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Background <p>Superior telescopic impaction of a tooth-bearing maxillary dentoalveolar segment into the orbital cavity is an exceptionally rare variant of midfacial trauma causing complex diagnostic and reconstructive challenges across the orbital, maxillary, and sinonasal regions.</p> Case Summary <p>A 34-year-old male presented four months after a high-energy motor vehicle collision with facial asymmetry, diplopia, and oroantral and oronasal fistulae. Imaging revealed a 4&#xa0;cm maxillary dentoalveolar segment (teeth 13–16) displaced superiorly into the right orbit with concurrent orbital floor and zygomaticomaxillary complex (ZMC) fractures, alongside a contralateral impacted nasal canine.</p> Intervention <p>The necrotic segment was retrieved via a modified upper blepharoplasty incision. Following a deliberate zygomatic arch osteotomy to create an infratemporal corridor, a pedicled temporalis muscle flap was transposed intraorally to reconstruct the combined palatal and orbital floor defect. The zygomatic arch was re-fixated using an 8-hole long miniplate, and rigid fixation of the ZMC buttress and infraorbital rim was performed using titanium miniplates.</p> Outcome <p>At six months, the patient demonstrated restored ocular motility, resolved primary gaze diplopia, improved mouth opening, and satisfactory aesthetics. Residual globe malposition from extensive medial wall injury necessitated referral to oculoplastic surgery. Staged secondary orbital reconstruction using a patient-specific implant (PSI) was subsequently completed following soft tissue stabilization.</p> Conclusion <p>This case highlights a rare orbito-maxillary trauma pattern managed through a staged, multidisciplinary approach. It underscores the importance of high-resolution imaging and vascularized regional flaps in complex midface reconstruction, particularly in delayed presentations.</p>

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Orbital Displacement of a Maxillary Dentoalveolar Segment Following Vertical Alveolar Impact: An Uncommon Sequela of Maxillofacial Trauma

  • 期刊论文

  • 发表日期：

    2026年6月17日

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  • Ankita Dahiya,
  • Virendra Singh,
  • Amrish Bhagol,
  • Rashmi Bawane

摘要

Background

Superior telescopic impaction of a tooth-bearing maxillary dentoalveolar segment into the orbital cavity is an exceptionally rare variant of midfacial trauma causing complex diagnostic and reconstructive challenges across the orbital, maxillary, and sinonasal regions.

Case Summary

A 34-year-old male presented four months after a high-energy motor vehicle collision with facial asymmetry, diplopia, and oroantral and oronasal fistulae. Imaging revealed a 4 cm maxillary dentoalveolar segment (teeth 13–16) displaced superiorly into the right orbit with concurrent orbital floor and zygomaticomaxillary complex (ZMC) fractures, alongside a contralateral impacted nasal canine.

Intervention

The necrotic segment was retrieved via a modified upper blepharoplasty incision. Following a deliberate zygomatic arch osteotomy to create an infratemporal corridor, a pedicled temporalis muscle flap was transposed intraorally to reconstruct the combined palatal and orbital floor defect. The zygomatic arch was re-fixated using an 8-hole long miniplate, and rigid fixation of the ZMC buttress and infraorbital rim was performed using titanium miniplates.

Outcome

At six months, the patient demonstrated restored ocular motility, resolved primary gaze diplopia, improved mouth opening, and satisfactory aesthetics. Residual globe malposition from extensive medial wall injury necessitated referral to oculoplastic surgery. Staged secondary orbital reconstruction using a patient-specific implant (PSI) was subsequently completed following soft tissue stabilization.

Conclusion

This case highlights a rare orbito-maxillary trauma pattern managed through a staged, multidisciplinary approach. It underscores the importance of high-resolution imaging and vascularized regional flaps in complex midface reconstruction, particularly in delayed presentations.