The zygoma is positioned into its proper three-dimensional position taking care to properly line up the lateral wall of the orbit with the greater wing of the sphenoid.
Click here for description of fracture fixation of zygomatic complex fractures.
The proper alignment of the zygomatic arch and the infraorbital rim must be taken into consideration during the reduction of the various fractures.
The completion of the reconstruction of the periorbital areas is performed by addressing the NOE and nasal fractures.
Note: Where reconstruction of the medial canthal tendon is necessary it is the final step before wound closure.
The next step in midface reconstruction is fixation across the Le Fort I level.
If everything has been perfectly aligned, the fractures at the Le Fort I level should also align perfectly. If a patient has a malalignment at the Le Fort I level, the surgeon needs to reassess the other fracture alignments, and consider a correction.
From an esthetic standpoint, a minimal malalignment at the Le Fort I level is not as noticeable as a malalignment of the orbits. The surgeon needs to decide whether the malalignment at the Le Fort I level will be associated with occlusal problems.
The last fractures to be reconstructed are generally the fractures of the orbital walls and orbital floor.