Treatment Of Zygomatic Fractures Research Articles

FACTORS RELATED TO THE RESULTS OF SURGICAL TREATMENT OF ZYGOMATIC FRACTURES WITH MINIPLATES

Background: Fracture of the zygomatic complex is one of the most common facial injuries in maxillofacial trauma and mainly caused by traffic accidents. The objective of this study was to investigate the factors related to the results of surgical treatment of zygomatic fractures with miniplates. Subjects and Methods: 46 patients (average age 34.24 ± 15.16) were diagnosed with zygomatic fractures. All of patients were operated and treated with titanium miniplates. This study assessed the general treatment results of: anatomy, aesthetics and function at the time of discharge, 3 months, 6 months postoperatively. This study also investigated the factors related to the results of surgical treatment of zygomatic fractures with miniplates. Results: Factors associated with post-operative results include: Clinical manifestations: restricted mouth opening, maxillary sinus fracture (p<0.05) X-ray: number of fracture lines (≥ 4 lines) and type IV fracture (p<0.01); overlapping fracture; comminuted fracture; depressed fracture (p<0.05); number of miniplates used: ≥ 2 (p<0.05). Conclusions: Evaluating factors related to surgical results helps clinicians evaluate and make prognosis in order to develop treatment plan in time and minimize complications after surgery. Key words: Fracture of the zygomatic complex; Affecting factors; Internal fixation with miniplates

Transconjunctival Surgical Access With Modified Aesthetic Lateral Canthotomy.

Displaced fractures of the zygomatic bone that require surgical treatment are accessed transcutaneously but these accesses to the skin can cause a hypertrophy scar in patients with this predisposition. This paper indicates a modification in the lateral canthotomy that aim to minimize the hypertrophic scar in the treatment of zygomatic fracture.

Surgical treatment of isolated zygomatic fracture: Outcome comparison between titanium plate and bioabsorbable plate

Zygoma fracture is of clinical importance because malar prominence plays an essential role in facial appearance. Traditionally, most maxillofacial surgeons perform osteosynthesis with titanium plates and screws for rigid fixation. However, this procedure has certain disadvantages that include the possibility of implant exposure, palpability or loosening of the screws, painful irritation, temperature sensitization, and radiographic artifacts. In this study, we compared the function and satisfaction outcome between Bonamates® bioabsorbable implant and Leibinger titanium implant. Consecutively 53 patients with isolated unilateral zygomatic fracture that were treated with the Bonamates® bioabsorbable plate system, n=53 were compared to patients with the titanium plate system, n=55 in the period between 2009 and 2013. All patients were followed-up at least 6 months. Preoperative and postoperative facial computed tomography (CT) scans were performed and scored from 0 to 2 in the 5 areas of zygoma. A score of 2 indicated the most severely displaced fracture in one of the areas. A visual analogue scale ranging from 0 to 10 was used to assess the postoperative aesthetic and functional satisfactions. The mean ages of the patients in the bioabsorbable and titanium plate groups were 33 years and 30 years, respectively. The male to female ratios were 1.2:1 (bioabsorbable plate group) and 1.1:1 (titanium plate group). The average preoperative CT scan scores of the bioabsorbable and titanium plate groups were 5.7 and 5.1, respectively. The postoperative CT scan scores of the bioabsorbable and titanium plate groups were 1.3 and 1.1, respectively. The implant cost of the bioabsorbable group was approximately 6-fold higher than that of the titanium plate group. The complication rate was similar in both groups and included complications such as palpable implant, skin irritation, and hypersensitive cheek. The patients in both groups attained similar mouth-opening function and a satisfactory score at 6 months after operation. This study revealed that the bioabsorbable plate outcome was similar to the titanium plate outcome for patients with isolated unilateral zygomatic fracture. The bioabsorbable implant system provides another option for internal fixation devices in the treatment of zygomatic fractures and avoids implant removal surgery; however, the implant cost of bioabsorbable plates is higher than that of titanium plates in Taiwan.

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.

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

Treatment of Zygomatic Fracture in a Hemophilic Patient

Treatment of Zygomatic Fracture in a Hemophilic Patient

Treatment-assessment of Zygoma-tripod, -quadripod, -arch and Orbital floor Fractures in the Elderly Patient: Results of a Longitudinal Clinical Study of 20 years (1995-2015) with 1318 Patients in a General Traumatology-department and Evidence-based Treatm

Introduction Although the incidence of zygoma- and related orbital-floor fractures decreased over the years towards the turn of the millennium for road-vehicle-accident related causes in the overall population of countries with mandatory passive and active safety-devices in cars and mandatory helmet-duty when motorcycling [1 Covington DS, Wainwright DJ, Teichgraeber JF, Parks DH (1994) Changing patterns in the epidemiology and treatment of zygoma fractures: 10-year review. J Trauma 37: 243-248. ], still zygoma-tripod and/or arch-fractures and related orbital-floor-fractures represent the most common trauma of facial bones representing a quarter of all cases, followed by generic orbital-floor-fractures [2 Scherer M, Sullivan WG, Smith Jr DJ, Phillips LG, Robson MC (1989) An analysis of 1,423 facial fractures in 788 patients at an urban trauma center. J Trauma 29: 388-390. ]

Clinical and radiographic evaluation of surgical treatment of zygomatic fractures using 1.5 mm miniplates system

Fractures of the zygomaticomaxillary complex are among the most common face traumas. Based upon the complexity and great variety of reported diagnoses and treatments, the proposal of this study was to evaluate, clinically and radiographically, unilateral zygomatic fractures treated through internal rigid fixation with miniplates and screws of 1.5 mm. Material and Method: 15 patients with unilateral fractures of the zygomaticomaxillary complex were analyzed, and compared with 15 patients without fractures so that a comparative analysis of the area and the perimeter of the orbital cavities could be made, as well as the distance from the nasal point to the zygomatic prominence between both groups. Results: In the radiographic analysis, the both groups presented similarity in the perimeter and in the area of the orbital cavities. Concerning the distance from the nasal point to the zygomatic prominence, only the operated group showed a significant difference between the sides, even though clinically the observation of the asymmetry had been absent or discreet. Conclusion: The treatment of unilateral fractures of the zygomaticomaxillary complex with the use of plates and screws of the 1.5 mm system proved to be effective, showing good esthetic results and low complication rates.

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

O.470 Treatment of zygoma fractures with percutaneous screws

O.470 Treatment of zygoma fractures with percutaneous screws

Experimental evaluation of relapse-risks in operated zygoma fractures

Objectives Prevention of relapse, or postoperative dislocation, of the fixed zygoma is necessary to achieve optimal results in the treatment of zygoma fractures. Assuming that the occurrence of intensified stresses on mastication at the screw–bone interface (SBI) constitutes the essential cause of the relapse, we evaluated the stresses for three different fixation methods—fixation at the frontal process (FP), inferior orbital rim (IOR), and zygomatico-maxillary buttress (ZMB). Methods We used 10 computer-aided design (CAD) models simulating zygoma fractures in the experiment. For each CAD model, we fixed the fractured zygoma with four screws and one mini-plate at the FP, IOR, or ZMB. After applying a 5.5 kg force simulating mastication, we calculated the intensity and distribution patterns of the stresses occurring at the SBIs of the fixation screws using the finite element method. Thereby, we evaluated dynamic stability of the fixed zygoma for each of the three fixation methods. Results Greater stresses occur at the SBIs with IOR fixation than at those with FP and ZMB fixation. Although the stresses occurring at the SBIs on mastication demonstrated evenly distributed patterns with the FP and ZMB fixation, the stresses demonstrated concentration on one screw with the IOR fixation. Conclusions The fixed zygoma is more likely to cause relapse with the IOR fixation than with the FP or ZMB fixation. Hence, in performing zygoma fixation at the IOR, care should be taken to minimize the likelihood of postoperative relapse that is caused by skewed distribution of the stresses on the fixation screws.

Epidemiology and Treatment of Fractures of the Zygomatic Complex

Objective: This descriptive analytical study evaluated the epidemiology and treatment of zygomatic fractures in China during a 10-year period, and compared findings with those in the literature.Patients and Methods: 152 patients with comparatively complete records from a total of 428 patients who had zygomatic complex fractures were reviewed, with special focus on epidemiology and treatment. Isolated fractures of the zygomatic arch were excluded. Strict medical follow-up was carried out for sourced patients.Results: There were 84 old fractures and 68 fresh ones in the patient group. Road traffic accidents were the predominant aetiological factor. The majority of patients were male, with age between 20 and 40 years. The most common feature was malar depression. Internal fixation with titanium plate was used in 123 patients, while wire fixation was done for 29 patients. 328 titanium plates were used in the rigid internal fixation group. Plates were distributed at the zygomatic-frontal suture (n = 86), zygomatic-maxillary suture and/or zygomatic crest (n = 105), zygomatic-temporal suture (n = 42), and across the fracture line (n = 95). One-site fixation was done for 21 patients, 2-site fixation for 56 patients, and 3-site fixation or higher for 75 patients.Conclusions: Results confirm that road traffic accidents remain the major cause of zygomatic fractures. Rigid internal fixation for such fractures has become more predominant and reliable with the development of improved fixation strategies.

Evaluation and Treatment of Zygomatic Fractures

Orbitozygomatic fractures are some of the most common facial fractures evaluated and treated by plastic surgeons. A considerable debate remains surrounding the manner of evaluation and appropriate treatment modalities. On the one hand, some would suggest that few fractures need formal open reduction and internal fixation, whereas others would argue that the pull of the strong masseter muscle ultimately leads to inferior and lateral rotation of the zygoma, which justifies open reduction and internal fixation of most fractures excepting those fractures that are nondisplaced at all points of articulation. The authors hope to shed some light on these issues by conveying their perspective on these fractures that has developed over several decades while servicing a single, major Level I trauma center. In general, the authors feel that through a detailed evaluation including an accurate physical examination of the face and orbit combined with detailed computed tomographic scanning of the craniofacial skeleton and soft tissues, an appropriate treatment plan can be generated. The common goal among all treatment plans should be the exact three-dimensional restoration of the disturbed anatomy, that is, anatomical reduction and the need for accurate restoration of orbital anatomy and volume when necessary.

Treatment of zygomatic fractures through upper buccal sulcus incision: Review of 200 cases

Treatment of zygomatic fractures through upper buccal sulcus incision: Review of 200 cases

Fixation of zygomatic fractures with a biodegradable copolymer osteosynthesis system: short- and long-term results

Biodegradable osteosynthesis devices can be viewed as addition to, not yet replacement for conventional metal osteosynthesis materials. In a series of 65 patients with zygomatic fractures, a short-term complication/sequelae rate of 22.8% and a long-term complication rate of 9.4% were recorded. Lactosorb ® plates, panels and screws were the only devices used for osteosynthesis. All complications associated with the biodegradable material could be considered minor and were resolved by the use of minor surgical procedures or conservative measures. The results of this study indicate that treatment of zygomatic fractures with biodegradable osteosynthesis material has no major long-term adverse effects beyond the total material resorption time.

Management of zygomatic fractures via a transconjunctival approach with lateral canthotomy while preserving the lateral ligament

This study reports on a modified approach to treat zygomatic fracture. For the surgical approach, a transconjunctival incision and, instead of a lateral canthotomy, a superficial incision of the skin and subcutaneous tissue was used, preserving the lateral ligament. The results are compared with those of previous techniques, especially the subciliary incision. In a prospective study, 30 patients (9 females and 21 males, mean age 32.1 years) with zygomatic fractures were operated using this approach. Mean follow-up time was 6 months after removal of the plates. Fractures were caused by trauma due to fighting, bicycle falls, or sport accidents. Follow-up radiographs were used to evaluate the position of the zygoma after reduction and rigid fixation. Reduction and rigid fixation of the fractures were possible to perform in all cases. The access to the orbital floor and the exposure of the inferior and lateral rim were satisfactory and an additional latero-orbital cut was not necessary. The disadvantage of the complete incision of the lateral ligament with the necessity of intraoperative refixation and possible ectropium of the eyelid could be avoided. Injuries or infections of the cornea or the bulbus did not occur. Postoperative complications such as scar formation resulting in entropium or ectropium were not seen. These results show that the transconjunctival approach with lateral superficial incision preserving the lateral ligament for treatment of zygomatic fractures is satisfactory in all cases of rigid fixation of both inferior and lateral rims. Because of its esthetic and functional advantages this approach has become standard in our department.

A clinical investigation on the surgical approach and fixation in operative treatment zygomatic fractures

To investigate the effect of soft tissue incision and rigid internal fixation in the treatment of zygomatic fracture. 70 cases with zygomatic fracture were entered into the study. The clinical data of 65 patients who were performed operations in the treatment were analyzed. The study focused on the incision, number and locations of Titanium plate. The facial contour, reduction,fixation, healing of incision, facial bisymmetry and complications of the operation were followed up 3 - 24 months after surgery. All the incisions were primary healing. Clinical and radiologic assessment of reduction was symmetric and stable in 91.5% of all cases, asymmetric in 8.5% of all cases. Subcutaneous hematoma happened in 5 cases, Ti plate exposure 1 in case, scalp scar width was more than 0.5 cm in 6 cases, frontal part or scalp paresthesia 8 cases. Coronal scalp incision has advantages such as good exposure, precise removal of the bone block and good symmetry of both sides. RIF can improve the stability of fracture, promotes fracture healing and guarantees the rehabilitation of zygomatic complex. direct reduction and rigid internal fixation with Titanium microplate or miniplate are satisfactory in zygomatic fracture.

Zygomatic and Orbitozygomatic Fractures

Zygomatic fractures may cause major inconveniences for patients both functionally and esthetically Orbitozygomatic fractures are characterized chiefly by involvement of the orbit and they often lead to some ocular dysfunction. Zygotnatic fractures, on the other hand, correspond chiefly to damage to the zygoma with anatomic involvement of the orbit. With the objective of rationalizing the treatment of zygomatic fractures, this paper suggests a classification based on the experience of treating and following-up 148 cases for at least three months in the Instituto da Face, in São Paulo, Brazil. Etiology of the trauma,gender, age, direction of theforce vector, time after the fracture and the presence of functional changes were taken into consideration. Fractures were classified as type I (51 cases or 34%) type II (59 cases or 40%) and type III (38 cases or 26%). Type I fractures were treated with transcutaneous reduction, and 48 cases (94%) evolved with good projection of the zygoma. Fractures types II and III underwent direct reduction with visualization of the fracture line, and 55 cases (92%) and 34 cases (89.5%) evolved, respectively, with good projection of the zygoma.

When can patients blow their nose and fly after treatment for fractures of zygomatic complex: the need for a consensus

Purpose: To determine current professional advice to patients about refraining from nose blowing and air travel following treatment of zygomatic fractures. Methods: A postal questionnaire was sent to 261 consultant oral and maxillofacial surgeons (OMFS) in the UK. They were asked about advice given to patients regarding length of time to refrain from nose blowing and air travel following treatment of zygomatic fractures. Results: A total of 184 (71%) replies were received. Advice regarding the length of time to refrain from nose blowing and air travel ranged from no advice to 8 weeks. About 90% of respondents based their advice on common sense and traditional practice. Conclusions: Advice given to the patients following the treatment of zygomatic fractures varies widely. Most consultants based their advice on traditional practice and common sense. In the absence of widely accepted guidelines, there is a need for an agreement among clinicians on advice given to the patients.

Analysis of zygomatic fractures with the submental-vertical radiograph

This study evaluated the displacement of zygomatic fractures using submental-vertical radiographs. A system of cephalometric analysis for the assessment of skeletal asymmetry in the horizontal plane is presented. This system uses six landmarks within the cranial base and maxilla providing reference lines with which to assess asymmetry. The mean tracing and measurement error was found to be less than 2 mm for all landmarks. In a clinical study seven trauma patients with zygomatic fractures were selected for treatment planning using this new system. The experience gained with these patients demonstrated how this analysis can evaluate the displacement of zygomatic fractures and allow successful restoration of facial symmetry. By defining the displacement of the zygomatic bone this method of cephalometric analysis is of great assistance to the surgeon in the diagnosis and treatment of zygomatic fractures.