Treatment Of Zygomaticomaxillary Complex Fractures Research Articles

Supraciliary Approach in Surgical Treatment of Zygomaticomaxillary Complex Fractures

Objective: To demonstrate the effectiveness of a supraciliary approach in zygomaticomaxillary complex fractures treatment.Case report: Patient A. (33-year-old man) was admitted to the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) with a diagnosis of traumatic fractures of the right and left zygomaticomaxillary complexes. According to the medical history, the injury was caused by a car accident. The patient underwent computed tomography of the facial skeleton. Computed tomography findings: fractures of lateral and medial orbital walls, supraorbital and infraorbital rims, glabella, and nasal septum. The patient underwent repositioning of the bone fragments and internal fixation with metal implants. The glabella fracture was reduced through a supraciliary approach. The function of the mimic muscles was fully preserved. The configuration of the face and soft tissues was restored. No soft tissue edema was observed. The postoperative scar is visualized after the unfolding of the orbito-palpebral fold of the upper eyelid.Conclusions: The systematic use of esthetic approaches by surgeons completely changes the rooted traditional way of managing patients with various maxillofacial pathologies. In addition to outstanding esthetic results, it increases the surgeons’ expertise level and the range of tasks a comprehensively developed specialist is capable of dealing with. One of the most crucial aspects is improvement of patients’ quality of life.

Efficacy of Two-Point Versus Three-Point Fixation for Zygomaticomaxillary Fractures: A Systematic Review and Meta-analysis.

The zygomaticomaxillary complex (ZMC) functions as the main buttress for the lateral portion of the middle third of the facial skeleton and because of its prominent position & convex shape, it is frequently fractured, alone or along with other bones of the midface. The management of the ZMC fractures is debatable as the literature is saturated with various theories. A number of techniques, from closed reduction to open reduction and internal fixation can be effectively used to manage these fractures. Controversies lie right from the amount of fixation (mostly 2-, 3-point fixation) required to the ideal approach, and there is no conclusive view on its ideal line of management. To systematically review the existing scientific literature to determine whether two-point or three-point fixation is a better treatment alternative for the patients with zygomaticomaxillary fractures through a meta-analysis. Review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic databases like PubMed, Google scholar and Ebsco Host were searched from January2000 to November2023 for studies reporting treatment of zygomaticomaxillary fractures through two-point and three-point fixation and reporting the outcome in terms of mean and standard deviation (SD). Quality assessment of included was evaluated using Cochrane risk of bias (ROB)-2 tool through its domains. The risk of bias summary graph and risk of bias summary applicability concern was plotted using RevMan software version 5.3. The standardized mean difference (SDM) was used as summary statistic measure with random effect model and p value < 0.05 as statistically significant. Eleven studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which only eight studies were suitable for meta-analysis. The pooled estimate through the standardized mean difference (SMD) of - 0.21 (- 0.83-0.41) favors two-point fixation employing random effect model with I2 (heterogeneity) value of 89% and p value 0.51. Publication bias through the funnel plot showed asymmetric distribution with systematic heterogeneity. In our systematic review, we aimed to evaluate which method of fixation is more effective in the treatment of zygomaticomaxillary complex fractures. Our pooled estimate using quantitative synthesis indicates that both two- and three-point fixation procedures are equally effective in the treatment of zygomaticomaxillary fractures. As a result, two-point fixation is as efficient as three-point fixation in treating zygomaticomaxillary complex fractures.

Direct or Indirect Surgical Approach of Zygomatic Complex Fracture: A Comparative Study.

Zygoma is considered the main support of the midface. Zygoma is frequently fractured owing to its prominent site on the face. Treatment of zygomaticomaxillary complex fractures can be performed through either conservative or surgical measures (closed or open reduction). The study was a cross-sectional retrospective observational investigation done at 4 hospitals in Ramadi and Baghdad cities, Iraq. This investigation covered a duration of 6 years (2016-2021). We reviewed the medical records of patients with ZCFs. The participants were divided into 2 groups according to the approach used for their management (direct versus indirect approach). Data regarding the demographic and clinical characteristics were recorded for each subject. Of 265 patients with ZCFs, 209 (78.9%) were males. The highest age group affected was 18 to 40 years (51.7%). The majority of the ZCFs were caused by road traffic accidents (31.7%). Most of the cases belong to single fractures (72.1%). Cheek flattening (73.6%) was the commonest sign of the ZCFs. The majority of the fractures were treated by direct approach, 65.4% of the isolated fractures and 62.2% for multiple fractures. Excellent patient satisfaction was seen in the majority of the cases. There were no statistically significant differences between the 2 approaches regarding the abovementioned variables ( P -value > 0.05). The majority of the cases were with excellent patient satisfaction (n = 149) while only 7 patients with poor satisfaction. The age groups below 18 years and 18 to 40 years were associated with excellent patient satisfaction than good and poor satisfaction. All (n = 7) of the cases with poor satisfaction belong to the age group above 40 years. The majority of male (n = 113) and female (n = 36) patients were with excellent satisfaction, while all patients with poor results were males (n = 7). There were statistically significant differences between the results of the patient satisfaction and age group and complications ( P -value < 0.05). The ophthalmic complications were the most complications seen after ZCF surgical treatment (2.56%). Direct and indirect approaches can be used safely in the treatment of ZCFs owing to excellent patient satisfaction in the majority of the cases and a low complication rate. This study aims to evaluate the demographic and clinical characteristics and to compare different surgical procedures to treat patients with zygomaticomaxillary complex fractures in a country overwhelmed by violence.

Management of zygomatico maxillary complex fractures.

Zygomatic bone fractures should be effectively diagnosed and treated because they affect how the face is shaped for both aesthetically and functional reasons. It is possible to compare different surgical techniques and their comorbidities objectively through using outcome quantitative assessments, which call for a treatment programme and long-term follow-up. The purpose of this study was to compare the outcomes of two procedures and the effectiveness of the zygomatic bone following open reduction internal fixation (ORIF) employing two-point fixation and ORIF employing three-point fixation. Two groups of twenty patients each were randomly assigned to. Twenty patients in Group A had ORIF treatment using two-point miniplate fixation technique, and twenty patients in Group B received three-point miniplate fixation treatment. Differences between the two categories were ascertained after they had been evaluated in terms of their advantages and disadvantages. We discovered that the two-point fixation group had the fewest facial complications and neurological side effects. At 1 month follow up, Group B's average radiological evaluation score was 2.47± 0.30, and then at 6 months follow up, it was found out to be 1.87±0.47. A significant statistical distinction between the average radiological evaluations was observed in study participants of Group A at follow up done after one month and six months of procedure. Student's paired t- statistical test was utilized from this statistical analysis. (t = 6.54, P < 0.01). On carrying out follow up after one month of surgery, average neurological assessment score in study participants of group A was found out to be 0.22± 0.42, and then at 6 months follow up, it was 0.61±0.63. The average neurological evaluation score in study participants of Group A on carrying out follow up after one month of surgical procedure and and after six months of surgical procedure months showed a significant statistical distinction when utilizing Student's paired t- statistical test (t = 2.51, P = 0.021).It was determined that the best available rehabilitation for the treatment of zygomaticomaxillary complex fractures is open reduction and internal fixation employing two-point fixation by miniplates.

Frequency of Infra Orbital Nerve Recovery after Open Reduction Internal Fixation of Zygomatico Maxillary Fracture

Objective: The current research aimed to assess the repossession frequency of infraorbital nerve paresthesia after open reduction internal fixation in the treatment of ZMC fractures. Methodology: Randomized control trial was conducted in department of Oral and Maxillofacial Surgery, Ziauddin hospital and Medical University, Karachi from Jan 2020 to July 2021. Data was collected after ethical approval. Patients with unilateral zygomatico maxillary bone fracture satisfying the exclusion and inclusion criteria, and who were ready to give knowledgeable approval after the given explanation about study procedure, how data taken from their cases will be used for research purpose, and after discussion on risk as well as benefits of the procedure, were involved in our study. Results: Data of 150 patients were collected. Out of these 150, 82 were and females 68 were male. The mean age (SD) was 31.48 (5.67 SD) years. Other socio-demographic characteristics are represented in table 1. 106 (71%) of ZMC patients recovered from infra orbital nerve after Open Reduction Conclusions: On the basis of this study it is recommended that open reduction as chosen mode of management whose outcomes in enhanced recovery of functional nerve amongst paresthesia patients after linked to closed reduction approaches. Keywords: Infra Orbital Nerve, Zygomatico Maxillary Complex (ZMC)

Lokalizace kostních dlah pri ošetření zlomeniny lícně-čelistního komplexu

Lokalizace kostních dlah pri ošetření zlomeniny lícně-čelistního komplexu

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.

Correlation between clinical findings and CT-measured displacement in patients with fractures of the zygomaticomaxillary complex

BackgroundThis prospective clinical study aimed to analyse the influence of displacement on duration and severity of symptoms of fractures of the zygomaticomaxillary complex. Methods47 patients, who received surgical treatment of zygomaticomaxillary complex fractures at the Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Hospital Jena were examined preoperatively, 1, 3 and 10 days as well as 6 months post-operation for ophthalmologic, occlusal and neurosensory changes. ResultsPreoperatively, periorbital haematoma and ooedema were present in 76.6% and 31.9% of the patients, which increased until day 1 post-op and decreased until the end of hospital stay. Preoperative diplopia was present in 83.0% of the patients and resolved postoperatively in all but 3 cases, in whom it persisted until end of the study. Occlusal disturbances and limited mouth opening were present in 21.3% of the patients and resolved by end of the study in all but 2 cases. Neither ophthalmologic nor occlusal changes correlated with the degree of displacement. Postoperatively no significant differences were detectable among the groups. In 44.8% of the patients neurosensory disturbances persisted until end of the follow-up. In the non-displaced fracture group none of the patients suffered from neurosensory disturbances at the 6-month follow-up. ConclusionAlthough the degree of displacement has a significant impact on the incidence of sensory disturbances preoperatively, postoperatively no differences were observed between displaced and non-displaced fractures.

Intraoperative Cone-Beam Computed Tomography in Oral and Maxillofacial Surgery Using a C-Arm Prototype: First Clinical Experiences After Treatment of Zygomaticomaxillary Complex Fractures

To describe the first clinical applications of intraoperative cone-beam computed tomography with an integrated flat-panel detector in oral and maxillofacial surgery after surgical treatment of zygomaticomaxillary complex fractures Nine cone-beam computed tomography datasets of patients with zygomaticomaxillary complex fractures were intraoperatively acquired using a mobile isocentric C-arm (PowerMobil; Siemens Medical Solutions, Erlangen, Germany), including a flat-panel detector. Datasets based on 400, 200, and 100 fluoroscopic images were performed with different tube currents (4.6 mA, 3.3 mA, 2.3 mA, 1.2 mA, and 0.5 mA) and a current tube voltage of 100 kV. Postprocessing resulted in 15 different datasets available for comparison with corresponding preoperative computed tomography datasets. Four oral and maxillofacial surgeons and 2 experienced radiologists evaluated each dataset regarding noise, transition, and the delimitation of landmarks. All examinations were successfully performed. Reconstructed datasets showed high-resolution images of all midfacial osseous structures in near-computed tomography quality. Regarding high-contrast structures, detailed analyses of datasets acquired in this study suggest that the parameters 400 projections, 1.2 mA, and 100 kV are sufficient. In terms of soft-tissue visualization, a higher level of mA seems preferable. The tested prototype predicts a new era in cone-beam computed tomography imaging. The integration of a flat-panel detector will overcome the limitations of current available systems. The size of the field of view is increased allowing regularly the visualization of the whole facial skeleton. Particularly in cases of open reduction of unilateral fractures, the assessment of symmetry is of clinical value.

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.

Changing trends in the treatment of zygomaticomaxillary complex fractures: a 12-year evaluation of methods used.

The efficacy of the current methods for the treatment of fractures of the zygomaticomaxillary complex was evaluated. One thousand two hundred seventy-seven patients with fracture of the zygomaticomaxillary complex and 196 patients with fractures of the zygomatic arch that were admitted between 1984 and 1995 were evaluated. One thousand one hundred fifty surgical procedures were performed, and in 401 cases, no operative treatment was considered necessary. The Gillie's approach was used in 514 cases, intraosseous wiring in 89 cases, bone plate osteosynthesis in 322 cases, Roger-Anderson pins in 180 cases, antral packing in 17 cases, and elevation with a hook in 28 cases. The best results were achieved with the use of semirigid fixation with miniplates applied at one or more sites of the fractured complex, occasionally used in combination with other methods such as Roger-Anderson pins. Semirigid fixation with miniplates offers the most reliable method available today for the treatment of zygomatico-orbital complex fractures and has practically replaced every other method in our institution. The increased cost and occasionally the necessity to remove the hardware are the main disadvantages of the method.

Changing trends in the treatment of zygomaticomaxillary complex fractures: A 12-year evaluation of methods used

Changing trends in the treatment of zygomaticomaxillary complex fractures: A 12-year evaluation of methods used

Bilateral fixation of a nasotracheal tube by transfacial kirschner wires

Because of the high margin for error with transfacial internal wire fixation, even in the hands of an experienced practitioner, alternative modalities in the treatment of zygomaticomaxillary complex fractures should be considered. When the use of transfacial rigid wire fixation is indicated, emphasis should be placed on prevention and early recognition of nasotracheal transfixation to avoid unnecessary postoperative catastrophies.