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Year : 2019  |  Volume : 22  |  Issue : 9  |  Page : 1307-1310

Management of ocular dystopia and lacrimal pathway obstruction in old multiple midfacial fractures: Case report

1 Resident of Ophthalmology Department, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
2 Plastic and Reconstructive Surgery Division, Ophthalmology Department, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Correspondence Address:
Dr. Y Irawati
Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Kimia Street No. 8, Central Jakarta - 10440
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njcp.njcp_460_18

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Midfacial fracture is discontinuity of the bone affect maxilla, palate, zygomatico-maxillary complex, nasal bones, orbits, nasal-orbital-ethmoid complex, and frontal sinus. Delayed treatment can lead to malunion or nonunion bone. A 28 years old man presented with epiphora of the left eye and upgaze diplopia. There were enophthalmos, hypoglobus of the left eye, flat nasal bridge, and depressed left malar eminence. CT scan examination revealed multiple fractures of left nasal bone, left and right anterolateral wall of maxillary sinuses, left medial orbital wall and orbital floor, and left zygomatic bone. Lacrimal irrigation test showed obstruction of left nasolacrimal duct. He underwent osteotomy and fixation with plate and screw, orbital floor reconstruction with silicone block implant, external dacryocystorhinostomy with silicone tube insertion procedure. In delayed treated malunion of midfacial fracture, fixation with plate and screw after refracture using an osteotome and orbital floor reconstruction with silicone block can be a good option for restoring normal anatomy. External dacryocystorhinostomy with silicone tube insertion is an effective treatment for post traumatic nasolacrimal duct obstruction.

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