Treatment Of Zygomatic Complex Fractures Research Articles

Intraoperative Computed Tomography in the Surgical Treatment of Zygomatic Complex Fracture: A Retrospective Cohort Study.

This study aimed to assess the effectiveness of intraoperative computed tomography (ICT) in managing zygomatic complex (ZMC) fractures surgically. A total of 143 patients (84 men, 59 women; average age 37.13y) undergoing surgical treatment for ZMC fractures participated in this retrospective cohort study, with 72 in the ICT group and 71 in the control group. There were no notable differences in gender, age, time from injury to surgery, and surgical duration between the two groups. The ICT group exhibited significantly fewer surgical approaches than the control group (1.39±0.519 vs. 2.07±0.617, P<0.001). Fixation points in the ICT group (1-point: 42, 2-point: 14, 3-point: 16) significantly differed from the control group (1-point: 15, 2-point: 17, 3-point: 39), P<0.001. Symmetry of reduction was assessed through immediate postoperative images, and stability was compared between immediate postoperative images and those taken at least 3 months later. Both assessments revealed no significant differences between the 2 groups. This study indicates that ICT facilitates prompt evaluation of ZMC reduction, minimizing the necessity for incisions and internal fixation, while achieving comparable reduction efficacy and long-term stability to conventional approaches.

The Value of Intraoperative Computed Tomography in the Treatment of Zygomatic Complex Fractures

Due to the complex anatomical morphology and lack of anatomic markers on the surface of zygomatic complex (ZMC), the treatment results of ZMC fractures are often suboptimal. The study aimed to evaluate the effectiveness of intraoperative computed tomography (ICT) in the treatment of unilateral ZMC fractures, and further study the feasibility of ICT to replace early postoperative Computed Tomography (CT). The investigators designed a retrospective cohort study. Adult patients who underwent surgery with unilateral ZMC fractures were enrolled. According to whether intraoperative CT was used, the subjects were divided into the ICT group and the control group (without ICT). Five distances and 3 angles representing bilateral ZMC symmetry were main outcome variables. The differences of outcome variables were compared between the 2 groups and the indices of ICT group were further compared with their postoperative indices. Demographics (eg age), etiology (eg traffic injury), dysfunction (eg diplopia), and surgical approach (eg vestibular incision) were collected as covariates while we conducted clinical investigation, examination, and implementation. The data were analyzed using independent-samples t test, paired-samples t test, Mann-Whitney U test, and χ2 test. P value < .05 was considered statistically significant. A total of 60 patients (18 to 59years) were enrolled in this study. All median values of the measurements in the ICT group were smaller than those in the control group, and the differences of horizontal displacement distance (0.56 vs 1.02mm), anteroposterior displacement distance (1.69 vs 2.34mm, 0.90 vs 2.35mm), horizontal angle of bilateral zygomatic arch (2.31 vs 4.19°), and horizontal angle of bilateral zygomatic process (1.77 vs 2.94°) were significantly different between the 2 groups with P value < .05. Moreover, there was no statistically significant difference in all indices between the intraoperatively and postoperatively injured sides in the ICT group. ICT can improve the treatment outcomes of ZMC fractures by evaluating the fracture reduction adequacy during surgery. Moreover, ICT can replace early postoperative CT.

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.

Loss of Lower Eyelid Bulge after the Reconstruction of Zygomatic Complex Fractures.

Background:Surgery for zygomatic complex fractures primarily aims to obtain facial symmetry. We investigated facial symmetry specific to lower eyelid bulges following zygomatic complex fractures approached through the lower eyelid.Methods:Forty-one consecutive patients underwent treatment of zygomatic complex fractures by swinging eyelid approach or subciliary approach. In both approaches, the periosteum was incised 2 mm caudal to the inferior orbital rim and the orbicularis retaining ligament (ORL) was released. The orbital rim periosteum was interruptedly sutured and reconstruction of the orbital septum or ORL was not performed at the time of closure. In cases with a lower eyelid bulge on the nonfractured side, in a frontal photograph 6 months after the operation, the degree of loss of the lower eyelid bulge on the fractured side was classified as either “none,” “mild,” or “severe.”Results:Lower eyelid bulge was present on the nonfractured side in 19 of 41 patients, all of whom were over 50 years old. Loss of lower eyelid bulge was observed on the fractured side in all cases: 15 cases following the swinging eyelid approach (mild/severe; 6/9) and four cases following the subciliary approach (mild/severe; 2/2).Conclusions:In reconstruction after zygomatic complex fractures, lower eyelid bulges were lost in both the swinging eyelid and subciliary approaches in patients over 50 years old. The cause was thought to be an ORL release or an unintended septal reset-like effect.

A comparative study between two point and three point fixation for zygomatic complex fractures

The fractured fragments of a zygomatic complex fracture near the suture lines needs to be restabilized by open reduction by fixation. Depending on the displacement of fracture segments and anticipating the stability of the reduced fracture, one, two or three point fixation is applied. The choice of points of fixation is inclusive and best left to surgeon and depending on the fracture type.The aim of this study was to compare and evaluate functional and aesthetic outcome of two point fixation at frontozygomatic suture and buttress with three point fixation at FZ, buttress and infraorbital region in patients with zygomatic complex fractures.This study included 30 patients who underwent treatment of zygomatic complex fractures between 2011 to 2013. Fifteen patients were treated with ORIF using two point fixation and remaining 15 with three point fixation and patients were evaluated and compared preoperatively, first post op day, 7 day, first month and third month post op for anatomic form, function, aesthetics and complications. There was no statistically significant difference in stability, function and aesthetics achieved with fixation and aesthetics. Two point fixation modality for displaced zygomatic complex fractures is as effective as three point fixation. The surgical treatment varies from surgeon to surgeon and also depends on the type of fracture.

Treatment of zygomatic complex fractures with surgical or nonsurgical intervention. a retrospective study

Background: Fracture of the zygomatic complex is one of the most common facial injuries in maxillofacial trauma.

Treatment of Zygomatic Complex Fractures with Surgical or Nonsurgical Intervention: A Retrospective Study.

Objective:Evaluate the 1-year treatment outcome of zygomatic complex fractures with surgical or nonsurgical intervention.Materials and Methods:One hundred and forty-two consecutive patients with a zygomatic complex fracture were enrolled. Sixty-eight patients underwent surgical intervention and 74 patients nonsurgical intervention. The 1-year examination evaluated cosmetic and functional outcome including malar symmetry, ocular motility, occlusion, mouth opening, neurosensory disturbances, and complications.Results:Forty-six patients allocated to surgical intervention responded to the 1-year follow-up examination. Satisfying facial contour and malar alignment was observed in 45 patients. All patients presented with identical position of the eye globe without enophthalmos and normal ocular movement. A habitual occlusion was seen in all patients with a mean interincisal mouth opening without pain of 49 mm. One patient presented with minor ectropion. Wound infection occurred in five patients. Persistent infraorbital neurosensory disturbance was described by 19 patients. The 1-year radiographic examination showed adequate fracture alignment in all patients with satisfying facial contour. However, dissimilar position of the orbital floor was seen in three patients having orbital reconstruction. None of the patients were re-operated or needed secondary correction of the zygomatic complex or orbital floor.Conclusion:Surgical intervention is an effective treatment modality of depressed zygomatic complex fractures, whereas a nonsurgical approach is often used for nondisplaced fractures. Most zygomatic complex fractures can be treated solely by an intraoral approach and rigid fixation at the zygomaticomaxillary buttress. Further exposure of the zygomaticofrontal junction or inferior orbital rim is necessary for severely displaced fractures, which require additional fixation.

Treatment of zygomatic complex fractures in an urban Saudi Arabian population: A 10-year retrospective survey

Background: Zygomatic complex fractures (ZMCF) are treated by various closed and open reduction procedures. The common goal, however, is to achieve three-dimensional stability of the fractured zygoma. Patients and Methods: All cases diagnosed with ZMCF were included in this study over a 10-year-period starting from December 2002 to December 2012 at Riyadh Dental Centre, King Saud Medical City-Riyadh, Saudi Arabia. Patient's gender, age, etiology, and type of treatment modality of the zygomatic bone fracture were retrieved and recorded. Data were stored and statistically analyzed using SPSS (ver. 16.0; SPSS Inc., Chicago, IL, USA). Results were presented as simple frequencies and percentages. Results: A total of 306 patients were diagnosed with ZMCF during the study period. There were 271 (88.6%) males and 35 (11.4%) females with a male-to-female ratio of 7.7:1. Age range of 21–30 years had the highest number of maxillofacial fracture. A total of 62 (20.3%) cases were treated by closed reduction while 235 (76.8%) cases were treated by open reduction and internal fixation using titanium miniplate (2.0 mm) and screws. Combination of treatment modalities was utilized in only 9 (2.9%) cases. Complications observed during the review period were palpable plate and screws in 26 (8.4%) patients. These palpable plates and screws, however, did not necessitate plate and screw removal from any of these patients. Conclusion: Most of the ZMCF were treated by open reduction and rigid internal fixation. Advances in imaging, surgical technique, and materials for fixation have allowed for improved functional and esthetic outcomes.

Health-related quality of life of patients with zygomatic fracture.

BackgroundThe objective was to evaluate health-related quality of life (HRQoL) before and after surgical treatment of zygomatic complex fracture and assess patients’ perceptions of the aesthetic and functional outcomes of surgery.Material and MethodsA prospective study of 79 adult patients before and after surgery for zygomatic complex fracture was conducted. HRQoL was measured using the generic 15-dimensional (15D) instrument, and patient satisfaction was assessed by an additional questionnaire.ResultsThe mean preoperative 15D score for patients was lower than for general population that was matched for age and gender (p=0.011). The mean 15D score was lowest on the first postoperative day (p<0.001) when patients were worse off for 6 of the 15 dimensions of the HRQoL instrument and better off for three dimensions. However, patients achieved, and even exceeded, the mean 15D score of the general population during the first month following surgery. Infraorbital sensory loss at the end of the six-month follow-up appeared to be the single most important factor that plagued the patients.ConclusionsHRQoL is significantly reduced after trauma but improves a few weeks after surgery. Infraorbital nerve sensory loss is a notable long-term factor that affects patients after zygomatic complex fracture. Key words:Zygomatic fracture, maxillofacial trauma, health-related quality of life, disturbance of infraorbital nerve, facial sensation.

Clinical observation on the improved reductive surgery for the treatment of zygomatic complex fractures

Objective To observe the clinical effect of improved reductive surgery for zygomatic complex fracture. Methods Thirty-two patients with zygomatic complex fractures were given zygomatic arch and lateral orbital wall fracture CT 3D reconstruction before operation to display position of fracture. The skin incision was made along the lower eyelid margin and extended about 15 mm outward canthus. Then the periosteotomy was done and the periosteum was separated to the back of zygomatic arch. The fracture was fixed with micro titanium nail plate to restore the normal anatomical position of zygomatic arch and to reset orbital margin completely. Results Two weeks after the operation, the soft tissue swelling of the orbital region faded. The deformity was completely corrected, and the opening movement of mouth was improved obviously compared with that before the operation. Three months after the surgery, the zygomatic appearance was symmetrical in 32 cases, with no obvious differences in appearance. Mouth opening degree was higher than 40 mm.The two eyeballs were symmetrical. Conclusion The improved subciliary approach combined with micro titanium nail and plate for zygomatic complex fracture has good effect. Key words: Fractures, traumatic; Zygomatic complex; Reductive surgery, modified; Incision

Retrospective analysis of 73 orbital floor fractures

Methods: After confirmation of a zygomatic complex fracture the patients were divided into groups of surgically and non-surgically treated fractures, with and without fracture displacement. The groups were compared according to age, gender, degree of fracture displacement and clinical signs. Results: 283 patients were included, with a mean age of 43 years and a domination of male patients. All type C-fractures and themajority of type B-fractures were treated surgically. Except for facial swelling, the symptoms frequently found in the surgically treated patients, were found less common in the non-surgically treated patient group. Extraoral steps, intraoral steps, and malar depression were significantly related to surgical treatment. Conclusions: The clinical characteristics extraoral steps, intraoral steps, and malar depression, in contrast to paraesthesia of the infraorbital nerve, were significantly related to surgical treatment of zygomatic complex fractures. Knowledge of the differences between the surgically and non-surgically treated patients may help physicians to develop future methods in clinical decision making.

Visual recovery following emergent orbital decompression in traumatic retrobulbar haemorrhage—case report

Methods: After confirmation of a zygomatic complex fracture the patients were divided into groups of surgically and non-surgically treated fractures, with and without fracture displacement. The groups were compared according to age, gender, degree of fracture displacement and clinical signs. Results: 283 patients were included, with a mean age of 43 years and a domination of male patients. All type C-fractures and themajority of type B-fractures were treated surgically. Except for facial swelling, the symptoms frequently found in the surgically treated patients, were found less common in the non-surgically treated patient group. Extraoral steps, intraoral steps, and malar depression were significantly related to surgical treatment. Conclusions: The clinical characteristics extraoral steps, intraoral steps, and malar depression, in contrast to paraesthesia of the infraorbital nerve, were significantly related to surgical treatment of zygomatic complex fractures. Knowledge of the differences between the surgically and non-surgically treated patients may help physicians to develop future methods in clinical decision making.

A 10-year analysis of the “Amsterdam” protocol in the treatment of zygomatic complex fractures

Despite many publications on the epidemiology, incidence and aetiology of zygomatic complex (ZC) fractures there is still a lack of information about a consensus in its treatment. The aim of the present study is to investigate retrospectively the Amsterdam protocol for surgical treatment of ZC fractures. The 10 years results and complications are presented. The study population consisted of 236 patients (170 males, 66 females, 210 ZC fractures, 26 solitary zygomatic arch fractures) with a mean age of 39.3 (SD: ±15.6) years (range 4–87 years). The mean cause of injury was traffic accident followed by violence and fall. A total of 225 plates and 943 screws were used. Twenty-eight patients presented with complications, including wound infection (9 patients) and transient paralysis of the facial nerve (one patient). Seven patients (2.8%) needed surgical retreatment of whom four patients needed secondary orbital floor reconstruction as these patients developed enophthalmos and diplopia. In conclusion this report provides important data for reaching a consensus for the treatment of these types of fractures.

Variables Related to Surgical and Nonsurgical Treatment of Zygomatic Complex Fracture

The aim of this retrospective research was to establish the association between variables for the surgical treatment of zygomatic complex (ZC) fractures. In a 10-year period, 532 patients were examined for ZC fractures. The medical records of patients were analyzed to obtain information related to sociodemographic characteristics, trauma etiology, sign and symptoms of patients, and surgical or nonsurgical treatment. Statistical analysis was performed using χ test with statistical significance of P < 0.05. Most fractures were sustained by subjects between 21 and 40 years of age (55.8%), being principally men (80.1%), and 153 patients underwent surgery (28.8%). Surgical treatment of ZC fractures was statistically associated to the presence of other facial fractures (P = 0.004), alteration of occlusion (P = 0.0001; probably due to jaw fractures), presence of the comminuted fractures (P = 0.0002), and infraorbital nerve sensory disturbances (P = 0.003). A mixture of complex variables can be associated to surgical treatment; however, variables as comminuted fracture and alteration of occlusion were associated to surgical treatment indications.

Treatment of Zygomatic Complex Fractures with Steinmann Pins

Head and Neck Surgery Ronald Reagan UCLA Medical Center JSalinas@mednet.ucla.edu This case series presents an update on our experience treating zygomatiomaxillary complex (ZMC) fractures through closed reduction, using a Steinmann pin. In order to gather data, charts for twenty-three consecutive patients with ZMC fractures presenting to the Otolaryngology-HNS Department at Harbor-UCLA Medical Center from 2005 to 2009 were reviewed. Of the twenty-three patients, twelve patients had sufficient data for analysis. Average operative time was significantly lower for patients treated via the closed technique as compared to the open technique: 65.3 minutes and 162.5 minutes (p = 0.02). Additionally, only a single one-centimeter incision was required with the closed-repair system versus several incisions using traditional methods. Treatment of Zygomatic Complex Fractures with Steinmann Pins Jonathan B. Salinas, M.D.; Darshni Vira, M.D.; David Hu, M.D.; Maie St. John M.D., Ph.D. Division of Head and Neck Surgery Ronald Reagan UCLA Medical Center

Reposition of zygomatic complex fracture via subciliary incision combined with preauricular temporal approach

Objective To investigate the application of subciliary incision combined with preauricular temporal approach in the treatment of zygomatic complex fracture. Methods Fifty-three patients with zygomatic complex fracture including 41 males and 12 females were selected. Subciliary incision combined with preauricular temporal incision was employed to exp the site of fracture. After reduction of the fractures, rigid internal fixation was applied to fix the fractured bones. The facial profile, mouth opening, occlusion, view sight, movement of eye ball and local scar were evaluated postoperatively. Results The wounds of all the cases healed by first intension. All the cases had been recovered with normal face profile, mouth opening, occlusion, view-sight and eye ball movement. Facial nerve function of one case among the three cases with facial nerve trauma preoperatively was recovered totally after surgical treatment. And one case with suborbital nerve dysfunction preoperatively was not recovered. There was no case with the complications of entropion and ectropion, visible scar and temporal amyotrophia. Permanent trauma of temporal branch of facial nerve and supraorbital nerve was not observed after surgical therapy, but temporary facial nerve dysfunction occurred in 18 cases postoperative 1-3 months. Conclusion It is suggested that the approach of subciliary incision combined with preatrricular temporal incision could be employed to treat zygomatic complex fracture. Key words: Zygomatic complex; Fracture; Subciliary incision; Preauricular temporal approach

Treatment of Zygomatic Complex Fractures with Steinmann Pins

Treatment of Zygomatic Complex Fractures with Steinmann Pins

A study on the classification and treatment of zygomatic complex fractures

To investigate a new classification and treatment of zygomatic complex fractures (ZCF) by clinical and radiographic studies. Standard radiographs with Waters, submental vertex views had been obtained before and after operation in 206 patients (212 sides) with ZCF. Patients with complicated fractures underwent two and three dimensional CT. Computer-assisted measuring system was used to measure the degree of displacement. ZCF were classified into 3 types and 6 subtypes according to the degree of displacement of segments and facial deformities. Treatment principles were proposed. The results were satisfied through clinical application and measurement of post-operative images. The treatment for ZCF should be selected according to the fracture types. The key of operation is to recover the malar prominence. Remodeling the length and radian of zygomatic arch guarantee the recovery of malar prominence. Zygomatic-sphenoid and zygomatic-maxillary fissures are very important reference marks for reduction and fixation.

The use of the hook in the treatment of zygomatic complex fracture

The use of the hook in the treatment of zygomatic complex fracture