Zygomatic Arch Fractures Research Articles

Modified Zimmer finger splint revisited

Introduction: Currently, many zygomatic complex fractures are treated with open reduction and semi rigid internal fixation. Isolated arch fractures are usually treated with closed reduction most often via a Gillies’ temporal incision. Unstable fractures however, do pose a problem. Surgical approaches to the zygomatic arch carry with it the risks of scarring and facial nerve disruption. A relatively simple technique such as the external modified Zimmer finger splint can be employed to treat unstable zygomatic arch fractures with very good results.

Temporal (Gillies) Approach to a Zygomatic Arch Fracture

Temporal (Gillies) Approach to a Zygomatic Arch Fracture

Temporal (Gillies) Approach to a Zygomatic Arch Fracture

Temporal (Gillies) Approach to a Zygomatic Arch Fracture

Use of a Balloon Catheter With Intraoperative C-Arm Fluoroscan for Reduction of Zygomatic Arch Fractures.

The purpose of this study was to evaluate the usefulness of C-arm fluoroscan with a balloon catheter in patients undergoing closed reduction of zygomatic arch fractures. All patients who had zygomatic arch reduction surgery between 2006 and 2015 were identified and classified into 2 groups. Group A included those patients who underwent closed reduction of zygomatic arch fractures. Group B included those who underwent zygomatic arch reduction surgery with a C-arm fluoroscan and supporting balloon. A balloon catheter was used to stabilize the zygomatic bone after reduction. Results were scored from 1 (poor) to 3 (good) to assess surgical outcomes based on 3 criteria: alignment of the zygomatic arch on a postoperative computed tomography scan, facial asymmetry in photography, and the patient's subjective satisfaction. The authors enrolled 32 patients with zygomatic arch fractures. 18 patients underwent closed reduction for zygomatic arch fractures (group A), while 14 patients underwent closed reduction with C-arm fluoroscan and balloon support (group B). The average score for group A was 2.00 for alignment, 2.56 for facial asymmetry, and 2.67 for subjective satisfaction compared with 2.64 for alignment, 2.86 for facial asymmetry, and 2.79 for subjective satisfaction in group B. There were statistically significant differences in the alignment and facial asymmetry scores between the 2 groups. The authors suggest that C-arm fluoroscan with balloon support is a useful modality for reduction of zygomatic arch fractures that provides better surgical outcomes than conventional closed reduction surgery.

Applications of 3D orbital computer-assisted surgery (CAS).

The purpose of the present report is to describe the indications for use of 3D orbital computer-assisted surgery (CAS). We analyzed the clinical and radiological data of all patients with orbital deformities treated using intra-operative navigation and CAD/CAM techniques at the Hôpitaux Universitaires de Genève, Switzerland, between 2009 and 2016. We recorded age and gender, orbital deformity, technical and surgical procedure and postoperative complications. One hundred and three patients were included. Mean age was 39.5years (range, 5 to 84years) and 85 (87.5%) were men. Of the 103 patients, 96 had intra-operative navigation (34 for primary and 3 for secondary orbito-zygomatic fractures, 15 for Le Fort fractures, 16 for orbital floor fractures, 10 for combined orbital floor and medial wall fractures, 7 for orbital medial wall fractures, 3 for NOE (naso-orbito-ethmoidal) fractures, 2 for isolated comminuted zygomatic arch fractures, 1 for enophthalmos, 3 for TMJ ankylosis and 2 for fibrous dysplasia bone recontouring), 8 patients had CAD/CAM PEEK-PSI for correction of residual orbital bone contour following craniomaxillofacial trauma, and 1 patient had CAD/CAM surgical splints and cutting guides for correction of orbital hypertelorism. Two patient (1.9%) required revision surgery for readjustment of an orbital mesh. The 1-year follow-up examination showed stable cosmetic and dimensional results in all patients. This study demonstrated that the application of 3D orbital CAS with regards to intra-operative navigation and CAD/CAM techniques allowed for a successful outcome in the patients presented in this series.

Risk factor analysis and idiographic features of mandibular coronoid fractures: A retrospective case\u2013control study

This study aimed to identify and distinguish various factors that may influence the occurrence of mandibular coronoid fractures. From January 2000 to December 2009, a total of 1131 patients with maxillofacial fractures were enrolled in this statistical study to evaluate the association between mandibular coronoid fractures and other risk factors. Among these patients, 869 had mandibular fractures, and 25 sustained a total of 25 coronoid fractures. More than half (13 of 25 patients, 52%) of the coronoid fractures in these patients were caused by motor vehicle accidents. Among these coronoid fractures, seven were associated with other mandibular fractures, and 23 (92.0%) were related to midfacial fractures. The most common site of midfacial fracture was the zygomatic arch (20 patients, 80%). Multivariate logistic regression analysis revealed that the most important influencing factor was the zygomatic arch fracture (odds ratio, 9.033; 95% confidence interval, 1.658, 49.218; p = 0.011). The majority of coronoid fracture fragments (19 of 25, 76%) were removed during operation. The most commonly used incision is hemicoronal or bicoronal approach (16 of 19, 84.2%).

Carotid Cavernous Fistula: Role of Open Surgery in The Era of Endovascular Treatment

A 18-year-old right handed girl presented with progressive proptosis, chemosis, diplopia and an orbital bruit of right eye, 3 days after alleged history of fall from a tree, The intraocular pressure was increased. The suspected diagnosis of a direct carotid cavernous fistula (CCF) was confirmed by CT angiography CT Angiography showed direct fistulous communication of cavernous segment of right internal carotid artery with right cavernous sinus (type A right CCF) and linear minimally displaced fracture of right zygomatic arch and linear undisplaced fracture of wall of right orbit. The patient underwent right pterional craniotomy and transcavernous occlusion of fistula of right internal carotid artery (ICA). Surgery was performed with gradual resolution of the symptoms and normalization of the intraocular pressure.The pathogencsis, symptomatology, treatment of carotid cavernous fistulas are discussed.Nepal Journal of Neuroscience, Volume 14, Number 1, 2017, Page: 36-39

Minimal access percutaneous approach for the management of zygomatic arch fractures

Minimal access percutaneous approach for the management of zygomatic arch fractures

Diagnostic validity of ultrasonogaraphy in zygomatic arch fractures: A clinical study

Objective: The Objective of the present study was to investigate the uses of ultrasonography in the diagnosis of zygomatic arch fractures and to identify the acoustic pattern between ultrasound image and true morphology of zygomatic arch. Method: Once the patient was positioned, the acoustic coupler was applied to the patients control side i.e., the normal zygomatic arch and a similar scanning was carried out on the fractured side using a linear array transducer utilizing a frequency of 11 MHz. The areas of interest were scanned under both transverse and longitudinal sections, findings were entered into the proforma and then the printouts of the ultrasound pictures were printed using Sony type 1 (normal) high quality printing paper using a B&W Thermal Printer UP-895CE Sony. Results: All the 16 patients were subjected to ultrasonography and in all 16 cases fracture of the zygomatic arch was confirmed, implying there is 100% accuracy. Conclusion: Ultrasound offers a safe, inexpensive, accurate adjunct to conventional radiography of the facial bones and is well tolerated by recently injured patients. Ultrasound may also be considered as an alternative to repeating plain X-ray films to answer any doubts about the configuration or displacements of fractures, as ultrasound is noninvasive and overcomes the disadvantages of radiography. This study emphasizes the need of the hour in diagnostic imaging and its possible role in intraoperative reduction of zygomatic arch fractures. The present study was also able to distinguish the patterns of zygomatic arch fractures as given by Honig Merten. Keywords: Diagnostic ultrasound, Real time imaging, Zygomatic arch fracture

Correlation between Loss of E-cadherin, Matrix-metalloproteinases and c-Jun expression in Oral Carcinogenesis

Introduction: Zygomatic complex fractures remain one of the most common maxillofacial injuries. They can occur as isolated fracture or associated with other maxillofacial injuries. The aim of this descriptive, analytical study was to analyze the epidemiological characteristics of patients treated for zygomatic complex and zygomatic arch fractures at our institution. Patients and Method: A retrospective study involving 60 patients admitted and treated for zygomatic complex and zygomatic arch fractures at the Dept. of dentistry, Sri Manakula Vinayagar medical college and hospital, Pondicherry, India from June 2011 to June 2016 was done. The data collection protocol included: age, sex, cause of injury, anatomical site, associated maxillofacial injuries and treatment modality. Results: 91.7% were males and 8.3% females. Most patients (46.7%) were aged 21-30 years and road traffic accidents (73.3%) was the most common etiology of fracture. Left side (51.7%) was involved a little more than right side (46.3%). The most common fracture site was zygomatic buttress (70%). A total of 51.7% patients had two process fractures, 26.7% had single process fracture and 21.7% had tripod fractures. Mandible fracture (28.6%) was most common associated maxillofacial injury. Surgery was performed with a closed reduction in 13.3% and open reduction in 86.7% of patients. Conclusion: The study concludes that road traffic accidents are responsible for most zygomatic complex and zygomatic arch fractures. Male patients, aged 21 to 40 years, more often sustained fractures. Keywords: Zygomatic complex fracture, Maxillofacial injuries, Road traffic accident

Zygomatico-Coronoid Ankylosis: A Case Report

Extra-articular ankylosis resulting from bony union between the coronoid process and the zygoma is very rare. It may result from facial fractures caused by gunshots, treated or untreated facial fractures or may arise as an extension of intracapsular ankylosis. We report a case of ankylosis between the coronoid process and the zygomatic arch in a 33-year-old Black male. The bony ankylosis was the result of a 2 year old untreated zygomatic arch fracture. Ankylosis developed secondary to heterotopic bone formation following trauma. The patient was treated by intra-oral coronoidectomy, followed by physiotherapy for three months. He returned for review one year later with a mouth-opening of 40 mm and a stable occlusion.

Metal tea strainer as an external fixation tool in comminuted zygomatic arch fractures, an inexpensive and practical technique

Metal tea strainer as an external fixation tool in comminuted zygomatic arch fractures, an inexpensive and practical technique

Internal splinting method for isolated zygomatic arch fracture using endotracheal tube: A new method

Internal splinting method for isolated zygomatic arch fracture using endotracheal tube: A new method

Keen's Approach: A Dynamic Approach for Zygomatic Arch Fracture Management

AbstractMaxillofacial fractures are often associated with blunt head injuries of which the outward projection of the Zygomatic Arch exposes it to frequent injury. Isolated Zygomatic arch fractures account for 10% of all Zygomatic bone fractures. Depressed Zygomatic arch fractures causes restricted mouth opening due to the partial or total obstruction of the movement of mandibular coronoid and condylar processes. Numerous techniques have been used to approach the site and reduce the fractured fragments, such as the Gillie's temporal approach, Keen's intraoral approach, anterior cheek skin incision and direct open approach.Below is a case report of an isolated Zygomatic arch fracture following a road accident in a middle aged woman that was surgically treated by open reduction through the Keen's intraoral approach. Successful reduction of the fractured segments and restoration of function was achieved with no scarring, minimal post-operative pain and satisfactory aesthetics.

Intra-oral reduction of zygomatic fractures.

Zygomatico-maxillary complex fractures present a challenging diagnostic and reconstructive task to the surgeon. Gillie's temporal approach has been a commonly used technique for zygomatic arch reduction, but surgeons have been commonly using a buccal sulcus approach for the reduction of zygomatic arch fractures as well as for combined zygomatico-maxillary complex fractures. This article outlines the use of Rowe's elevator (modification of Bristow's elevator) intra-orally to reduce zygomatic arch fractures and, if required, simultaneously plate the zygoma through the same approach. A retrospective analysis of 379 patients treated with this technique in the last 10 years has been presented along with a comprehensive treatment protocol including a description of its advantages over the Gillie's approach. Based on the inclusion criteria, the study group consisted of 327 patients. In 281 patients, the zygomatic complex was fractured, whereas 46 patients presented with a solitary zygomatic arch fracture. Two hundred and three cases were successfully treated with the buccal sulcus approach, whereas 124 cases required both the buccal sulcus and the extra-oral lateral orbital approaches. The described approach has advantages over Gillie's temporal approach by being simple, faster and cost-effective, can be performed under local anesthesia, and is more esthetic as it does not leave any scars.

Use of Percutaneous Access via Combination of Transconjunctival and Lateral Canthotomy Approach for Rigid Fixation and Reconstruction of the Unstable Zygomatic Arch

Introduction: Zygomatic arch fractures are common injuries in the maxillofacial injuries. Sometimes it is necessary to fix the unstable fragments of the zygomatic arch. Case Presentation: We introduce a combination of transconjunctival and lateral canthotomy for open reduction and percutaneous access for rigid fixation of the arch in the zygomatic maxillary complex (ZMC) fracture in a 44-year-old man. Conclusions: This approach may be an appropriate approach to the zygomatic arch in the ZMC fractures and eliminates the use of the coronal flap.

Preoperative Use of Radiopaque Materials on Fractured Zygomatic Arch.

Fractures of the zygoma are relatively frequent and their management has been extensively described. Above all, isolated zygomatic arch fractures comprise about 10% of all zygomatic fractures. Temporal approach is common surgical method, Gillies approach, but it has the limitation of blinded surgical approach. So, the mobile intraoperative fluoroscan is used famously for more suitable reduction, but it needs an additional man to control the machine and increases irradiation doses. The authors got the simple idea, but so helpful tool, and it has been performed since 2012. The authors have gotten good surgical results, so introduce this idea that favors the surgery on isolated zygomatic arch fracture.

Uso de fluoroscopia intraoperatoria en el tratamiento de fracturas aisladas de arco cigomático. Ensayo clínico aleatorizado

PurposeIsolated zygomatic arch fractures (IZAF) are habitually reduced at a distance, via a temporal approach. Open reductions are not recommended due to the associated morbidity and complications. However, performing closed reductions makes it difficult to determine whether it was done satisfactorily. This study aims to determine whether the acquisition of intraoperative images with a C-arm to evaluate IZAF reductions is a useful technique in treating such fractures. MethodsOur hypothesis is that acquiring intraoperative images with a C-arm reduces the need for a second surgery. Between 2009-2012, 50 patients who were diagnosed with IZAF requiring surgery were randomly distributed into 2 groups: 25 patients in the experimental group, where fracture reduction was performed and immediately corroborated intraoperatively for an adequate result using a C-arm; 25 patients were assigned to a control group where the fracture reduction was controlled with post-surgery imaging. ResultsThe results did not reveal significant differences between both groups (P=.05). Nevertheless, the experimental group had the advantage of being able to immediately reduce the fracture again if the result was unsatisfactory. ConclusionsDespite the fact that the results are not statistically significant, the authors recommend undertaking an intraoperative imaging analysis in areas where we are not certain of the reduction.

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

Fractures of the posterolateral maxillary sinus: a masticator space blowout injury?

Segmental, depressed fractures of the posterolateral maxillary sinus may occur as a result of trauma to the masticator space, previously described in association with mandibular fractures. The authors hypothesize that the fracture is due to a transient increase in pressure in the masticator space (blow out) and therefore should be seen in association with other regional fractures. Injuries of the masticator space were retrospectively identified by searching the imaging database from January 2014 to November 2014 for keywords that would identify regional trauma. The images were reviewed for segmental depressed fractures in the posterolateral aspect of the maxillary sinus accompanied by herniation of a variable amount of masticator space fat and/or muscle into the adjacent sinus. Three neuroradiologists reviewed the images and agreed by consensus on the presence or absence of a masticator space blowout fracture. Forty-three zygomaticomaxillary complex (ZMC) fractures, 89 mandibular fractures, and 49 isolated zygomatic arch fractures were identified. While all of the ZMC fractures had a maxillary component, 3 of 43 (7.0%) additional fractures met our fracture definition. Five of 89 (5.6%) of the mandibular fractures and 6 of 49 (12.2%) zygomatic arch fractures had an associated posterolateral maxillary fracture. Segmental depressed fracture of the posterolateral maxillary sinus is relatively common, occurring in conjunction with other regional injuries. The authors hypothesize that it is due to a transient increase in pressure in the masticator space and is a separate entity from other fractures of the region that may occur concurrently.