Treatment Of Zygomatic Bone Fractures Research Articles

Causes, Types and Management of Zygomatic Bone Fracture in Patients Presenting at Tertiary Care Hospital

Aim: To assess the frequency of different causes, types and management options of zygomatic bone fractures. Method: A cross sectional study was conducted from March 2022 to March 2023 at Oral & Maxillo-Facial Surgery Department, Nishtar Institute of Dentistry, Multan. Seventy two zygomatic bone fracture patients were included meeting inclusion & exclusion criteria after complete clinical & radiological examination.Patient's demographic data, cause, type of fracture and treatment modality executed were collected on a specially designed proforma. Data was analyzed using SPSS version 22. Frequencies, percentages, mean ± standard deviation were taken. Results: Male to female ratio was 3.8:1 with male predominance. Road traffic accident was the leading cause of zygomatic bone fractures (n= 43,60.6%)while Rowe & Kelly’s type IV (inward & posterior) Fracture was most common type of fracture(n=21, 29.2%). ORIF with Two-point fixation was the most common treatment modality executed(n=27,37.5 %). Conclusion: Etiology varies due to geographic area, socio-economic status °ree of RTA. Type fracture depends upon side of impact and Open reduction is modality of choice for the treatment of zygomatic bone fractures. Keywords: Road traffic accidents (RTA);Open reduction & internal fixation (ORIF); zygomatic bone fracture.

Minimally Invasive Technique for Treatment of Zygomatic Bone Fracture

Minimally Invasive Technique for Treatment of Zygomatic Bone Fracture

Outcome of treatment of Zygomatic bone fracture by two point fixation versus three point fixation in Mayo Hospital Lahore.

To compare the outcome of two-point internal fixation versus three-point internal fixation for the treatment of zygoma fractures.The quassi-experimental study was conducted at the King Edward Medical University, Mayo Hospital, Lahore, Pakistan, from April to September 2016, and comprised patients with zygomatic bone fracture who were randomly divided into two groups. In Group A, patients were treated with two-point fixation and in Group B, patients were treated with three-point fixation. All patients were treated by the same consultant. Patients were followed up on first, third and sixth week postoperatively and malar height and mouth opening were recorded at the sixth week follow-up. Data was analysed using SPSS 17.Of the 60 patients, there were 30(50%) in each of the two groups. There were 39(65%) males and 21(35%) females. The mean age in Group A was 29.56±9.89 years (range: 17-50 years), while in Group-B it was 29.45±8.68 years (range: 17-49 years). Mean malar height at 6th week post-operative follow up showed a significant reduction in Group B compared to Group A (p= 0.001). Significant improvement in mouth opening was seen in Group B compared to Group A (p= 0.034).Three-point fixation was found to give more stable reduction compared to 2-point fixation for treating zygomatic bone fractures in terms of malar height and mouth opening.

Closed reduction of zygomatic tripod fractures using a towel clip

Background: The zygomatic bone constitutes the prominence of the cheek. Fractures of the zygomatic bone are the second most treatment of zygomatic bone fractures and can be examined under two headings, open and closed reductions. This paper describes a new technique in the closed reduction of tripod fractures using a towel clip.Methods: Seventeen consecutive patients (three females, 14 males) with a mean age of 35.5 years (range = 18–66 years) with zygomatic tripod fracture were treated using the towel clip technique between December 2011 and February 2014.Results: Patients were assessed in the first and 6 months postoperatively, by physical examination and computed tomography. Preoperatively, nine patients had paresthesia in the infraorbital nerve region. Three of these cases regressed postoperatively. Persistent collapse of the zygomatic projection was present in one patient.Conclusion: Non-comminuted zygomatic tripod fractures can be easily treated percutaneously with the towel clip method in the absence of preoperative ocular problems such as diplopia, enophthalmos, or restricted eye movements. The technique is economical, fast, and safe. The possibility of persistent zygoma collapse after reduction should be kept in mind, and preoperatively the team should be warned of the possibility of progression to open reduction during surgery.

Clinical application of modified preauricular and temporal approach for open reduction and fixation in zygomatic bone and arch fracture

Objective To explore a new approach that is better than coronal scalp incision and facial percutaneous small incision in surgical treatment of zygomatic bone and zygomatic arch fracture. Methods The modified auriculotemporal incision was applied in 43 patients with zygomatic bone and zygomatic arch fracture that needed open reposition, and the exposure degree, bleeding, postoperative elasticity and texture of skin, facial nerve function and satisfactory degree were evaluated after operation. Results In present study, the upper part of zygomatic arch and lateral orbital margin could be greatly explored for operation of zygomatic bone and zygomatic arch fracture in all 43 patients by application of this approach. Less bleeding was observed during operation. All patients had primary healing and none of them presented with temporal numbness and facial palsy. After 6 months follow-up, 41 cases (95.3%) and 43 cases (100%) showed fine elasticity of operative skin and satisfactory degree, respectively. Conclusions The modified auriculotemporal incision is better than conventional approach in surgical treatment of zygomatic bone and zygomaticarch fracture. Key words: Zygomatic bone; Zygomatic arch; Fracture; Modified auriculotemporal incision; Functionality and aesthetics

Three-dimensional evaluation of postoperative swelling in treatment of zygomatic bone fractures using two different cooling therapy methods: a randomized, observer-blind, prospective study

BackgroundSurgical treatment and complications in patients with zygomatic bone fractures can lead to a significant degree of tissue trauma resulting in common postoperative symptoms and types of pain, facial swelling and functional impairment. Beneficial effects of local cold treatment on postoperative swelling, edema, pain, inflammation, and hemorrhage, as well as the reduction of metabolism, bleeding and hematomas, have been described.The aim of this study was to compare postoperative cooling therapy applied through the use of cooling compresses with the water-circulating cooling face mask manufactured by Hilotherm in terms of beneficial impact on postoperative facial swelling, pain, eye motility, diplopia, neurological complaints and patient satisfaction.MethodsForty-two patients were selected for treatment of unilateral zygomatic bone fractures and were divided randomly to one of two treatments: either a Hilotherm cooling face mask or conventional cooling compresses. Cooling was initiated as soon as possible after surgery until postoperative day 3 and was applied continuously for 12 hours daily. Facial swelling was quantified through a three-dimensional optical scanning technique. Furthermore, pain, neurological complaints, eye motility, diplopia and patient satisfaction were observed for each patient.ResultsPatients receiving a cooling therapy by Hilotherm demonstrated significantly less facial swelling, less pain, reduced limitation of eye motility and diplopia, fewer neurological complaints and were more satisfied compared to patients receiving conventional cooling therapy.ConclusionsHilotherapy is more efficient in managing postoperative swelling and pain after treatment of unilateral zygomatic bone fractures than conventional cooling.Trial registrationGerman Clinical Trials Register ID: DRKS00004846

Patient Satisfaction After Open Reduction and Internal Fixation of Zygomatic Bone Fractures

To optimize treatment of zygomatic bone fractures, patients' subjective evaluations of symptoms are necessary. The visual analog scale (VAS) was used for the quantitative assessment of subjective evaluation for symptoms and treatments in patients who underwent open reduction and rigid fixation. Degree of satisfaction and annoyances resulting from residual symptoms (deformity, pain, paresthesia, and trismus) and incisions used for exposure of the fracture site were investigated using an anonymous postal questionnaire. Forty-three patients provided responses. Total satisfaction was rated as 72.5% +/- 21.6%. Scores from the VAS for annoyance were significantly higher for paresthesia than for deformity, pain, or trismus. Residual deformity and pain significantly influenced total satisfaction. Upper vestibular, lower lid, and lateral brow incisions showed almost equivalent tendencies for annoyance. The VAS provided otherwise inaccessible information about patients' subjective evaluation. Treatment strategies should be optimized toward not only evaluation with objective measures but also patients' subjective evaluation.

Evaluation of a Single Miniplate Use in Treatment of Zygomatic Bone Fracture

Different methods of internal fixation of simple displaced zygomatic fracture, such as wiring, miniplate, and screw fixation, were compared for postreduction rotational stability caused by muscular forces. This study was performed to evaluate the minimally invasive therapy in cases of zygomatic bone fracture. Seventeen patients were treated by percutaneous hook reduction and miniplate fixation along the frontozygomatic suture. Postoperatively, repositioning of aesthetic and stability and also bone ends approximation were assessed clinically and radiologically. The patients were followed up for 6 to 49 months. Preoperative symptoms were subsided except the infraorbital sensitivity disturbances in one of the patients. Postoperative complications such as diplopia and hematoma were minimal and subsided by time. In this study, orbitozygomatic, commuted, and zygomatic bone fractures simultaneously with diplopia were excluded. We showed that treatment of an isolated zygomatic bone fracture according to aesthetic and functional requirements may be achieved by insertion of a single miniplate at the lateral rim of the orbit.

Treatment of tripod fracture of zygomatic bone by N-2-butyl cyanoacrylate glue fixation, and its effects on the tissues

The standard treatment of zygomatic bone fractures is fixation by microplates or miniplates and screws today. It is very difficult to place plates and screws into thin bones or small bone fragments especially in the facial bones and bones adjacent to important structures. Cyanoacrylate is used as a hemostatic agent, an embolic agent, in retinal tears, in corneal ulcers, in fixation of mandibular osteotomies and in craniofacial surgery. N-2-Butyl cyanoacrylate is a form of cyanoacrylate which is bioabsorbable and biocompatible. It is easily applied to the tissues. We aimed to determine the effect of N-2-butyl cyanoacrylate in the fixation of displaced zygomatic bone fractures. We examined the histotoxicity and the effects on healing and foreign body reaction of N-2-butyl cyanoacrylate. Eight New Zealand white rabbits underwent zygomatic osteotomies bilaterally. The fractures on left sides of the rabbits were determined as study site and right sides as control site. Knight and North classification of zygomatic bone fractures were used and group 4 fractures were made bilaterally. Open reduction of fractures was performed bilaterally and N-2-butyl cyanoacrylate was applied only on left sides. No fixation was made on right sides representing the control group. Postoperatively in the first, second, third and fourth weeks, two rabbits were sacrificed and the fracture sites were examined macroscopically and histopathologically. In the glued study group, fixation was obtained in all cases whereas in the control group, all the fractures were seen to be displaced. Tissue reaction was similar in the study and the control groups.

The influence of the mode of treatment of zygomatic bone fractures on the healing process of the infraorbital nerve

Several authors have described the influence of the method of treatment of a fracture of the zygomatic complex on the recovery of the infraorbital nerve. In this study, the results of treatment of 106 patients with an isolated, non-comminuted, unstable fracture of the zygomatic bone are presented. Thirty-eight patients underwent fixation with interosseous wiring and 68 patients were treated with a miniplate osteosynthesis across the frontozygomatic suture. In the group with wire fixation, 50% suffered persistent reduced sensitivity in the infraorbital region at follow-up examination, whereas in the group with a miniplate osteosynthesis only 22.1% had persistent neurological sequelae. On the basis of these findings we recommend a miniplate osteosynthesis in all unstable zygomatic bone fractures with displacement.

頬骨骨折におけるミニダブルプレートの使用経験

The facial antral wall is composed of very thin compact lamellae. So, in the treatment of zygomatic bone fractures, simple mini plate application is sometimes difficult or inadequate for proper stability.The mini double plate developed by Paulus and Hardt has two plates on one side of its arm, and in the immobilization of zygomatic fractures, the facial wall of the maxillary sinus can be stabilized with it due to the surface stress and tensile effect of the plate arm on the osseous lamellae between the two plates.Recently, we introduced a mini double plate in two cases of zygomatic bone fractures and had a successful course.This is a report of our experience concerning the treatment.

The use of the foley catheter in the treatment of zygomatic bone fractures

Summary A technique of reduction of zygomatic bone fractures by the use of the Foley catheter has been described. The advantages of this method over the antral pack have been discussed. The good results obtained on twenty patients should warrant the use of this procedure in selected cases.