Zygomatic Bone Fractures Research Articles

Clinical application of submandibular endotracheal intubation in craniomaxillofacial fracture

ObjectiveTo explore the clinical application of submandibular endotracheal intubation in craniomaxillofacial fractures. MethodsThe submandibular endotracheal intubation was used to treat 10 patients with cranio-maxillofacial fractures and contraindications to nasal intubation.Ventilator monitoring data including SPO2(oxygen saturation of blood), Freq,VT,MV,PEEP, PLAT and PEAK were monitored before and after the operation of submandibular endotracheal intubation. The technique of submandibular intubation was assessed intraoperatively and in the postoperative period. The outcomes and complications are presented. ResultsThe study included 10 patients aged between 18 and 63 years(6 males and 4 females). All patients had mandibular fractures, with 6 midface fractures (60 %), 5 nasal bone fractures (50 %), 6 zygomatic bone fractures (60 %). The procedure time ranged from 6 to 10 min (mean, 7.9 min). NO delayed extubation was performed in 10 cases. The technique has proved to be straightforward and satisfactory. A postoperative superficial infection occurred in 1 patients, whereas hypertrophic scars occurred in another 1 patients. ConclusionSubmandibular endotracheal intubation is a safe procedure for intraoperative airway control in maxillofacial trauma patients who present contraindication to nasotracheal intubation.

A clinical prospective study on the surgical management of zygomatico-maxillary complex fractures using two-point fixation

The ZMC fractures are one of the most frequently occurring maxillofacial injuries due to its prominence and facial contour. The ZMC forms a principle buttress of face and helps transmit occlusal forces to skull base. Fracture of zygomatic bone leads aesthetic and functional deformity. Restoration to premorbid condition is most predictable by ORIF. In this study was to evaluate efficacy of two-point internal fixation using conventional miniplates and screws for ZMC fractures. 35 patients with established unilateral isolated ZMC fractures were operated using two-point fixation method i.e. the maxillary buttress and the fronto-zygomatic suture, followed up for 3 months. Patients were assessed clinically and radiographically at different follow up intervals. Charts of patients were reviewed for age, gender, etiology, malar height analysis and vertical dystopia. 35 patients in this study, underwent ORIF under GA with two-point fixation. Preoperatively, mean malar height of the patients recorded was 66.55 ± 3.02. There was a significant increase in malar height postoperatively (P < 0.0001). 70.24 ± 2.05, at 1st week, and 69.87 ± 1.98. in 3rd and 6th weeks. Preoperatively, mean vertical dystopia of patients was 2.24 ± 0.71. Postoperative resolution of vertical dystopia was statistically significant (P<0.0001), with value of 0.52 ± 0.52.Integrity of ZMC is important in maintenance of normal facial width and prominence of cheek. Two‑point fixation shows satisfactory results functionally, esthetically and also provides additional advantage by eliminating another surgical site. Thus we conclude that our study provides a basis for further research.

Retrospective epidemiological study over 8‐year period on zygomatic complex fractures: A single centre experience

AbstractObjectivesThe purpose of this study was to do a retrospective analysis of patients with zygomatic fractures who were treated at the Department of Maxillofacial Surgery, Regional University Hospital of Perugia, Italy, between 2016 and 2023.Materials and MethodsPatients were evaluated based on various parameters including age, sex, aetiology, symptoms, comorbidity, clinical findings, zygomatic fracture type, other facial fractures, treatment, waiting time before the operation, complications and sequelae. In the period described, we had 123 cases of zygomatic fractures requiring surgical intervention.ResultsAmong the patients, 101 were male (82.1%) and 22 were female (17.9%). The average age of the patients was 48.65 years (ranging from 7 to 94 years).The leading cause of these fractures was sports‐related injury (n = 32; 26.01%), and isolated zygomatic bone fractures were the most frequent (72.43%). The most common clinical signs and symptoms were pain, depression of the facial profile, difficulty in chewing, limitation of the buccal opening, difficulty in protrusion movements and mandibular lateralization. Ninety‐six per cent of patients underwent surgery under general anaesthesia, with open reduction and internal fixation.ConclusionsThe successful and effective management of zygomatic fractures requires a solid understanding of its anatomy, pathophysiology and related biomechanical structures and forces. The continuous research in epidemiology, aetiology, materials and techniques will further refine our treatments which are nowadays more and more customized according to the type of trauma.

Management of Atypical M-Shaped Zygomatic Arch Fractures.

M-shaped zygomatic arch fractures can usually be treated effectively through closed reduction. It consists of 2 fracture segments: the anterior zygomatic segment and the posterior temporal bone segment. In clinical practice, atypical M-shaped fractures are often encountered, in which the anterior and posterior fracture segments are discontinuous and separated. Closed reduction usually cannot achieve the desired anatomic reduction effect for this type of fracture. The preoperative design showed that the anatomic reduction of the posterior zygomatic arch fracture segment was hindered due to bone spurs in the most concave area of the anterior zygomatic bone fracture segment. Open reduction and fixation were performed to achieve anatomic reduction and restore facial symmetry. The fracture sites were exposed through a hemicoronal incision. After the bone spurs are removed, the posterior bone segment can be anatomically reduced. Absorbable plates were used for fixation. The patient's facial appearance was restored after the surgery. The postoperative computed tomography scan showed a good alignment of the fracture. The authors believe that for patients with high requirements for facial symmetry, the presence of atypical M-shaped fractures can indicate open reduction and fixation.

Maxillofacial trauma and its management presenting at a tertiary care hospital in Lahore during Covid-19 pandemic.

The objective of this study was to assess the patterns of maxillofacial injuries, aetiology and their management during the pandemic of Covid-19 in a tertiary care hospital in Lahore, Pakistan. This is a single center, prospective cross-sectional study. Patients from all age groups who presented at the Emergency room of Jinnah Hospital Lahore and managed by the Oral and Maxillofacial Surgery Department during 1st December 2020 till 31st January 2021 were included. Data were analyzed using IBM SPSS for Windows, Version 20.0. Total 202 patient were analyzed, 161 (79.7%) were male and 41 (20.3%) were females. Male to female ratio was 4:1. About fifty three percent of patients belonged to the age group 15-35 years. The most common cause was road traffic accidents (RTA), followed by fall. Eighty-three (41.1%) had only soft tissue injuries without any bony fracture and 119 (58.9%) had facial bones fractures. Zygomatic bone fracture was most common (53.8%) followed by mandible fracture (31.1%). Sixty-one out of 119 patients with fractures were treated with Open Reduction Internal Fixation (ORIF). Three patients had complete loss of vision because of facial trauma. Only 56 (28%) patients were managed under General Anaesthesia. During the initial pandemic era, a large majority of patients presenting with maxillofacial injuries were young male adults. The most common cause of maxillofacial trauma was RTAs. Soft tissue injuries were predominant followed by facial bone fractures and zygomatic bone was more frequent among the fracture cases. Covid-19 pandemic increased the difficulties faced in the management of maxillofacial trauma patients.

Management of zygomatic fractures using different surgical approaches.

Management of zygomatic complex fractures using closed reduction, two point open reduction with internal fixation (ORIF), closed reduction with three point ORIF and two point ORIF is of interest to dentist. 150 patients with zygomatic bone fractures between the ages of 14-60 years were included in the study. At final assessment, the percentage of stable condition was greater in closed reduction + two point ORIF and closed reduction + three point ORIF when compared to two point ORIF alone and three point ORIF alone and closed reduction alone. It was observed that stable condition was lowest in closed reduction alone. It was also observed that stable condition was lower in closed reduction + two point ORIF as compared to closed reduction + three point ORIF. It was also further noticed that stable condition was lower in two point ORIF alone as compared to three point ORIF alone. The treatment approach involving closed reduction and three point ORIF had better outcomes for management of zygomatic complex fractures.

A Comprehensive Look at Maxillofacial Traumas: On the Basis of Orbital Involvement.

Orbital wall fractures that may develop in maxillofacial traumas (MFTs) may cause ophthalmic complications (OCs). The aim of this study is to determine the frequency of orbital fractures (OFs) accompanying MFTs and findings suspicious for orbital traumatic involvement. Computed tomography (CT) images of 887 patients who presented to the emergency department within a 1-year period with a history of MFT were retrospectively scanned. During the examination, patients with orbital wall fractures, craniofacial bone fractures, and posttraumatic soft tissue changes were recorded. OF was observed in 47 (5.3%) of the patients admitted for MFT. In cases with OFs, accompanying nasal (25.5%), ethmoid (2.1%), frontal (19.1%), maxillary (38%), and zygomatic bone fracture (10.6%), sphenoid (4.3%), and soft tissue damage (55.3%) were observed. It was observed that the pathologies mentioned at these levels were significantly higher than in patients without orbital involvement (p < 0.05). In our study, mild (48.9%) and moderate-severe (2.12-4.25%) OCs accompanying OFs were observed after MFT. The frequency of MFT varies depending on various factors, and such studies are needed to take preventive measures. Knowing the risk and frequency of orbital damage accompanying MFTs may help reduce complications by allowing rapid and accurate diagnosis.

Frequency and Pattern of Presentation of Infra-Orbital Nerve Injury in Patients of Zygomatic Bone Fracture

Aim: In order to evaluate the frequency and kind of infraorbital nerve injury in zygomatic bone fractures Method: A cross-sectional study was conducted from February 2022 to January 2023 at the Oral and Maxillo-Facial Surgery Department, Nishtar Institute of Dentistry, Multan. Sixty-four zygomatic bone fracture patients were included, meeting inclusion and exclusion criteria after a complete clinical and radiological examination. Clinical neuro-sensory testing (NST) was performed to assess nerve injury. The patient's demographic data, cause of fracture, presence, and type of nerve injury were collected on a specially designed proforma. The data was analysed using SPSS version 22. Frequencies, percentages, and mean ± standard deviation were taken. Results: Sixty four patients were included with male into female ratio of 4.34:1. There was male predominance. Most common cause of ION injury, in zygomatic bone fractures was RTA (n=13,46.4%) while nerve injury was present in 29 patients (46.77%) of patients. Most common presentation of ION nerve injury was paresthesia n=10,34.5%. Conclusion: Zygomatic bone fracture is the leading cause of infra-orbital nerve injury and its most common presentation is paresthesia. Keywords: infra-orbital nerve (ION) injury, paresthesia, zygomatic bone (ZMC) fracture

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 &amp; Maxillo-Facial Surgery Department, Nishtar Institute of Dentistry, Multan. Seventy two zygomatic bone fracture patients were included meeting inclusion &amp; exclusion criteria after complete clinical &amp; 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 &amp; Kelly’s type IV (inward &amp; 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 &amp; internal fixation (ORIF); zygomatic bone fracture.

Multidetector computed tomography in evaluation of maxillofacial injuries

Facial injuries occur in significant proportion in trauma patients requiring prompt diagnosis and management. The number of maxillofacial injuries is continuously increasing due to rise in traffic, failure to take preventive measures in the traffic leads to road traffic accidents, which is the main etiological factor in maxillofacial fractures. To study role of multidetector tomography in evaluation of maxillofacial injuries. To describe the advantages of 3D reconstructed images over axial images in the imaging of facial fractures. This cross-sectional study included 100 patients who underwent CT evaluation of facial bones when they presented with evidence of fracture of maxillofacial bones on a 64-slice volume scanner (SIEMENS SOMATOM definition) in Geetanjali Medical College and Hospital, Udaipur during February 2019 to July 2020. RTA comprised of 76.19% cases. Assault and fall from height were 11.42 and 12.38%. The maxilla, the walls of its sinus were the most commonly involved bone with 71.42% next was Naso-orbito-ethmoid 68.57%. Zygomatic bone and mandible fractures were 50 and 38.09%. The type 2 frontal bone fractures were commonly seen 12 (31.5%) followed by Type 3, 10 (26.02%), Type 4 &amp; Type 1 seen in 6 (15.7%) and Type 5 was the least common injury seen 4 (10.52%). The medial wall of the orbit was most commonly involved 49 (35.76%). Le Fort fracture lines were identified in 17 occasions with Le Fort II seen 9 (52.9%). The advantages of 3D images within the assessment of facial trauma might be described especially in mandible and cheekbone. 3D images were better within the identification of Le Fort fracture lines. The coronal reconstructed images are superior in the detection of fractures in the orbit and maxilla. 3D images have a limited role in fractures involving the naso-orbito-ethmoid region and also when there is minimal fracture displacement.

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.

Management of Zygomatic Arch Fracture in Polycythemia Vera Patient-A Case Report

Polycythemia vera (PV) is a myeloproliferative neoplastic condition characterized by an unregulated synthesis of red blood cells (RBCs). There is often simultaneous stimulation of the megakaryocytic and myeloid lineages; this causes an increase in the synthesis of white blood cells and platelets2. As a result, there is an increased risk of thrombosis and bleeding. Due to the extensive vascular network of the face and jaw7 and limited surgical access to perform hemostasis, traumatic injuries and surgical procedures are among the most common causes of increased blood loss. Zygomatic bone fracture is one of the most frequent fractures of the facial skeleton. The zygomatic bone is a strong bone that supports the maxilla and the skull base. However, its prominence makes it highly susceptible, mainly when impact occurs on both sides of the face4. Facial bone fractures are associated with 1–11% excess blood loss. These complications have the potential to increase perioperative morbidity and mortality significantly. Adequate precautions must be taken in treating these patients for successful outcomes. The management of patients with PV includes therapeutic preoperative phlebotomy, increased fluid intake, and antiplatelet therapy. This report demonstrates the management of a complex procedure such as maxillofacial trauma in a PV patient with a normal coagulation profile.

Does maxillary sinus size affect the risk for zygomatic complex fractures?

The purpose of the study was to measure the maxillary sinus sizes in patients with and without zygomatic bone fractures. In this cross-sectional study computed tomography data of a case group of consecutive treated patients with displaced zygomatic bone fractures were compared to a control group with mandibular fractures. Maxillary sinus sizes were measured in width, height, depth, and volume. We compared sinus sizes between the case and control group, followed by a subgroup analysis of slightly and severely displaced fractures using T-tests. We identified 89 cases, thereof 46 with slightly and 43 with severely displaced fractures. The control group consisted of 110 patients. The mean sinus volume of the case group (19,313 mm3 ± 5237) was significantly larger than in the control group (17,645 mm3 ± 4760; p=0.02). Subgroup analyses revealed that this difference in volume was more pronounced between patients with severely displaced fractures (20,354 mm3 ± 5416; p=0.003) and the control group. In two-dimensional measures, only sinus height was significantly greater in the case group (37.41 mm ± 4.25 vs. 35.33 mm ± 4.88; p=0.002). The same holds for the subgroup with severely displaced fractures (38.27 mm ± 3.91; p=0.001). Sinus width and depth showed no significant differences between the groups. A maxillary sinus volume larger than 20,000 mm3 is a predictive risk factor for a displaced zygomatic bone fracture. Greater sinus height indicates a larger surface area of the zygomaticomaxillary buttress that decreases the resistance to facial trauma.

Epidemiological study of zygomatic bone fractures: A five-year retrospective analysis of a single-center experience

Introduction. Zygomatic bone fractures are prevalent in the maxillofacial region. This study aims at analyzing the epidemiology and clinical presentation of isolated zygomatic bone fractures. Material and Methods. The retrospective study, conducted at the Clinic of Maxillofacial Surgery of the University Clinical Center of Vojvodina, included 128 patients diagnosed with isolated zygomatic bone fractures. The following parameters were taken into consideration: gender, age, trauma etiology, clinical presentation, computed tomography analysis of the fracture localization and pattern. The fractures were classified into five groups according to Zingg classification system. Results. The study included patients aged 10-82 divided into four groups, with the most affected group being 30-49 years old. Men were more often treated for zygomatic bone fractures (male: female ratio 3:1). Left-sided fractures of the zygomatic bone occurred more often (55.2%) than the right-sided ones. Type B was the most common type of fracture, while the zygomaticomaxillary buttress fracture was the most common injury. Early treatment was administered in 78 patients (60.94%), while 50 patients (39.06%) underwent delayed reconstruction. The analysis of complications concerning the time of surgical intervention revealed a higher incidence of ectropion in cases treated early, while infraorbital paresthesia and facial asymmetry were more prevalent in cases treated late. Conclusion. Zygomatic bone fractures have high morbidity risk, and may cause temporary incapacity to work, and potentially permanent and functional damage.

Pattern and management of maxillofacial fractures in Jordanian children and adolescents.

The aim of this study was to analyze the characteristics, etiology and treatment of maxillofacial fractures among children and adolescents in northern part of Jordan. A retrospective cohort study which included 91 children and adolescents patients who were treated for maxillofacial fractures during a period of three years between January 2019 and December 2021 at a tertiary hospital in Jordan. Over a period of three years, a total of 91 children between the age of 0 and 19 years were treated with 156 total maxillofacial fractures. Of these, 68 (74.73%) were males and 23 (25.27%) were females. One tenth of patients (10 (10.99%) were children of the preschool group and 55 patients (60.44%) were adolescents. Road traffic accident (RTA) was the most common cause of maxillofacial fractures, accounting for 57 (62.64%) of cases. Mandibular fractures were the most common and accounted for 82 (90.2%) of all fractures, followed by the zygomatic bone fractures 40 (44%). The most common treatment was intermaxillary fixation (IMF) with 53 (33.97%) fractures. Maxillofacial fractures are predominant among adolescents in comparison to children. RTA was the most common cause of maxillofacial fractures, mandibular fractures were the most common fractures, and intermaxillary fixation (IMF) was the most common treatment modality.

Combined use of 3D printing and computer-assisted navigation in the clinical treatment of multiple maxillofacial fractures

ObjectivesIn the field of computer-assisted surgery, 3D printing technology and computer-aided navigation (CAN) technology have led to advances in craniofacial surgery. However, the application of these two techniques in maxillofacial fractures is mostly limited to unilateral zygomatic bone and zygomatic arch fractures, and few studies have investigated their use for multiple maxillofacial fractures. This study summarizes the combined application of 3D printing technology and CAN for complex maxillofacial fractures to guide clinical practice. Materials and methodsTwenty-six patients with multiple maxillofacial fractures from 09/2017 to 03/2021 were retrospectively studied and divided according to surgical method into an experimental group (navigation-aided surgery combined with a 3D-printed guide) and a control group (navigation-aided surgery only). The surgical time was compared between the groups, and posttreatment computed tomography and follow-up visits were conducted at 1 week and 3 months, respectively, to compare the quality of treatment in terms of infection, occlusal disorder, restricted mouth opening, midline displacement, and bilateral asymmetry. ResultsAccording to our results, the combined use of CAN and 3D printing significantly improved the treatment results of double-sided maxillofacial fractures (rs = 0.448, P < 0.05). The surgical time of the experimental group was significantly shorter than that of the control group (Z = −2.083, P < 0.05). ConclusionsThis study broadens our understanding of the treatment of multiple maxillofacial fractures. The combined use of 3D printing technology and CAN effectively shortened the operation time and achieved a better therapeutic effect.

Association between type of fixation and a length of stay amongst maxillofacial fracture patients: A retrospective charts review.

We aimed to explore the predictors of hospital length of stay for patients admitted and with maxillofacial injuries. Patients presenting with maxillofacial trauma were included. Poly-trauma involving neurosurgery and/ or needing orthopaedics intervention were excluded. Logistic regression was applied to explore the predictors associated with the hospital stay of > 4 days. There were 241 patients with mean age 29.35 ± 12.5 years (age range 12-80 years). Mandibular fracture was the commonest observation 121(50.2%), followed by maxillary 48(19.9%), and zygomatic bone fracture 9 (3.7%). Road traffic accident 196 (81.3%) appears to be the most common etiology of maxillofacial injuries in the studied sample. The mean length of hospital stay among bone plating patients was 5.96 ±6.8 days compared to 4.15±6.2 days for ones treated without bone plating; p-value 0.05. It was concluded that longer length of stay is required in patients with more complex management including bone plates.

Isolated traumatic aniridia with full and partial iris expulsion in pseudophakic eyes

BackgroundTotal aniridia after ocular trauma without disruption of the intraocular lens (IOL) has been reported in patients with a history of small-incisional cataract surgery. We report one case each of total and partial aniridia after accidental falls experienced by two elderly Japanese women.Case presentationsCase 1. A 76-year-old woman with a history of small-incisional cataract surgery more than 10 years previously fell onto concrete and had a contusion that affected the left side of her face. At the initial visit, the best-corrected visual acuity (BCVA) was hand motions and the intraocular pressure (IOP) was 38 mmHg in her left eye (OS). A blood clot was present in the well-formed anterior chamber and expulsed iris tissue was seen beneath the conjunctiva. Exploratory surgery showed no scleral laceration other than the previous sclerocorneal tunnel. After hyphema removal, total aniridia and an intact in-the-bag fixed IOL were seen. By 4 months, the BCVA was 1.2 and the IOP was 13 mmHg OS. Case 2. An 88-year-old woman with a history of small-incisional cataract surgery more than 10 years previously had a fall that resulted in right-sided zygomatic and maxillary bone fractures. The BCVA was light perception and the IOP was 29 mmHg in her right eye (OD). Exploratory surgery showed no scleral laceration and the previous sclerocorneal tunnel was found; iris strand prolapsing from the sclerocorneal tunnel was seen. After hyphema removal, partial iris loss and an intact lens position were seen. By 1 week postoperatively, the BCVA was 0.05 OD and the IOP was 12 mmHg OD.ConclusionsIt has been postulated that previously created small-incision tunnels can function as release valves during blunt trauma by preventing further global rupture and limiting IOL prolapse or retinal injury. Our cases suggested this can happen even long periods after cataract surgery. The case with partial aniridia demonstrated the process of the expulsive aniridia, and its findings do not contradict the postulated mechanisms.

SURGICAL CILIATED CYST OF THE MAXILLA: REPORT OF A RARE LATE SURGICAL COMPLICATION

Surgical ciliated cyst (SCC) is a rare lesion supposed to arise due to the entrapment of the remnants of the maxillary sinus lining epithelium in the surgical bone wound. A 51-year-old White woman complained of painful enlargement in the right malar region for approximately 1 year. Her medical history revealed a surgical intervention after a zygomatic bone fracture 10 years earlier. Computed tomographic sections showed a hypodense unilocular image causing expansion of the maxillary sinus walls and fenestration of the orbit floor. Surgical enucleation and reconstruction of the bone defect were performed. Histopathologic examination showed a cyst with a lining that varied from cuboidal, ciliated cylindrical pseudostratified to stratified squamous epithelium with scattered mucous cells. The fibrous wall had hyaline acellular areas with a chronic inflammatory infiltrate. The diagnosis was SCC. After 1 year of follow-up, no recurrence was noted.

Teamwork Approach in Management of Zygomaticomaxillary Complex (ZMC) Fracture with Globe Rupture: A Case Report

Introduction : Zygomaticomaxillary complex (ZMC) fractures are one of the most common fractures of the facial skeleton. Zygomatic fractures can cause ocular and mandibular functional impairment, along with cosmetic defects. The characteristic clinical signs of zygomatic bone fracture include diplopia, infraorbital nerve paraesthesia, flattening of the cheek, and trismus, whereas maxillary fracture may typically cause flattening of the midface and malocclusion. Therefore, surgical reconstruction is required to restore the function and appearance.Case Report : A 31-year-old man with ZMC fracture and globe rupture underwent open reduction and internal fixation using plate and orbital mesh. We collaborated with an ophthalmologist who performed enucleation and tarsorrhaphy.Discussion : The reconstruction improved functional and physical aspects and therefore psychological wellbeing. The main goal of the ZMC fracture treatment is to reconstruct the face in terms of functions and aesthetic. Furthermore, reconstruction of the left orbit (orbital rims and walls) as a secondary objective despite the blind eye, improved his appearance enabling formation of a pocket into which an eye implant was inserted. Satisfying functional and aesthetic outcome was achieved in this patient.Conclusion: A teamwork approach in surgical reconstruction for this case with ZMC fracture which always has an orbital component, was recommended to obtain an effective and optimal result. Both plastic surgeon and ophthalmologist can elaborate patient needs for facial reconstruction especially orbital region with good result.