - endoscopic surgery

• References

• 1 Le Fort R. Experimental study of fractures of the upper jaw: parts I and II. Rev Chir Paris 1901; 23: 208 ; translated by Tessier P and reprinted in Plast Reconstr Surg 1972;50:497
• 2 Manson PN, Hoopes JE, Su CT. Structural pillars of the facial skeleton: an approach to the management of Le Fort fractures. Plast Reconstr Surg 1980; 66 (01) 54-62
• 3 Stanley Jr RB. Rigid fixation of fractures of the maxillary complex. Facial Plast Surg 1990; 7 (03) 176-184
• 4 McRae M, Frodel J. Midface fractures. Facial Plast Surg 2000; 16 (02) 107-113
• 5 Kelley P, Hopper R, Gruss J. Evaluation and treatment of zygomatic fractures. Plast Reconstr Surg 2007; 120 (07) (Suppl. 02) 5S-15S
• 6 Yaremchuk MJ, Kim WK. Soft-tissue alterations associated with acute, extended open reduction and internal fixation or orbital fractures. J Craniofac Surg 1992; 3 (03) 134-140
• 7 Meslemani D, Kellman RM. Zygomaticomaxillary complex fractures. Arch Facial Plast Surg 2012; 14 (01) 62-66
• 8 Cultrara A, Turk JB, Har-El G. Midfacial degloving approach for repair of naso-orbital-ethmoid and midfacial fractures. Arch Facial Plast Surg 2004; 6 (02) 133-135
• 9 Paul MD, Calvert JW, Evans GR. The evolution of the midface lift in aesthetic plastic surgery. Plast Reconstr Surg 2006; 117 (06) 1809-1827
• 10 Ducic Y. Fat grafting in trauma and reconstructive surgery. Facial Plast Surg Clin North Am 2008; 16 (04) 409-416 , v–vi
• 11 Phillips JH, Gruss JS, Wells MD, Chollet A. Periosteal suspension of the lower eyelid and cheek following subciliary exposure of facial fractures. Plast Reconstr Surg 1991; 88 (01) 145-148
• 12 Gruss JS, Whelan MF, Rand RP, Ellenbogen RG. Lessons learnt from the management of 1500 complex facial fractures. Ann Acad Med Singapore 1999; 28 (05) 677-686
• 13 Frodel Jr JL, Rudderman R. Facial soft tissue resuspension following upper facial skeletal reconstruction. J Craniomaxillofac Trauma 1996; 2 (04) 24-30
• 14 Quatela VC, Marotta JC. Pitfalls of midface surgery. Facial Plast Surg Clin North Am 2005; 13 (03) 401-409
• 15 Defatta R, Ducic Y. Midface lifts. Operative Tech Otolaryngol 2007; 18: 217-232