Jochbein- und Mittelgesichtsfrakturen sowie posttraumatische Orbitadefekte – primäre und verzögerte primäre Versorgung

Midface fractures represent the most frequently occurring fractures in the facial region and are usually caused by blunt trauma or road traffic accidents. Symptoms vary depending on the extent of the fracture and the degree of dislocation. High-resolution three-dimensional imaging (CT or CBCT) should be performed as standard in cases of clinical suspicion. Immediate surgical intervention is often unnecessary; in the orbital region it is, however, essential if there are signs of incarceration of the intraorbital musculature and in the case of space-occupying bleeding, to prevent permanent damage to the visual apparatus. In the case of midface fractures, primary surgical treatment in the form of open reduction and internal fixation is usually the treatment of choice. The number and position of osteosynthesis plates should be decided individually according to the injury pattern to be determined by the abovementioned algorithm. In the case of orbital fractures, the location of the defect is often decisive for the clinical symptoms. A decision must then be made between conservative and (delayed) primary surgical treatment. State of the art here is treatment with patient-specific implants if the so-called key areas are involved radiologically, ideally in combination with intraoperative navigation and intraoperative imaging.