If you walk down a street with two friends, people you consider to be brothers, though blood is not a matter of the relationship or bond

, then it may be of benefit to know whether they share the same sentiment. Brotherhood implies devotion and devotion is quite often tested. If one of the two friends happens to share a different sentiment, a proper testing will surely prove the matter. Sometimes this proof will prove painful, and sometimes blood will indeed be a matter of the bond, or lack thereof.

After inducing general anesthesia with endotracheal tube intubation, you will be prepped and draped in the usual sterile manner, most likely with the placement of sclera shells.

If you and the assumed brothers happen upon a group of men vastly outnumbering your trio, and these men pass regrettable remarks upon you, a proper test of brotherhood and devotion may have arrived. If one of your brothers chooses to respond with words equally regrettable, it is your duty as family to appropriately deal with any resulting circumstances regardless of how dire they may be. If dire circumstances do not immediately result, you may find that you have misidentified the situation as a proper test of brotherhood and devotion.

Your left lateral canthus and lower eye lid will be infiltrated with local anesthetic. This is to ensure that the lateral canthotomy and inferior cantholysis do not rouse you from the aforementioned general anesthesia. A transconjunctival incision will be made below the inferior tarsal border with cutting cautery. Dissection will be carried down to the infraorbital rim, where traction sutures will eventually be placed. Then, with that same cutting cautery, the periorbita and periosteum will be incised at the level of the rim. This may expose multiple floating fragments that are characteristic of a comminuted fracture, likely the result of a fracture involving the orbital rim.

If one of the two assumed brothers happens to expediently disappear shortly after you part ways with the discourteous men, you may think nothing of it. They, however, may think differently and choose to launch what many call a “surprise attack.”

The periobita will be meticulously elevated off the orbital floor using orbital retractors and Freer elevators. Cottonoids may also be used to support the elevation. There may be a large fracture involving the orbital floor. If this is the case, the orbital contents will be elevated out of this orbital fracture, and care will be taken to ensure that no additional injury to the infraorbital neurovascular bundle is made during such a dissection.

As a result of such an unanticipated assault, you and your remaining brother will be forced to prove unequivocal devotion to one another. In hindsight, you’ll likely find it unfortunate that your third assumed brother had unceremoniously departed and was unable to stand with you in such an unquestionably uncivilized but unavoidable state of affairs. You may think of many unpleasant words beginning with “un” that you may choose to apply to your absentee acquaintance and the way you choose to interact with him henceforth.

Attention will be directed to the superior lateral orbital rim, the skin infiltrated with local anesthetic. A 15 blade will be used to incise the skin with a sub-brow incision. Dissection will be carried down to the periosteum. The periostium will be incised with cutting cautery. If a frontozygomatic fracture exists, it will be isolated with the placement of traction sutures.

With the number of assailants being more than you and your remaining brother, you may find it difficult to maintain a proper defense. At some point, you may find yourself pinned against a parked automobile by two of these men: one holding you firm against the automobile, while the other ensures your arms are restrained behind your back. A third may then choose to deliver several powerful blows to your face with his fist. You may assume that your best defense is a strong offense by means of those limbs that remain unrestrained. Nevertheless, you will find this to be a futile plan regardless of how many times your foot strikes your assailant in the face as he advances repeatedly with said fist. The analgesic effects of phenylcyclohexylpiperidine will prevent any physical pain from registering within your assailant, while its hallucinatory effects will cause him to interpret your blows in such a manner that only further stimulates the rage psychosis typically accompanying phenylcyclohexylpiperidine absorption.

Kocher clamps will be used to elevate any zygomatic and maxillary fractures into appropriate alignment. A Synthes plate, most likely titanium and of very precise dimensions, will be used to bridge the fronotzygomatic fracture. Several screws, again most likely titanium, will be used to anchor the Synthes plate in place.

Your assailants, being fond of surprises, will indeed be very surprised if your proven brother had a “secret weapon” in his possession for such unexpected, yet entirely possible, situations. If your brother were to use his secret weapon against your assailants to properly defend both of you from their assault, you will find that you must thereafter keep the use of the secret weapon a secret indeed. For a proper test of brotherhood and devotion may come not only in the form of uncivilized circumstances, but also in the form of maintaining confidentiality.

Attention will then be directed to the infraorbital rim where a fracture is also likely to exist. Again, a titanium Synthes plate will be placed to bridge the fracture of the inferior orbital rim, though it will be necessary to form it in an appropriate contour after being cut to precise dimensions. As before, a hand-held manual drill will be used to place several titanium screws in order to anchor the Synthes plate. If any free-floating bone fragments remain, they will be anchored to either of the Synthes plates using stainless steel wire with knots buried in the surrounding tissue.

If you walk down a street with a person you choose to consider to be a friend, and you consider that friend to be a brother, it would be very wise to know whether they share such sentiment. Brotherhood implies a blood relationship, and though no blood relationship may exist, blood may indeed be a matter of the bond…or lack thereof.