Reduction Of Zygomaticomaxillary Complex Fractures Research Articles

Preauricular Incision Approach as a Management of Zygomaticomaxillary Complex Fracture Reduction: A Case Report

Introduction: A zygomatico maxillary complex fracture is a facial bone fracture that commonly occurs as a centrally and laterally protruding zygomatic area. The effective surgical approach and exact reduction of the displaced fracture is the most important task in the treatment of a zygomatic fracture, from the aesthetic point of view. Determination of surgical approach and the fixation point of zygomatic arch fracture is one of the most challenging procedure. The purpose of this case report is to find out that the preauricular incison approach is one of the effective methods for reduction of zygomaticomaxillary complex fracture. Case Report: A 53 years old male patient presented with right zygomatico maxillary complex fractures. Diagnosis of right side tetrapod zygomatico maxillary complex fracture deformity was done by clinical examination and confirmed by computed tomography which included 3-D reconstruction view. The authors performed 4-point fixation using the preauricular approach to counter the disadvantages of the coronal approach. The results and usefulness of preauricular approach with 4-point fixation are reported in this study. Conclusion: Preauricular incision is an effective surgical approach for the reduction of zygomatic arch fracture. 4-point fixation using the easier-to-manipulate preauricular approach would be more useful than the conventional method that uses the coronal approach. Satisfactory reduction that showed exact correction was observed. In an outpatient follow-up, no complication such as nonunion or malunion was found, and facial symmetry was also shown. In addition, the preauricular scar was hardly observed. Keywords: zygomaticomaxillary complex fracture, preauricular incision, reduction, fixation

Comparison of Functional Recovery of Infraorbital Nerve Paresthesia Following Open and Closed Reduction of Zygomaticomaxillary Complex Fractures

Objective: To compare the functional recovery of infraorbital nerve paresthesia following open reduction as compared to closed reduction in zygomaticomaxillary complex fracture management. Study Design: Randomized controlled trial. Place and Duration of Study: Oral and Maxillofacial Surgery Dept. Dentistry Section, Ayub Medical College & Teaching Hospital, Abbottabad from 1st April 2016 to 30th September 2016. Methodology: Eighty two patients of infraorbital nerve recovery were included. They were divided in two groups; group A was treated by closed reduction technique, and group B was treated by open reduction with internal fixation technique using mini plates. Permuted blocks of 6 were used to ensure equal representation in both groups. All patients were underwent surgical management within 1-7 days following trauma. Patients were assessed post-surgery for infraorbital nerve recovery. Results: There were 63.4% males and 36.6% females in group A while 60.9% males and 39.1% females were included in group B with mean age was 28.44±7.15 years in group A and 27.93±7.33 in group B respectively. 51.2% patients have infraorbial nerve recovery in group A while 65.8% have infraorbital nerve recovery in group B. Conclusion: Closed reduction approach was found to be the best reduction technique and open reduction was effective in terms of stability, prevention of relaps and functional recovery of infraorbital nerve injuries. Key words: Functional recovery, Infraorbital nerve, Paresthesia, Closed reduction, Zygomaticomaxillary complex fracture

Intraoperative Use of Ultrasonography in the Reduction of Zygomatico-Maxillary Complex Fractures.

A single blind randomized controlled study. The aim of this study is to evaluate the use of ultrasonography intraoperatively to assess the reduction of unilateral zygomatic complex fractures with a control group using the conventional blind digit palpation. The study comprised of a sample size of 24 patients with 21 male and 3 female patients. Patients of all age groups diagnosed with unilateral displaced zygomatic complex fracture with or without mandible fracture were included in the study. The subjects were randomized into study and control groups based on a standard protocol with a total of 24 patients. Imaging was in the form of a preoperative and postoperative 3D computed tomography scan with reconstruction of the maxilla and mandible to interpret the diagnosis for all subjects. The inter-fracture distance of the fractured infraorbital rim were measured in 3 dimensions (antero-posterior, medio-lateral and supero-inferior) and compared pre and postoperatively. Preoperative, intraoperative and postoperative ultrasonographic examination was performed and recorded on all patients at the frontozygomatic region, infraorbital rim and zygomatic buttress to assess the proximity of the fractured margins pre reduction, post reduction and post fixation of the fracture segments. Statistical analytic results were significant in all 3 dimensions when measured postoperatively using computed tomography. Ultrasonography is an effective screening and intraoperative tool in the armamentarium of oral and maxillofacial surgery to assess zygomatic complex fractures, avoiding incisions in aesthetic areas of the maxillofacial region.

Defining the Zygomaticosphenoidal Angle as a Guide to Anatomic Zygomaticomaxillary Complex Fracture Reduction.

Alignment of the zygomaticosphenoid suture is fundamental to reduction of zygomaticomaxillary complex fractures. To prevent a rotational deformity, the correct angle of the zygoma relative to the cranial base must be restored. Clinically, this can be a challenge, especially when there is comminution of the zygomaticosphenoid suture. Defining a zygomaticosphenoidal angle would provide a reference for use with stereotactic navigation to achieve anatomic reduction. A single-center retrospective analysis of 100 patients was designed to determine normative zygomaticosphenoidal angle values. An angle subtended by the midline and a best-fit line through the zygomaticosphenoid suture on axial computed tomography was measured bilaterally in patients with isolated mandibular or nasal fractures. The mean of this measurement for 3 vertically adjacent cuts was calculated with position of central cut determined by the equator of the globe and trigone of the sphenoid. Multivariate regression was completed to identify changes in zygomaticosphenoidal angle with age, sex, and race. The mean zygomaticosphenoidal angle was 47° (range 39°-55°). 97% of angles were within 2 standard deviations (8°) of mean. Regression analysis demonstrated no significant change in angle with age (P = 0.74) or sex (P = 0.89). For each angle, the variation across the 3 sample cuts was ≤4.5°. Patients demonstrated high fidelity in zygomaticosphenoidal angle bilaterally with mean difference of 3°. The zygomaticosphenoidal angle is a useful reference, in conjunction with stereotactic navigation, for reduction of zygomaticomaxillary complex fractures. Contralaterally obtained patient-specific data may be used to guide unilateral repair. Normative values may serve as reference in bilateral injury.

Quantitative assessment of symmetry recovery in navigation-assisted surgical reduction of zygomaticomaxillary complex fractures

PurposeTo evaluate the effects of surgical navigation in zygomaticomaxillary complex (ZMC) fracture reduction. ZMC symmetry was assessed quantitatively. Materials and methodsThe sample comprised 25 patients who underwent surgical reduction of comminuted ZMC fractures. They were divided into two groups according to the use of surgical navigation. Reduction outcomes were evaluated using three-dimensional computed tomography models. Five pairs of landmarks were identified on all craniofacial models, and asymmetry scores were calculated based on their coordinates. In quantitative analyses, symmetry and orbital volume were compared between groups. ResultsAll patients recovered uneventfully. Greater symmetry was observed in the navigation group than in the control group for three of the five pairs of landmarks (p < 0.05). Although postoperative volumes of the injured orbits were similar between the two groups (p > 0.05), reduced orbital volumes were larger in the navigation group, indicating better restoration of the fractured orbits (p < 0.05). ConclusionsThe use of surgical navigation can increase postoperative symmetry of the bilateral ZMC. The quantitative evaluation of clinical outcomes is precise and highly reliable.

Comparison of infraorbital nerve recovery after open and closed reduction of zygomaticomaxillary complex fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Zygomaticomaxillary complex (ZMC) fracture is quite commonly seen fracture in the road side accidents (RTA). It is the second most common fracture after nasal bone fractures. Infraorbital nerve is almost always involved with ZMC fractures which can be treated with open reduction and internal fixation or closed reduction.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The aim of this study was to compare the recovery of infraorbital nerve paresthesia following open reduction and internal fixation verses closed reduction in the management of ZMC fractures. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Two groups with n=50 patients each, qualifying our inclusion criteria were selected, examined, reduced by open and closed reduction respectively and followed up.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The functional infraorbital nerve recovery was found among 74% patients those who underwent open reduction and internal fixation. While the patients treated with closed reduction the functional nerve recovery was seen in 52%.&lt;/p&gt;

The significance of orbital floor exploration during open reduction of zygomaticomaxillary complex fractures

The significance of orbital floor exploration during open reduction of zygomaticomaxillary complex fractures

Transconjunctival versus subciliary approach to the infraorbital margin for open reduction of zygomaticomaxillary complex fractures: a randomized feasibility study

Although some studies addressed the differences between subciliary and transconjunctival approaches, no previous prospective comparative study on displaced zygomaticomaxillary complex (ZMC) fracture that repaired by three-point internal fixation using also upper gingivolabial incision and upper eye lid incision. So, the effect of these incisions on the comparison was not investigated. The purpose of this study was to compare transconjunctival and subciliary approaches for open reduction and internal rigid fixation (OR/IF) of ZMC fractures. This prospective study was carried out on 40 patients had displaced ZMC fractures repaired by OR/IF. Patients were randomly assigned into two equal groups (20 patients for each); subciliary group subjected to subciliary approach and transconjunctival group subjected to transconjunctival approach for inferior orbital rim repair. In both groups, frontozygomatic and zygomaticomaxillary buttresses were also approached by lateral eye brow and superior gingivolabial incision, respectively. Primary outcome measures include accessibility (need for lateral canthotomy), the exposure duration, postoperative pain, early postoperative edema, and operative complications. Secondary outcome measures include dental occlusion, average intrinsic vertical mouth opening, post subciliary scar assessment, late postoperative complication, and opthalmological assessment concerning ectropion, entropion, scleral show, and eye globe affection (enophthalmos or diplopia). The mean duration from incisions to fracture exposure was 13.7±2.17min in subciliary approach and 14.6±2.31min in transconjunctival approach with nonsignificant difference (p=0.1284). Lateral canthotomy was required for proper exposure of the fracture and OR/IF using transconjunctival approach while not needed with subciliary approach. Ectropion and scleral show occurred in 10 and 15% respectively in subciliary group and were not encountered in transconjunctival group. Although postoperative periorbital edema was significantly more sever in transconjunctival group within the first postoperative week (p=0.028), no persistent periorbital edema was reported. Infection, hematoma, and globe complication were not detected in any patient. All authors characterized all scars of the subciliary group as unnoticeable. Transconjunctival approach mostly needs lateral canthotomy that was not needed with subciliary approach. Transient postoperative edema is more in transconjunctival approach while postoperative ectropion and sclera show was detected only with subciliary approach. So, building up of experience in transconjunctival approach will be beneficial for maxillofacial surgeons and more measures to avoid ectropion are needed with subciliary approach.

Evidence-Based Medicine: Evaluation and Treatment of Zygoma Fractures.

After studying this article, the participant should be able to: 1. Diagnose zygomaticomaxillary complex fractures from physical examination and radiographic findings. 2. Plan the necessary surgical approaches for operative treatment of zygomaticomaxillary complex fractures depending on severity. 3. Understand the three-dimensional anatomy of the orbit and zygomaticomaxillary complex and the importance of the zygomaticosphenoid suture along the lateral orbital sidewall. 4. Be aware of pitfalls and associated fractures that can complicate anatomical reduction of zygomaticomaxillary complex fractures. Fractures of the zygoma are some of the most commonly treated facial fractures, yet reconstruction of the three-dimensional structure of the zygomaticomaxillary complex can be challenging, and malunions are common. This article presents an evidence-based, systemic approach to the assessment and treatment of zygoma fractures from the simple to the complex. Anatomy, approaches, techniques, and pitfalls are described in an effort to improve the treatment of these common facial fractures.

Intraoperative use of C-Arm as an Aid in Reduction of Zygomatic Complex Fractures

ABSTRACT To monitor the efficacy of C-Arm as a intraoperative tool in reduction of zygomatic complex fractures. 15 patients with isolated zygomaticomaxillary complex fracture, were selected for reduction of the same. C-Arm (image intensifier) images were taken intraoperatively. Standardization of all postoperative radiographs were done to evaluate the discrepancy in reduction. The maximum discrepancy after analysis of postoperative radiographs was within 2 mm, which was considered as acceptable limit. Thus, C-Arm is considered a useful tool for reduction of zygomatico-maxillary complex fractures with enhanced postoperative esthetics and functional results.

Postoperative imaging of zygomaticomaxillary complex fractures using digital volume tomography

Three-dimensional imaging using digital volume tomography after reduction of zygomaticomaxillary complex fractures was performed and evaluated. Ten patients admitted for surgical treatment of zygomaticomaxillary complex fractures were included in the study. All patients were male, aged 17 to 81 years (average, 43.8 years). Preoperative diagnostics and surgical treatment involving open reduction under general anesthesia were performed as usual. One to 3 days (average, 1.6 days) postoperatively, a digital volume tomography data set was generated using the NewTom 9000 (NIM s.r.l., Verona, Italy). After DICOM-import in eFilm Workstation 1.8.3 (Merge Technologies Inc, Milwaukee, WI), axial, coronal, and sagittal reconstructions were evaluated by 6 examiners with the help of 5 defined criteria. One data set was sufficient to visualize all fracture sites of the midface in all patients. Postprocessing using eFilm was successfully performed in all cases. Best scoring results were found regarding bony anchorage of screws and fitting of plates. Remarkable was the low level of metal artifacts in primary and secondary reconstructions, even in close proximity of the material. Most difficulty was encountered during the identification of the medial orbital wall, especially next to poorly ventilated ethmoidal cells. Osseous structures of older patients with decreased bone density proved difficult to visualize. Digital volume tomography using the NewTom 9000 is suitable for assessment of postoperative results after zygomaticomaxillary complex reduction.

Status of the internal orbit after reduction of zygomaticomaxillary complex fractures

Purpose We sought to determine the status of the internal orbit before and after reduction of zygomaticomaxillary complex (ZMC) fractures when treated without internal orbital reconstruction. Patients and methods We conducted a retrospective study of preoperative and postoperative computed tomography (CT) scans in 65 patients with unilateral ZMC fractures who were treated by reduction of the ZMC complex without internal orbital reconstruction. The size and location of the internal orbital defects, orbital soft tissue displacement, and orbital volume were assessed in the preoperative and postoperative CT scans. Results Reduction in the ZMC fractures was considered ideal in 58 of the 65 patients. Only minor malpositions occurred in the remaining 7 patients. The size of the internal orbital defects increased slightly with ZMC reduction but the internal orbital fractures were realigned, and few had increases in orbital volume or soft tissue sagging into the sinuses. Examination of follow-up CT scans in several patients taken weeks to months later showed that the residual defects became smaller and that none of these patients had an increase in orbital volume or soft tissue sagging. Conclusion The preoperative CT scan can be used to assess the amount of internal orbital disruption for purposes of developing a treatment plan in patients with ZMC fractures. When there is minimal or no soft tissue herniation and minimal disruption of the internal orbit, ZMC reduction is adequate treatment.

A method for reduction of zygomaticomaxillary complex fractures

Many techniques have been developed for mobilization of the displaced zygomaticomaxillary complex fracture. These include the temporal fossa approach first described by Gillies et al, 1 Gillies HD Kilner TP Stone D Fractures of the malar-zygomatic compound, with a description of a new X-ray position. Br J Surg. 1927; 14: 651 Crossref Scopus (142) Google Scholar an upper buccal sulcus approach, 2 Balasubramanian S Intra-oral approach for reduction of malar fractures. B J Oral Surg. 1967; 4: 189 Abstract Full Text PDF PubMed Scopus (9) Google Scholar a lateral coronoid approach useful for medially displaced fractures, 3 Quinn JH Lateral coronoid approach for intra-oral reduction of fractures of the zygomatic arch. J Oral Surg. 1977; 35: 321 PubMed Google Scholar and multiple percutaneous approaches using hooks, 4 Crowe WW Treatment of depressed fracture of the zygomatic bone. J Oral Surg. 1952; 10: 3 PubMed Google Scholar , 5 Poswillo D Reduction of the fractured malar by a traction hook. Br J Oral Surg. 1976; 14: 76 Abstract Full Text PDF PubMed Scopus (20) Google Scholar Carroll-Girard screws, 6 Kreutziger KL Zygomatic fractures: Reduction with the T-bar screw. South Med J. 1992; 85: 1193 Crossref PubMed Scopus (15) Google Scholar and pins. 7 Manson P Discussion: Transcutaneous reduction and external fixation for the treatment of noncomminuted zygoma fractures. J Oral Maxillofac Surg. 1998; 56: 1387 Abstract Full Text PDF Google Scholar