An 18-year-old patient with a head injury due to a traffic accident.
The patient had a Le Fort II fracture and right type II and left type I nasoethma that produced an anterior open bite, hypertelorism and bilateral orbital ecchymosis.
After ferulization of both arches, the maxilla is reduced and rigid block is performed.
Fractures are exposed from bilateral lower approaches.
A good stabilization of the maxilla and of the nasoethnic fracture in the left side was achieved.
A transconjunctival incision is made in the right that extends with a transcaruncular incision.
Both approaches join after the inferior oblique is deinserted.
Fragments were reduced to prove the reduction plane in the medial wall.
Osteosynthesis with microplates in an infraorbital rim.
We placed 20 mm per 25 mm SDP grafts on the medial wall until adequate volumetric restoration.
With a 13 mm needle Vicryl 5/0, suture of the periosteum was performed and the inferior oblique was reinserted.
A transconjunctival approach is not closed.
The patient did not report diplopia, and neither deficit or overaction of the lower oblique or the rest of the musculature was observed in controls at one week and two months after the intervention.
