Significance of the orbital floor in zygomatic injuries.

Fifty years after the publication of Harold Gillies' work, an assessment of zygomatic injuries is made, in the light of a half century of medical advances. Recent experience suggests that the fractured orbital floor is the commonest and most significant component of all zygomatic injuries. Exploration of 582 floors in the last 5 years revealed that over 20% had true blowout fractures, without damage to the orbital rim. A further 5% had torn periosteum with only minimal bony damage. Only two cases (0.3%) had fractures of the rim without a blown-out floor. The significance of floor damage is considered. This is usually more severe than expected. Even minimal damage--torn periosteum alone--may be followed by severe late sequelae, out of proportion to the magnitude of the apparent injury. If such sequelae develop late, their relationship to the injury is not suspected. The related soft tissues are very vulnerable. Vigorous manipulation of the malar (or maxilla in LeFort II injuries) does as much damage to them, as did the original trauma. Our therapy should be designed to protect these tissues during necessary manipulation.