Zygomatic Bone Research Articles

Jacob’s Disease: case report

ABSTRACT Jacob’s disease or osteochondroma is a rare disease that presents as a pseudo-joint between the coronoid process of the mandible and the posterior surface of the zygomatic bone. The present case report is of an 11-year-old female patient with a maximum mouth opening of 2mm. When evaluating computed tomography with three-dimensional reconstruction, a mushroom-shaped increase in the coronoid process of the mandible on the left side was observed, intimately connected to the zygomatic bone (inferoposterior region of the body of the zygoma), which suggests a pseudoarticulation. Surgical removal of the tumor mass was performed under general anesthesia via intraoral access and is called coronoidectomy. Histopathological, the presence of hyaline cartilage was observed, a condition that is pathognomonic for Jacob’s Disease. Jacob’s disease case reports are still rare in the literature, with mushroom shape and histopathological confirmation due to the presence of hyaline cartilage.

Tumoral Resection followed by Blepharoplasty in Squamous Cell Carcinoma Treatment in the Lower Eyelid of a Horse

Background: Equines are routinely subjected to enucleation due to palpebral tumors. Blepharoplasties in horses, especially in the lower eyelid, are rarely performed due to the difficulty of sliding once the tissue around the eyes presents low mobility. Defects involving more than 50% of the lower eyelid is considered challenging after tumor removal. Squamous cell carcinoma (SCC) is the second most reported neoplasm in horses, being very common in regions of the lower eyelid, third eyelid, sclera and or cornea. The aim of this study is to present the Destro VY skin advancement flap as a blepharoplasty technique performed after surgical excision of a SCC, with total commitment of the lower eyelid, completely covering the right eye of a mare.Case: A 8-year-oldmarePaint Horse, weighing420 kg,was referred for evaluation of tumor tissue of 6.0 x 4.0 x 2.0 cm, with nodular and ulcerated appearance, involving the right lower eyelid, in its total extension and completely covering the eye, without adhering to it. Considering the initial suspicion of SCC, the treatment strategy performed was surgical eyelid excision and maintenance of the eye, followed by blepharoplasty as an attempt to reconstruct the eyelid. Under general inhalation anesthesia, the animal was placed in left lateral recumbency, when the surgical region was prepared and local anesthetic block was performed. After antisepsis, a skin incision was made circumscribing the tumor, respecting a margin of 10 mm apart and excision of all visible tumor tissue was performed followed by intralesional ozone therapy. Blepharoplasty was performed to cover the portions of the exposed lacrimal and zygomatic bones, as well as correction of the eyelid aesthetics. For this, Destro VY skin advancement flap was performed for reconstruction of the lower eyelid. An incision of approximately 7 cm in V-shaped skin was performed, and the subcutaneous tissue under the V was dissected, maintaining a central pedicle, responsible for the vascularization of the flap, which was slid, approximately 20 mm, towards the eye. After obtaining the desired skin approximation, Y-suture was performed, covering the exposed bone and reconstructing the lower eyelid. In the postoperative period, local instillation of mitomycin eye drops and systemic meloxicam administration were instituted. The mare had her vision restored, presenting satisfactory morpho functional and aesthetic results and no tumor recurrence during 1-year of follow-up. Discussion: The repair of lower eyelid imperfections is challenging, especially when they have large defects, and there are no reports of performing the Destro VY skin advancement flap technique in horses for lower eyelid reconstruction. In this case, the importance of the blepharoplasty technique is emphasized, avoiding enucleation, preserving horse’s vision and aesthetics. In addition, aiming to avoid tumor recurrence, especially if surgical safety margins can not be achieved, other complementary treatments should be associated, including intralesional ozone therapy, mitomycin, an antineoplastic chemotherapy drug, and meloxicam, a COX-2 selective, non-steroidal anti-inflammatory drug, as performed in this study. It is concluded that the use of the Destro VY skin advancement flap technique for reconstruction of the external lamella in cases of SCC in the lower eyelid of horses is a feasible technique, which preserves the animal's vision, as well as aesthetics. The safety margin in the surgical excision of the SCC and the association of complementary therapies in the resolution of the condition are important points also to be considered.Keywords: epidermoid carcinoma, equine, ophthalmology, plastic surgery, skin tumor. Título: Exérese tumoral seguida de blefaroplastia no tratamento de carcinoma de células escamosas em pálpebra inferior de equino

ПЕРЕЛОМЫ СКУЛОВЕРХНЕЧЕЛЮСТНОГО И СКУЛО-ОРБИТАЛЬНО-ВЕРХНЕЧЕЛЮСТНОГО КОМПЛЕКСОВ

During the period 2017-2021, 112 patients with fractures of the zygomaticomaxillary and zygomatic-orbito-maxillary complexes were diagnosed and surgically treated. The patients were divided into 2 groups. In the first group, after a comprehensive study of the clinical and radiological picture of the injury area, 86 patients were treated in the traditional way. The essence of the method was to create access through a small puncture-incision along the lower edge of the zygomatic bone and perform the reposition of fragments using the hook of A.A. Limberg. The remaining 26 patients were treated with open reposition and rigid fixation of bone fragments with transconjunctival, intraoral, and sometimes blepharoplastic incisions using titanium microplates and micro-screws. The results of the “traction test” were checked to identify the infringement of the lower oblique muscle of the eyeball. A computed tomography scan revealed a symptom of a “hanging drop” in combination with damage to the bottom of the eye socket. Despite such disadvantages as the need for a longer intervention, high financial costs and additional skills of the operating surgeon, after the treatment of the second group of patients, there was a decrease in postoperative complications and thus an improvement in the results of surgical treatment.

The Use of magnetic-laser Therapy in the Rehabilitation period for patients with Infraorbital nerve Damage

Aim: The aim of the study was to assess the effectiveness of magnetic-laser therapy in complex treatment of patients with zygomatic fractures accompanied by the infraorbital nerve damage. materials and methods: The study included 32 patients with single fractures of the zygomatic bone accompanied by infraorbital nerve injury. Patients were divided into two groups: the main group (n=17) and the control one (n=15). In both groups the complex treatment was used, which included: the fragment reposition operation, broad-spectrum antibiotic, nonsteroidal anti-inflammatory drug, anti-edematous therapy, vitamin B complex. In the main group of patients in the postoperative period the magnetic-laser therapy was applied. Assessment of qualitative and quantitative indices of pain was carried out on the 1st, 7th and 14th days of treatment. Results: In the main group of patients the magnetic-laser therapy significantly reduced the intensity of nociceptive pain, led to moderate regression of all types of neuropathies associated with infraorbital nerve damage. When comparing 2 groups the best pain relief had patients of the main group. At the end of treatment a significant positive dynamics of improving the electrical sensory of infraorbital nerve has been noted, as indicated by recovery of sensory threshold, pain threshold and pain tolerance almost to the level of intact contralateral side. Conclusions: The use of magnetic-laser therapy in the combined treatment of infraorbital nerve damage allows to improve the recovery of infraorbital nerve sensory changes following zygomatic fractures, reduce the pain, increase the effectiveness of treatment and provide rapid postoperative rehabilitation of patients.

Influence of Glycemic Control on the Survival of Implants Placed in the Zygomatic Bone of Edentulous Patients With and Without Type 2 Diabetes Mellitus: 10-Year Follow-Up Results.

It is hypothesized that under optimal glycemic control (GC), there is no difference in the survival of implants placed in the zygomatic bone of edentulous patient with and without type 2 diabetes mellitus (T2DM). The aim was to assess the influence of GC on survival of implants placed in the zygomatic bone of an edentulous patient with and without T2DM at the 10-year follow-up. Twenty patients with T2DM (10 with poorly controlled T2DM and 10 with well-controlled T2DM) and 12 patients without T2DM were included. Hemoglobin A1c (HbA1c) levels were recorded, and demographic data were collected from all participants. Peri-implant inflammatory parameters (plaque index [PI], probing depth [PD], crestal bone loss [BL], and gingival index [GI]) were measured in all patients. Group comparisons were done, and P values, which were less than .01, were indicative of statistical significance. Twenty and 12 male patients with and without T2DM, respectively, were included. Among patients with T2DM, 10 and 10 individuals had poorly and well-controlled T2DM, respectively. The mean HbA1c levels were significantly higher in patients with poorly controlled T2DM (9.2 ± 0.7%) compared with well-controlled T2DM (4.8 ± 0.3%; P < .01) and nondiabetic individuals (4.6 ± 0.3%; P < .01). The crestal BL on the mesial (P < .01) and distal (P < .01) surfaces, PD (P < .01), PI (P < .01), and GI (P < .01) were significantly higher around all zygoma implants placed in patients with poorly controlled T2DM compared with patients with well-controlled T2DM and patients without T2DM. These clinicoradiographic parameters were comparable around zygoma implants placed in patient with well-controlled T2DM and in subjects without T2DM. Optimal GC is essential for the long-term stability of zygomatic plants in patients with T2DM.

Long-Term Effect of Honeycomb β-Tricalcium Phosphate on Zygomatic Bone Regeneration in Rats.

In recent years, artificial bones with high biocompatibility have been developed for hard tissue reconstruction. However, current bone replacement methods are inadequate for large defects, causing infection, exposure, and damage. We have developed a new honeycomb β-tricalcium phosphate (TCP) material, which achieved good bone regeneration after implantation in a rat complete zygomatic bone defect. In this study, we further investigated the ability of honeycomb β- TCP for remodeling after bone regeneration as a long-term result. Bone morphogenic protein (BMP)-2-free honeycomb β-TCP (TCP group) and honeycomb β-TCP with BMP-2 (BMP group) were implanted in the zygomatic bone of rats. Micro-computed tomography was performed to track the zygomatic bone morphology, and specimens were histologically examined for osteogenesis and remodeling. In the TCP group, no bone formation was observed at 1 month, but it was observed at 6 months. Bone formation was observed in the BMP group at 1 month, and β-TCP absorption reproducing the zygomatic bone morphology was observed at 6 months. This honeycomb β-TCP with BMP-2 may provide appropriate remodeling that reproduces good bone formation in the early stage and good morphology in the long term, offering an alternative bone reconstruction material to vascularized bone grafts.

Interrelation between facial soft tissue lessions, underlying fracture patterns and treatment of zygomatic bone trauma: a 10\u2009year retrospective study

BackgroundThe pattern of zygomatic bone fractures varies in the literature, their features being frequently masked by the presence of associated soft tissue lesions. In this context the clinical diagnosis and the therapeutic indications can be difficult. The aim of this study was to evaluate the clinical features of zygomatic bone fractures and their interrelation with concomitant overlying soft tissue injuries, as well as to assess the type of treatment methods applied depending on the fracture pattern and the results achieved depending on the incidence rate of postoperative complications. We will use these results in order to improve the diagnosis and the establishment of correct treatment of this pathology.MethodsA 10-year retrospective evaluation of midface fractures was performed in patients diagnosed and treated in a tertiary Clinic of Oral and Maxillofacial Surgery. Statistical analysis was performed with the MedCalc Statistical Software version 19.2 (MedCalc Software bvba, Ostend, Belgium; 53 https://www.medcalc.org; 2020). Nominal data were expressed as frequency and percentage. The comparisons of the frequencies of a nominal variable among the categories of another nominal variable were made using the chi-square test. Multivariate logistic regressions were used in order to establish the independent association between variables and lacerations/excoriations. After using the Bonferroni correction for multiple comparisons, a value of p < 0.025 was considered statistically significant.ResultsThe study included 242 patients with zygomatic bone fractures. The majority of the fractures were displaced n = 179 (73.9%), closed n = 179 (73.9%) and complete n = 219 (90.5%). Hematoma was the most frequent associated soft tissue lesion n = 102 (42.1%) regardless of the fracture pattern (p = 1.000). Complete zygomatic fracture (OR – 2.68; p = 0.035) and fractures with displacement (OR – 3.66; p = 0.012) were independently associated with the presence of laceration. Fractures with displacement (OR – 7.1; p = 0.003) were independently associated with the presence of excoriation. The most frequent type of treatment applied was Gillies reduction (61.9%), followed by ORIF (30.9%). The most frequent postoperative complication was malunion secondary to Gillies treatment (4,6%).ConclusionsPatients presenting lacerations and excoriations on clinical soft tissue examination will most frequently have an underlying complete, displaced or comminuted zygomatic fracture. In the case of displaced, open or comminuted fractures we achieved the best results secondary to ORIF treatment method, while in the case of non-displaced and closed fractures, the best results achieved were secondary to conservative treatment.

Impact of intraoperative cone beam computed tomography in the management of zygomatic fractures

AimTo evaluate the impact of intraoperative cone beam computed tomography (CBCT) assessment for the surgical management of zygomatic bone fracture (ZF). MethodsA prospective study was conducted on patients operated on for unilateral ZF during a two-year period. Repositioning of the fractured zygoma was assessed intraoperatively by measuring the position of malar eminences in three dimensions on CBCT. A difference of more than 2 mm between both sides was considered significant and the reduction was judged inadequate. Surgical procedure was adapted to intraoperative imaging findings. ResultsThe surgical procedures of 47 patients treated for ZF were analyzed. In 15% of the cases (7 patients), the intraoperative CBCT showed an inadequate reduction while the morphological results seemed correct. Those patients benefited from an immediate correction of the reduction. From these 7 patients, reduction was optimized further without the need of osteosynthesis in one case, additional osteosynthesis was performed in 4 cases and 2 patients required both reduction and osteosynthesis revision. ConclusionIntraoperative CBCT control helps to achieve anatomic repositioning in case of ZF. It may reduce the risk of under-treatment and possible reoperation, and of over-treatment meaning systematic ORIF in all fractures.

The Impact of 3D Technology in Optimizing Midface Fracture Treatment—Focus on the Zygomatic Bone

In the context of the ongoing development and expanding availability of 3-dimensional (3D) printing, there is increasing interest in designing simplified workflows that would encourage more medical practitioners to include 3D printing in their current practice. The purpose of this study is to present our experience regarding the use of 3D printing in the preoperative planning and management of acute midface trauma, an area less explored by existing studies. We performed a retrospective case series study including admitted patients who underwent surgical repair of midface fractures, in which 3D-printed stereolithic models were used preoperatively for shaping the osteosynthesis material. We recorded standard information about the patients, imaging method used, and type of midface fracture. We also logged the details and durations of each main step in the preoperative 3D printing workflow and documented the durations and outcomes of each surgical procedure. We identified 29 cases of midface fractures that benefited of a preoperative stereolithic model. From the 2 main methods of obtaining the virtual model, mirroring and virtual fracture reduction, the longest duration was recorded in a case in which the later method was used. The longest stereolithic model printing time was found in a complex midface fracture case. All the prebent osteosynthesis material was used intraoperatively and fitted the reduced fracture sites, also serving as an intraoperative guide for correct fracture reduction. The particularities, benefits, as well as the possible challenges associated with the application of 3D printing in acute trauma cases are discussed. Our 3D printing protocol was applicable and rendered favorable outcomes in the acute midface trauma setting. Proper understanding of the steps involved in achieving the stereolithic model is key for the adaptation of 3D printing to the current management of acute midface trauma.

Comparative Evaluation of 2 Point VS 3-Point Fixation of Zygomatic Bone Fractures in Adult Patients

Comparative Evaluation of 2 Point VS 3-Point Fixation of Zygomatic Bone Fractures in Adult Patients

Langerhans Cell Histiocytosis of the Orbit: Spectrum of Clinical and Imaging Findings

To evaluate the clinical and imaging characteristics of orbital lesions of pediatric Langerhans cell histiocytosis (LCH). A retrospective analysis of clinical data and central review of magnetic resonance imaging scans in patients with LCH, enrolled into one of the consecutive international trials LCH I-III, or submitted for a second opinion between 1994 and2015. Data from 31 children (34 involved orbits) were analyzed. Orbital LCH was the only disease manifestation in 15, part of a multifocal skeletal in 5, or a multisystem LCH in 11 patients. Orbital LCH was part of the initial disease presentation in 23 or developed at relapse in 8 cases. Orbital involvement was unilateral in 28 and bilateral in 3 patients (34 affected orbits). Proptosis was present in 9 patients. Frontal and zygomatic bone were most commonly affected. All orbital lesions were extraconal. Associated extraorbital imaging findings were dural tail sign in 19, neurodegeneration in 8, and hypothalamic-pituitary mass in 3 patients. Sixteen patients (52%) had at least 1 documented disease relapse. Permanent consequences were prominent proptosis in 1, diabetes insipidus in 8, growth hormone deficiency in 2, radiologic neurodegeneration in 8, and clinical neurodegeneration in 3 patients. Predominantly unilateral orbital LCH can be the only disease manifestation or part of a disseminated disease. Orbital lesions in LCH are exclusively extraconal, typically located at the roof and the lateral wall of the orbit. The optimal treatment approach of unifocal LCH of the orbit remains controversial and warrants a prospective evaluation.

Masseter muscle adaptation following orthognathic surgery - Biomodelling analysis - A pilot study

Purpose: This pilot investigation was designed to apply several, newly developed and more sophisticated methods of measuring muscle structure, function and fibre orientation to a situation where adaptation of muscle is pivotal to the success of a therapeutic approach. Materials and Methods: Patients attending the combined orthodontic / orthognathic surgery clinic at Clitrofa – Centro Médico, Dentário e Cirúrgico, in Trofa - Portugal were screened using Magnetic Resonance Imaging protocol. Ten patients scheduled for a bimaxillary osteotomy involving a combination of maxillary Le Fort I impaction procedure coupled with a sagittal split advancement of the mandible were select to form the study group. An Experimental design used to provide information in relation to masticatory muscle adaptation following orthognathic surgery. The study involved the contribution of two independent examiners that measured the changes in fibre orientation at the different jaw positions using AnatomicsTM software, at three different time moments. A combination of different parametric tests has been used to compare the different experimental variables. Results: Statistical differences have been identified between examiners measurements and between operations. There were no significant differences testing different times. Conclusions: The discrepancies between examiners probably arise from small variations in the experimental methodology used by them. The differences between operations reveal masseter muscle adaptation following orthognathic surgery. The measurement of “P1 masseter muscle/ zygomatic bone / process mastoid anterior angle” and “P2 masseter muscle / mandibular angle” can therefore be a valuable tool for controlling the reworking of masseter muscle upon orthognathic surgery.

Evaluation of The Anatomic Variations in Zygomatic Bone Using Cone Beam Computed Tomography and Its Correlation with Gender.

Evaluation of The Anatomic Variations in Zygomatic Bone Using Cone Beam Computed Tomography and Its Correlation with Gender.

Abordagens cirúrgicas em fraturas do complexo zigomático: revisão de literatura

Introdução: O complexo zigomático é de grande importância no estudo da traumatologia devido a sua posição anatômica muito suscetível a traumas. Devido a sua interação direta com a órbita, o osso zigomático é uma importante proteção do globo ocular, assim como um dos responsáveis pela dissipação e transmissão de forças mastigatórias. Objetivo: O presente estudo objetiva revisar as formas de diagnóstico, exames complementares e as principais abordagens cirúrgicas bem como as possíveis complicações. Metodologia: Os dados selecionados foram obtidos através do acesso as bases de dados eletrônicos Medline, PubMed e Science direct. Foram selecionados 1 livro e 15 artigos publicados entre 2013 e 2019. Resultados: Diversas abordagens cirúrgicas podem ser utilizadas em fraturas do complexo zigomático dependendo da extensão e localização da fratura. As cirurgias são consideradas procedimentos seguros, com baixos níveis de complicações e sem problemas maiores no pós-operatório. Com a tecnologia 3D, o diagnóstico e planejamento dos casos se torna facilitado e mais preciso, levando a um procedimento mais seguro e previsível. Conclusão: O diagnóstico de fraturas no osso zigomático deve ser minucioso, envolvendo aspectos clínicos e exames complementares, o tratamento deve ser realizado de forma a preservar não só a função bem como a aparência, visto que erros no reposicionamento pós-trauma do processo zigomático pode causar simetria facial evidente no paciente, assim como o afundamento do globo ocular, diplopia, fissura orbital superior e hemorragia retrobulbar.

Hyperbaric Oxygen Therapy in the Management of Zygomatic Bone Osteomyelitis.

Zygomatic bone osteomyelitis is a rare condition having an incidence of 1.42%. Zygomatic osteomyelitis can be due to haematogenous infection with tubercle bacillus, facial bone fractures or very rarely due to an unknown aetiology like in our case. If surgically managed alone, it would lead to complete loss of zygomatic bone, causing high morbidity to the patient in terms of function and aesthetics like loss of globe support causing dystopia, loss of facial projection causing facial asymmetry. Restoration of facial symmetry and globe support would require extensive procedures such as non-vascular bone grafting or patient-specific implant placement or microvascular bone flap transfer. Hyperbaric oxygen therapy (HBOT) was used to try and preserve the zygoma by promoting revascularisation. The patient received 100% oxygen at 2.5 absolute atmospheric pressure for 90 min, one session per day for 5 days in a week using a mask system in a multiplace chamber. The patient was reviewed clinically and radiologically after each 5 dives of HBOT sessions. After a total of 30 dives of HBOT, CT examination was repeated. There was partial reconstitution of cortical bone without any additional residual bone lesion. Minimal residual sequestra were noted. At this stage, the patient underwent conservative sequestrectomy in contrast to extensive surgery if HBOT was not contemplated. HBOT has the potential to be a very useful adjunct in the treatment of osteomyelitis in head and neck surgery; however, there is a need for carefully designed trials, avoiding methodological bias due to the great variability of patients, infectious agents, antibiotic resistance, host factors, to broaden the evidence of this therapeutic modality.

Extrasinus Zygomatic Implants for the Immediate Rehabilitation of the Atrophic Maxilla: 1-Year Postloading Results From a Multicenter Prospective Cohort Study

The use of zygomatic implants is an alternative to major grafting procedures for the treatment of the atrophic posterior maxilla. However, only few studies reported solid and correct data about the use of extrasinus zygomatic implants. Starting from these considerations, this study aims to investigate the 1-year survival and success rates of extrasinus zygomatic implants immediately loaded in patients with severe atrophy of the posterior maxilla. Twenty-three consecutive patients fully edentoulus or with failing dentition in the upper arch and with a severe atrophy of the posterior maxilla were enrolled. All patients underwent prosthodontic rehabilitation with the application of implants in both anterior maxilla areas and zygomatic bone. All the zygomatic implants were inserted with an extrasinus path. Primary outcomes were prosthesis and implant failures. Secondary outcomes were complications, bleeding scores, probing pocket depths, and peri-implant marginal bone-level changes. A total of 98 implants were inserted. During the 1-year follow-up, no implant failure was reported as well as no pain and/or no sinusitis were detected. No other significant events were reported, except for minor soft tissue and technical problems. A maxillary sinus membrane rupture occurred during the surgical phase in 4 (17.4%) patients, but healing was not compromised. Peri-implant mucositis was observed in 2 (8.7%) patients. Twelvemonths after surgery, average bone loss around conventional implants was 1.11±0.23mm. In addition, no peri-implant radiolucency was observed around zygomatic implants. Within the limits of this study, preliminary short-term data (1-year after loading) suggested that extrasinus zygomatic implants represent a predictable treatment option for the atrophic maxilla. Further follow-up data (≥5years) are needed to confirm these results. The present study supports the conclusion that extrasinus zygomatic implants for the immediate rehabilitation of the atrophic maxilla have high success rate with minimal or no complications.

A Clinical Trial to Evaluate the Efficacy and Safety of 3D Printed Bioceramic Implants for the Reconstruction of Zygomatic Bone Defects.

The purpose of this study was to evaluate the clinical efficacy and safety of patient-specific additive-manufactured CaOSiO2-P2O5-B2O3 glass-ceramic (BGS-7) implants for reconstructing zygomatic bone defects at a 6-month follow-up. A prospective, single-arm, single-center, clinical trial was performed on patients with obvious zygoma defects who needed and wanted reconstruction. The primary outcome variable was a bone fusion between the implant and the bone evaluated by computed tomography (CT) at 6 months post surgery. Secondary outcomes, including implant immobilization, satisfaction assessment, osteolysis, subsidence of the BGS-7 implant, and safety, were assessed. A total of eight patients were enrolled in the study. Two patients underwent simultaneous reconstruction of the left and right malar defects using a BGS-7 3D printed implant. Cone beam CT analysis showed that bone fusion at 6 months after surgery was 100%. We observed that the average fusion rate was 76.97%. Osteolysis around 3D printed BGS-7 implants was not observed. The mean distance displacement of all 10 implants was 0.4149 mm. Our study showed no adverse event in any of the cases. The visual analog scale score for satisfaction was 9. All patients who enrolled in this trial were aesthetically and functionally satisfied with the surgical results. In conclusion, this study demonstrates the safety and promising value of patient-specific 3D printed BGS-7 implants as a novel facial bone reconstruction method.

Zygomatic Implants: A Review

Zygoma implants (or zygomatic implants) vary from traditional dental implants in that they attach in ratherthan maxilla (upper jaw) in the zygomatic bone (cheekbone). They can be used where the consistency orquantity of maxillary bone is insufficient for normal dental implant placement. Inadequate maxillary bonevolume can be due to bone resorption as well as maxillary sinus pneumatization or a mixture of both. Therequired bone height for typical implant placement in the upper jaw posterior area should be approximately10 mm to ensure appropriate implant survival. Where there is inadequate bone available, bone graftingprocedures and sinus raising procedures should be done to increase bone volume. Procedures for bonegrafting in the jaws have the downside of extended care, limiting denture wear, the morbidity of donorsurgical site &amp; graft rejection.

Pterygo-Maxillary Fissure as a Landmark for Localization of Internal Maxillary Artery for Use in Extracranial-Intracranial Bypass.

Internal maxillary artery (IMax) is a relatively new donor vessel used in the extracranial-intracranial bypass surgery. However, unfamiliarity and relatively elaborate techniques of its harvest precluded its widespread use. To present a simplified technique of IMax harvest based on constant anatomical landmarks without the need of extensive skull-base drilling while providing adequate space for proximal anastomosis. Cadaveric dissection on 4 cadaveric heads (8 sides) was performed. Zygomatic osteotomy was performed and temporal muscle was dissected off the zygomatic process of the frontal bone and the frontal process of the zygomatic bone and reflected inferiorly into the bony gap created by the zygomatic osteotomy. Posterior wall of the maxilla (PWoM) was palpated. Following PWoM inferiorly leads to pterygo-maxillary fissure (PMF), which is a constant landmark IMax passes through. IMax was localized following this technique before its entrance into PMF in every specimen. Proximal dissection was carried on to the exposed adequate length of the vessel. Depending on the relationship with the lateral pterygoid muscle, this might need to be incised to allow for identification of the IMax. After its transection, proximal stump is mobilized superiorly into the surgical field. Clinical application of this technique was demonstrated on an aneurysm case. Using the palpation of the PWoM as a landmark for localization of PMF facilitates harvesting of IMax without need for extensive skull-base drilling and shortens the time of the surgery.

FREQUENCY OF DIPLOPIA IN PATIENTS WITH ZYGOMATICOMAXILLARY COMPLEX(ZMC) FRACTURES REPORTED TO TERTIARY CARE HOSPITAL

Objective:&#x0D; To determine the frequency of diplopia in patients with zygomaticomaxillary complex (ZMC) fractures reported to Tertiary care hospital.&#x0D; Materials and Methods:&#x0D; The study design was descriptive cross sectional and was conducted in oral and maxillofacial surgery unit Hayatabad Medical Complex Peshawar and duration was 6 months from 4th june 2018 till 4th December 2018. Chi square test was used for association of diplopia with age &amp; gender. Pvalue &lt;0.05 was taken is siginificent.&#x0D; Results:&#x0D; Out of total 126 patiens, 30(23.80%) were recorded in 15-30 years age groups while mostly 60 (47.61%) were recorded in 31-45 years of age grpups must of the participants were 108 (85.71%) male. As per Zygomaticomaxillary complex fractures, 22 (17.46%) patients were recorded with Diplopia out of 126 patients.&#x0D; Conclusion:&#x0D; As Zygomatic bone plays an important role in facial contour therefore with the help of this study we have been able to understand the etiologies and characteristics of ZMC fractures such as diplopia thus forming a foundation to properly diagnose and treat it, and to reduce its incidence in this region.