Management Of Zygomatic Complex Fractures Research Articles

The ‘Manchester’ method of minimal access fixation of the zygomatic arch in zygomatic complex fractures: a case series

We have introduced a minimally invasive approach for the fixation of the zygomatic arch during the surgical management of zygomatic complex fractures. Access for this technique is provided by a preauricular approach and eyelid incisions with the addition of transcutaneous stab incisions overlying the arch. These stab incisions allow transcutaneous drilling and screw placement through a size CH 20 (5.0 mm) paediatric nasopharyngeal airway (NPA). We present a case series of seven patients. In all patients the arch component was successfully reduced and fixed, and no intraoperative or postoperative complications were observed. The use of an NPA is novel. It functions as a flexible self-irrigating sleeve and protects the skin from mechanical and thermal damage. The technique uses readily available equipment, is easy to learn, and simplifies surgery to the zygomatic arch.

Management of zygomatic fractures using different surgical approaches.

Management of zygomatic complex fractures using closed reduction, two point open reduction with internal fixation (ORIF), closed reduction with three point ORIF and two point ORIF is of interest to dentist. 150 patients with zygomatic bone fractures between the ages of 14-60 years were included in the study. At final assessment, the percentage of stable condition was greater in closed reduction + two point ORIF and closed reduction + three point ORIF when compared to two point ORIF alone and three point ORIF alone and closed reduction alone. It was observed that stable condition was lowest in closed reduction alone. It was also observed that stable condition was lower in closed reduction + two point ORIF as compared to closed reduction + three point ORIF. It was also further noticed that stable condition was lower in two point ORIF alone as compared to three point ORIF alone. The treatment approach involving closed reduction and three point ORIF had better outcomes for management of zygomatic complex fractures.

Retrospective Analysis of Management of Zygomatic Complex Fractures

Introduction Zygomatic bone and its surrounding bony anatomy are essential for maintaining facial contour—cheek prominence and orbital integrity. Management of the zygomatic complex (ZMC) fractures are important in the maintenance of function and facial integrity. Aim and Objectives To analyze the incidence, aetiology, surgical management, and complications encountered in the treatment of ZMC fractures in our super-specialty hospital, and to compare the number and location of fixation points and surgical access in our patient cohort with the literature. Materials and Method Retrospective analysis of all operative cases (Open Reduction and Internal Fixation) of ZMC fractures over a 3-year period (2017-2021) were reviewed. Craniofacial maxillofacial trauma patient’s medical records were collected and out which only the ZMC fracture cases were reviewed. Only the medical records from the period from 2017 to 2021 were included. The parameters such as etiology, site of the ZMC fracture, type of fracture, associated injuries, clinical findings, treated with conservative or surgical intervention, type of incisions used, number of fixation used, and any complications encountered were reviewed and analyzed. Results Out of 428 cases of craniofacial injury, 96 cases were ZMC fractures, isolated ZMC fractures accounted for 43%, 33% with associated injuries, 13% isolated arch, while 11% accounted isolated infraorbital rim fracture. Most common clinical findings were subconjunctival ecchymosis (71%), flattening of cheek (39%), malocclusion (22%), and so on. Buccal sulcus incision (66%) was mainly used, followed by upper blepharoplasty incision (59%). Depending on degree of displacement of fracture 1-point fixation (8%), 2-point fixation (30%), or 3-point fixation (27%) was performed. About 33% of cases were conservatively managed and followed up on regular intervals. Lymph edema, infra orbital paresthesia, temporary blindness, diplopia, hemianopsia were some of the complications encountered which were managed successfully and followed up. Conclusion ZMC fractures are most commonly occurring midface fractures with variable etiologies. The most common ZMC fracture pattern was tripod type of fracture. Greater portion of the patient were treated with 2-point fixation. Most of the complications were due to the impact and velocity of trauma.

Comparative radiological assessment of orbital volume restoration following management of zygomatic complex fractures

ObjectiveComparative radiological assessment of Orbital volume (OV) restoration following management using an established protocol in Low (LE) (Group I), Middle (ME) (Group II) and High Energy (HE) (Group III) Zygomatic Complex (ZMC) fractures on Non-Contrast Computed Tomography (NCCT). MethodsA prospective study was conducted with a total of 60 patients (20 in each group) which included patients greater than 18 years with clinical and radiological diagnosis ZMC fractures. Patients with history of Midface fractures and/or surgical procedures, pre-existing facial asymmetry were excluded. The volume of the bony orbit on the affected side (OVpre) and the unaffected side(OVN) were elicited using the software available with the CT scanner. Management was undertaken according to contemporary protocols. Post-surgical orbital volume (OVpost) on the treated side was elicited after 06 months. ResultsNo significant differences between OVN and OVpre, OVpre and OVpost, OVN and OVpost were evident in both Group I and Group II. In Group III, significant differences between OVN and OVpre as well as between OVpre and OVpost were identified. No significant differences were evident between OVN and OVpost. ConclusionThis study validates this widely used protocol based on restoration of orbital volume. It can be concluded that management of LE and ME fractures have to be driven clinically other than OV, while with HE fractures, OV is an important objective parameter that should be addressed. The contemporary protocols used in the current study restores the volume of the affected orbit.

Commentary on “surgical management of zygomatic complex fractures in a major trauma centre”

Commentary on “surgical management of zygomatic complex fractures in a major trauma centre”

Surgical management of zygomatic complex fractures in a major trauma centre

Aim: To analyse the epidemiology, aetiology, and surgical management of zygomatic complex (ZMC) fractures in our major trauma centre, and to compare the number and location of fixation points and surgical access in our patient cohort with the literature.

The Management of Zygomatic Complex Fractures: A Review

The face symmetry has prominent role in the human body after injuries and accident. The zygomatic region is important factor in the injuries face. Due to its location, its fracture is the 2nd frequent fractured bone of mid-facial. Zygomatic bone fractures are more abundant in young males and its incidence and etiology is different based on location. Post-traumatic facial deformity is the most incorrect reconstruction of the facial skeleton. Inadequate healing of the supported soft tissues lead to malposition of landmarks, shrinkage and thickening. The zygomatic bone fracture and coronoid process impingement lead to restricted mouth opening. Interruption in zygomatic position has psychological, aesthetic and functional effects which impairs the function of mandible and ocular tissue. Therefore, diagnose and properly management of the zygomatic bone injury is important. Healing displaced fragments of zygomatic bone after inadequate fixation and reduction of fracture consequences facial asymmetry. There is a lack of information about evaluation of benefits and costs of different zmc fracture methods. So, this literature review was done to characterize the etiology, incidence, clinical findings and results of different treatment trends of zygomaticomaxillary complex fractures. Surgeons have been utilized numerous approaches, but there are different ideas for the best one.

Efficacy of two-point fixation in the management of zygomatic complex fractures - A prospective clinical study.

Introduction:Anatomic disfigurement caused by zygomatic fracture warrants intervention tore establish facial symmetry. It is most predictably restored to pre morbid condition by ORIF.Aim:To evaluate the efficacy of 2 point fixation in Zygomaticomaxillary complex fractures.Material and Method:20 patients with established ZMC fractures were operated using two point fixation method and followed up for upto 3 months.Results:2 point fixation revealed satisfactory functional and esthetic results.Conclusion:2 point fixation offers efficient outcome as compared to other modalities of management of ZMC.

Patient Perspective in the Management of Zygomatic Fractures.

Background:A clinical study was undertaken on the management of zygomatic complex fractures using various surgical approaches in the Department of Oral and Maxillofacial surgery during the past 3 years.Aims:The aim of this study is to evaluate the versatility of various surgical approaches.Materials and Methods:A total of 15 cases were selected following a clinical and radiological examination of fractures of the zygomatic complex. A standard pro forma was used to record the case history and findings. These cases were treated by mini plate or micro plate osteosynthesis. Reduction techniques used were Gillie's temporal approach, Dingman's lateral eyebrow approach, upper buccal sulcus approach, and inferior orbital approach. Fixations were done either by mini plate or micro plate osteosynthesis. To compare the effectiveness of the reduction and fixation techniques the following parameters were assessed: facial symmetry-corrected/unaltered, wound healing-good/impaired, mouth opening good/restricted, diplopia-present/absent, infraorbital nerve – present/absent.Results and Conclusion:Successful surgical treatment of the zygomatic complex fracture is influenced by its geometry. Whether the alignment may be successfully achieved or not by open reduction at single or multiple locations, can vary with the individual surgeon's experience.

Orthopaedic Bone Tap: A 'Jugaad' for Zygomatic Bone Reduction.

The use of the Carroll-Girard screw in the management of zygomatic complex fractures has been well documented. The instrument provides an excellent degree of control over the movements of the disrupted zygomatic bone. Often mentioned in textbooks and literature, they are not routinely available for the Indian maxillofacial surgeon. This often prevents the regular use of this approach. We have used the 2.5-mm orthopaedic bone tap that is very commonly available and routinely used in orthopaedic surgeries for reduction of the malar bone. The orthopaedic bone tap is easy to use and functions as an excellent alternative to the traditional Carroll-Girard screw.

‘Y’ Modification of the Transconjunctival Approach for Management of Zygomatic Complex Fractures: A Prospective Analysis

The purpose of this study was to clinically and radiologically evaluate reduction and fixation of isolated zygomatic complex (ZMC) fractures treated by Y modification of the transconjunctival approach. A prospective evaluation of ten patients was undertaken for a period of 6months using this modified approach from Jan 2012 to Jun 2013. Patients were examined preoperatively and post operatively at the end of 6months for symmetry discrepancies involving A-P globe projection, lateral canthal level, malar projection and diplopia in direct and extreme gazes. Cosmetic outcomes were assessed by clinical assessment and examination of photographs. Quality of reduction and stability of fixation was assessed by examination of postoperative images. All patients underwent a three point fixation of ZMC with reconstruction of the orbital floor using titanium mesh. Patients were post surgically followed up at regular intervals of 1, 3 and 6months. Immediate complications noted were chemosis, lid edema and lower lid retraction. Late complications included minor scleral show in two cases. All patients experienced significant improvement with excellent esthetic appearance and function. Y modification of transconjunctival approach provides excellent surgical exposure for ZMC fractures potentially avoiding the use of a second incision in the area of ZF suture. Although this technique provides good exposure and excellent esthetics, it requires more operating time and detailed knowledge of the anatomy of the lateral canthal region.

Management of zygomatic complex fractures – 9 year review in the Indian armed forces

Management of zygomatic complex fractures – 9 year review in the Indian armed forces

Management of zygomatic complex fractures in a tertiary hospital: a retrospective study.

This retrospective study was done to analyse the management of zygomatic complex fractures necessitating surgical intervention in a tertiary care hospital in a 8 year period in terms of incidence, cause, pattern and treatment. Two hundred and thirteen cases of zygomatic complex fractures treated during this period were analysed. One hundred and eighty three cases of zygomatic complex fractures were treated by a two point fixation while additional fixation was used in 25 cases and single point fixation in five cases. The main etiology in zygomatic complex fractures was Road traffic accidents (RTA) (83.56 %-178 cases) followed by sport injuries (10 cases-4.65%), accidental falls (19 cases-8.9%) and domestic violence (2.81%-6 cases). The average age at the time of injury was 34.36years with the age range being 7years to 75years. The highest incidence of fractures was seen in the third decade of life (102 cases) (47.88 %) followed by the second decade (44 cases) (20.65%), 41 cases (19.24 %) in the 4th decade, 8 cases each (3.75%) in the 5th and 6th decades, six cases (2.81%) in the 7th decade and four cases (1.87%) in the 8th decade. The protocol of two point fixation was found to be adequate in most cases of zygomatic complex fractures in terms of stability and restoration of contour and function.

Zygomatic complex fractures at the University College Hospital, Ibadan, Nigeria.

To determine the pattern of zygomatic complex fractures in a Nigerian population. A prospective study of cases managed. University College Hospital, Ibadan, Nigeria. Seventy six patients seen and managed between 1995 and 1999. The most common aetiological factor was road traffic accidents (81.6%). The male/ female ratio was 5.3:1. Most of the fractures occurred in the age group 21-30 years (51.3%). The most common fracture type was type 3 (32.5%) while open reduction and transosseous wiring was the most commonly performed surgical procedure for the management of zygomatic complex fractures in this study (46.25%). There is a need to pay attention to the improvement in automobile safety devices, compliance by motor vehicle occupants and improvement in rules and regulations guiding sporting activities.