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Fat Transposition to Decrease Orbital Rim Hardware Palpability
Ashley Leberfinger, MD, Michael Subichin, MD
Summa Health
2024-01-26
Presenter: Ashley Leberfinger
Affidavit:
This represents the original work of the fellow.
Director Name: Ananth Murthy
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND:
Zygomaticomaxillary complex (ZMC) fractures are the most common midface fracture, accounting for 15-23.5% of fractures. Adequate reduction is important for both aesthetic and functional reasons. Hardware may become palpable, visible, or cause cold sensitivity requiring removal. Incidence of plate removal from the infraorbital rim (IOR) has been reported as high as 30%. We sought a technique to minimize the risk of palpable or visible IOR plates.
METHODS:
We performed a retrospective review of patients with ZMC fractures and IOR plates seen by a single surgeon from 2020-2023. To decrease palpable or visible hardware, we utilized a technique commonly used in cosmetic lower eyelid surgery: fat transposition. The lower lid medial and middle fat pads were transposed over the IOR plate.
RESULTS:
The fat transposition technique was used in five patients. Four males and one female. Patient ages ranged from 20-40. There were no complications and operative time was similar. Minimum follow-up time was three months. The lower lid incisions healed well. No patients developed palpable or visible hardware during the follow-up period. Comparatively, patients without this technique had a hollow lower eyelid, palpable hardware, and hardware extrusion.
CONCLUSION:
Similar to facial aging, fat atrophy is seen after trauma. Lower lid fat transposition of the medial and middle fat pads reduces IOR hardware palpability and visibility after ZMC fracture fixation. This decreases the need for plate removal. There is minimal increased risk and operative time added to the procedure. Further studies will include a larger sample size with longer follow-up.
