Zygomatic Complex Research Articles

Inter personal violence-related facial injuries: a 10-year survey

Introduction: Interpersonal violence (IPV) has emerged as a worldwide health problem affecting predominantly the face. Patients and methods: This study reports the characteristics of violence, victims and injuries in IPV-related facial injuries patients, in a 10-year survey, in a tertiary hospital of Burkina Faso. Results: Patients’ age ranged from 11 to 75 years (mean 31 years) and 58.2% of the patients were aged between 20 and 39 years. There were 74 males and females 24 giving a male-to-female ratio of 3.1:1. The circumstances of injuries were brawls (80.6%) consisting mostly in facial blows, and hold-ups (19.4%). Fractures involving predominantly the mandible or the zygomatic complex were the most common injury, accounting for 53.2%. Soft tissues injuries accounted for 37.2% and dental trauma for 9.2%. In 27.5% of the patients, extra facial injuries were encountered, dominated by cerebral trauma and limb fractures. Conclusion: In this study, IPV-related facial injuries are mostly mandibular or zygomatic fractures in young and males adults involved in brawls. These findings command strategies for prevention of violence in this specific group.

Patient Perspective in the Management of Zygomatic Fractures.

Background:A clinical study was undertaken on the management of zygomatic complex fractures using various surgical approaches in the Department of Oral and Maxillofacial surgery during the past 3 years.Aims:The aim of this study is to evaluate the versatility of various surgical approaches.Materials and Methods:A total of 15 cases were selected following a clinical and radiological examination of fractures of the zygomatic complex. A standard pro forma was used to record the case history and findings. These cases were treated by mini plate or micro plate osteosynthesis. Reduction techniques used were Gillie's temporal approach, Dingman's lateral eyebrow approach, upper buccal sulcus approach, and inferior orbital approach. Fixations were done either by mini plate or micro plate osteosynthesis. To compare the effectiveness of the reduction and fixation techniques the following parameters were assessed: facial symmetry-corrected/unaltered, wound healing-good/impaired, mouth opening good/restricted, diplopia-present/absent, infraorbital nerve – present/absent.Results and Conclusion:Successful surgical treatment of the zygomatic complex fracture is influenced by its geometry. Whether the alignment may be successfully achieved or not by open reduction at single or multiple locations, can vary with the individual surgeon's experience.

Patterns of Zygomatic Complex Bone Fracture in Saudi Arabia.

Introduction:Zygomatic bone (ZB), also known as the cheekbone, articulates with the maxilla, temporal sphenoid, and the frontal bones. It forms the prominence of the cheek and part of the orbit, and because of its prominence, it is susceptible to trauma. The aim of this study was to present the pattern of ZB fracture in a country in the Middle East.Patients and Methods:The medical records of all trauma cases admitted to the Department of Oral and Maxillofacial Surgery Ward, Riyadh Dental Centre, King Saud Medical City, Riyadh, Saudi Arabia, were reviewed and all cases with ZB fractures were included in this study from December 2002 to December 2012. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, IL, USA). The results were presented as simple frequencies and percentages.Results:A total of 1487 patients had maxillofacial trauma and 306 cases were diagnosed with ZB fractures during the study. There were 271 (88.6%) males and 35 (11.4%) females with male: female ratio of 7.7:1. Age group of 21–30 years has the highest number of fracture cases (133 [43.5%]). Road traffic accident (RTA) remained the leading etiology of zygomatic complex fracture (ZMCF; 221 [72.2%]). August has been observed to be associated with the highest cases of ZMCF (40 [13.1%]). The years 2005 and 2006 recorded the highest frequency of ZMCF cases (46 [15.0%] and 44 [14.4%], respectively).Conclusion:The results of this study showed that RTA is the leading cause of ZB fractures followed by assaults. The most commonly fractured site was the zygomaticomaxillary. Proper road traffic regulation is paramount to help reduce maxillofacial trauma.

Orthopaedic Bone Tap: A 'Jugaad' for Zygomatic Bone Reduction.

The use of the Carroll-Girard screw in the management of zygomatic complex fractures has been well documented. The instrument provides an excellent degree of control over the movements of the disrupted zygomatic bone. Often mentioned in textbooks and literature, they are not routinely available for the Indian maxillofacial surgeon. This often prevents the regular use of this approach. We have used the 2.5-mm orthopaedic bone tap that is very commonly available and routinely used in orthopaedic surgeries for reduction of the malar bone. The orthopaedic bone tap is easy to use and functions as an excellent alternative to the traditional Carroll-Girard screw.

Appropriate assessment of eye observations in the Accident and Emergency department in patients with zygomatic complex / orbital fractures requiring surgical treatment

Appropriate assessment of eye observations in the Accident and Emergency department in patients with zygomatic complex / orbital fractures requiring surgical treatment

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.

MAXILLOFACIAL TRAUMA, ETIOLOGY AND PROFILE OF PATIENTS: AN EXPLORATORY STUDY.

ABSTRACTObjective:To describe the profile of patients with facial trauma admitted in a hospital located in a metropolitan area of Northeast Brazil. Methods:A cross-sectional and exploratory study was performed. A total of 244 cases were in agreement with the eligibility criteria. The variables include the sociodemographic characteristics of patients, etiology, type of trauma, treatment modalities, length of stay in a hospital and quarter of care. Descriptive statistics and Cluster Analysis were performed. Results:The average age of patients was 31.16 years (SD = 15.17 years) and average hospitalization was 6.32 days (SD = 7.75 days). It was verified the automatic formation of four clusters with different profiles of patients. The variables which most contributed to the external differentiation between clusters were: length of stay in a hospital (p <0.001), etiology (p <0.001), type of facial trauma (p <0.001), presence of associated trauma (p <0.001), treatment modalities (p <0.001) and quarter of care (p <0.001). Conclusion:The most of patients were men, victims of traffic accidents, which suffered fracture of zygomatic complex and underwent surgery. Level of Evidence III, Retrospective Study.

Epidemiological study of facial fractures at the Oral and Maxillofacial Surgery Service, Santa Casa de Misericordia Hospital Complex, Porto Alegre - RS - Brazil.

to investigate the incidence and etiology of face trauma with diagnosis of facial fracture treated at the Buccomaxillofacial Surgery and Traumatology Service of the Santa Casa de Misericórdia Hospital Complex in Porto Alegre. we conducted a cross-sectional, retrospective epidemiological study of 134 trauma victims with 153 facial fractures. the male gender was the most affected (86.6%) and the incidence was higher in the age group from 21 to 30 years. The main etiology was assault (38.8%), followed by motor vehicle accidents (14.2%), motorcycle accidents (13.4%), falls (9%), road accidents (6.7%), sports accidents (5.2%), work accidents (5.2%), firearm injuries (4.5%) and cycling accidents (3%). The most frequent fractures were those of the zygomatic complex (44.5%), followed by fractures of the mandible (42.5%), maxillary bone (5.2%), nasal bones (4.5%) and zygomatic arch (3.3%). the fractures of the zygomatic complex and the mandible were the ones with the highest incidence in the facial traumas, having physical assaults as their main cause.

Surgical treatment of synkinesis between smiling and eyelid closure

Synkinetic movements are common among patients with incomplete recovery from facial palsy, with reported rates ranging from 9.1% to almost 100%.The authors propose the separation of the neural stimulus of the orbicularis oculi from that of the zygomatic muscular complex to treat eyelid closure/smiling synkinesis. This technique, associated with an anastomosis between the masseteric nerve and a central branch of the facial nerve, as well as with the use of a cross-facial nerve graft, resolves most of the spasms of the midface musculature, leading to a more relaxed tone when the mimic muscle is at rest and enhancing muscle excursion during voluntary and spontaneous smiling.Between 2011 and 2016, 18 patients affected by segmental paresis of the middle of the face underwent surgical treatment at the Maxillofacial Surgery Department of the San Paolo Hospital (Milan, Italy). Of these patients, 72.22% of cases with hypertone obtained partial to complete relaxation. Synkinesis was completely resolved in 83.33% of cases, and a significant improvement in facial movement was achieved in all patients.Neurorrhaphy of the masseteric nerve and the central branch of the facial nerve appears to produce favorable results. These initial data should be confirmed by further studies.

Compound Zygomatic Complex Fractures – A Case Series

Compound Zygomatic Complex Fractures – A Case Series

Does Dexamethasone Facilitate Neurosensory Function Regeneration After Zygomatic Fracture? A Randomized Controlled Trial

This study sought to clarify the rate of neurosensory disturbance (NSD) after zygomatic complex fractures in general, as well as the effect of perioperatively administered dexamethasone on neurosensory recovery. This was a single-blinded randomized study aiming to clarify the benefits of perioperative dexamethasone after surgery. The patients were randomly assigned either to receive dexamethasone (up to a total dose of 10 or 30mg) or to act as control patients (no glucocorticoid treatment). The outcome variable was NSD, the presence of which was established when patients had any sensory disturbance of the infraorbital nerve. Other predictor variables included in the analysis were age, gender, time span from accident to surgery, surgical approach to the fracture line, and relation of the fracture to the infraorbital foramen. The statistical significance of associations was evaluated with χ2 tests. We included 64 patients in the analyses. Of the patients in the dexamethasone group (either 10 or 30mg), 58.3% had NSD at 6months postoperatively, whereas in the control group, 66.7% of the patients had NSD. This finding was not statistically significant (P=.565). At the 1-month interval, the patients without a fracture through the infraorbital foramen had less NSD (P=.009); this finding was not significant at 3 and 6months postoperatively. Age, gender, injury mechanism, surgical approach, and time span from accident to surgery were not significant predictors of NSD. In total, 64.4% of the patients still had NSD at 6months postoperatively. This study showed no benefits of short-term, high-dose dexamethasone administration in the neurosensory recovery of patients with zygomatic complex fractures. The type of primary trauma is the main cause of NSD, but the precise predictors remain unknown.

Association of traumatic head injuries and maxillofacial fractures: A retrospective study.

The association of traumatic head injury (THI) with maxillofacial fractures (MFF) is a major health concern worldwide. In spite of the close anatomical proximity of maxillofacial bones to the cranium, the association of THI with MFF is controversial. The aim of this study was to assess the association between THI and MFF. Other factors associated with THI in patients with MFF were also investigated. A hospital-based retrospective study was conducted at the OMFS Unit, Hospital USM, Kelantan, Malaysia. From 12 June 2013 to 31 December 2015, 473 patient records with MFF were reviewed to evaluate the association of THI and MFF. A total of 331 patients (69.98%) presented with concomitant THI. The most common associated THI were cranial bone fractures (68.6%) followed by intracranial injuries and concussion. A significant association existed between the Glasgow coma scale (GCS) score and the presence of THI concomitant MFF with P-value <.001. The univariable logistic regression analysis revealed that age group (31-40years), cause of injury (road traffic accident-RTA), all midface fracture types and most of the mandibular fracture types were statistically associated with the presence of THI. The multivariable logistic regression analysis revealed that the cause of the injury (RTA) and MFF types (nasal bone, zygomatic complex, zygomatic arch, orbital wall, maxillary sinus wall and the alveolar process of mandible fractures) were statistically significantly associated with THI in patients with MFF. There was a high prevalence of THI among patients with MFF (69.98%). RTA, nasal bone, zygomatic complex, zygomatic arch, orbital wall, maxillary sinus wall and mandibular alveolar process fractures were significantly associated with THI in patients who sustained a MFF.

A Novel Technique for Reduction Malarplasty by Inward Displacement of Infractured Zygomatic Arch Without Fixation

Reduction malarplasty is one of the most common esthetic surgical procedures performed in the Asian population. Traditional procedures have several complications, such as bone nonunion, malunion, cheek drooping, and damage to the infraorbital nerve and maxillary sinus. Therefore, a more straightforward and effective method of reducing the width of the midface is needed. In this study, we introduce an infracture technique using inward displacement of the zygomatic arch without fixation. A total of 680 patients received zygoma reduction using our method from 2012 to 2016 in the Department of Plastic Surgery, Minhang Shanghai Hospital. Radiologic and photographic documentation was completed preoperatively. The mean follow-up period was 24months. The preoperative and postoperative photographs were compared. All patients were satisfied with their results. The mean operation time was approximately 35minutes.The patients were discharged 5days after the surgical procedure, and the mean recovery time was 2weeks. The continuity of the outer cortex of the zygomatic complex and excellent bone union were observed in all patients 6months postoperatively. The malar prominence underwent relapse in 23 patients and was reset. The new method that we developed has been proved safe and effective. It has 3 advantages. First, cheek drooping is avoided, and the damage caused by periosteum dissection on the whole zygomaticomaxillary area is limited. Second, bony fixation is unnecessary; thus the risk of bone nonunion, malunion, and a step-off deformity caused by improper fixation or looseness is prevented. Third, the operation time and the recovery time are short.

The Pattern of Orbital Fractures Managed at Two Referral Centers in Nairobi, Kenya.

Orbital fractures are one of the commonest injuries in mid-face trauma and can lead to significant functional and cosmetic defects. This study was aimed at analyzing the pattern of orbital fractures at 2 referral centers in Nairobi. It was a descriptive prospective hospital-based study of the demographics, etiology, clinico-radiological features, and management modalities among patients presenting with orbital fractures at the University of Nairobi Dental Hospital and Kenyatta National Referral Hospital in Nairobi, Kenya. A total of 60 patients (52 males, 8 females; P <0.05) with confirmed orbital fractures were recruited during the 6-months study period. Orbital fractures occurred most frequently in the 21 to 40-year-old age group (80%, P<0.05). The principal etiological factors were motor cycle crashes; 30%, interpersonal violence 23.3%, public vehicle crushes 20%, private vehicle crushes; 10%, injury from flying objects 10% and falls 8.3%. The most commonly affected anatomical sites were the floor (75%), the lateral wall (71.7%), infra-orbital rim (66.7%), zygomatico-frontal suture (63.3%). There were 5 (8.3%) cases of total blindnessThe impure orbital fractures that involve the satellite bones especially the zygomatic complex predominate.

Management of Zygomatico-Maxillary Complex Fracture in Military Dental Centre, Dhaka: A Study of 40 Cases

Introduction: Zygomatic bone is closely associated with the maxilla, frontal, temporal bones which are usually involved when a zygomatic bone fracture occurs. The most common causes of these fractures are from the assaults, road traffic accidents and falls. Aesthetic beauties and functions are greatly hampered with the displacement of the fractured fragments.&#x0D; Objective: To analyze the aetiology, clinical presentations, surgical intervention and complications associated with zygomatic complex (ZC) fractures in a tertiary level healthcare facility.&#x0D; Materials and Methods: This descriptive observational study was carried out in the Oral and Maxillofacial Department, Military Dental Centre, Dhaka during the period of January 2016 to December 2016. Data were obtained from clinical notes and surgical records of the patients using standardized data collection form specifically designed to examine the variables and features of zygomatic complex fractures.&#x0D; Results: Road traffic accidents were the leading cause (75%) of zygomatic fractures. The mean operation time was found 99.5±31.2 minutes with a range from 60 to 125 minutes. Open reduction and two-point internal fixation were employed in more than two-third (67.5%) of the cases. Four (10.0%) patients developed postoperative complications; among them 2(5.0%) cases suffered paresis of temporal branch of facial nerve and trismus. Other complications included paraesthesia, ectropion, scar and palpability of plate. Twenty-five (62.5%) patients were found having limited mouth opening preoperatively and postoperative improvement occurred in 21(52.5%). Thirty three (82.5%) patients had facial asymmetry preoperatively and postoperative improvement occurred in 29(72.5%).&#x0D; Conclusion: More than two-third of the patients received two point fixations. Only four patients out of forty in this study were found having post operative complications. The functional and Aesthetic outcome was found to be fair in terms of improvement in limitation of mouth opening and correction of facial asymmetry.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 71-74

The orbit first! A novel surgical treatment protocol for secondary orbitozygomatic reconstruction

A novel surgical treatment sequence for secondary orbitozygomatic complex (OZC) reconstruction is described. Orbital reconstruction is performed before OZC repositioning. A surgical plan is made: the affected OZC is virtually osteotomized and aligned with a mirrored model of the unaffected OZC. A patient-specific implant (PSI) is designed for orbital reconstruction. Screw holes from the primary reconstruction are used for fixation. Primary screw hole positions at the repositioned OZC are embedded in the design, to guide OZC repositioning. A second patient-specific design is made for guidance at the zygomaticomaxillary buttress.The workflow was utilized in two patients. The PSI was positioned using navigation feedback. After repositioning of the zygomatic complex, the screw hole positions at the infraorbital rim and zygomaticomaxillary buttress seemed to align perfectly: no screw hole adjustments were necessary. Minor deviations were seen between planned and acquired PSI position; the mean errors between planned and acquired OZC position were 1.5 and 1.2 mm.Orbital reconstruction with a PSI before OZC repositioning ensures true-to-original orbital reconstruction. The use of old screw hole positions enables the PSI to be used as a static guide for OZC repositioning. The combination of static and dynamic guidance increases predictability in secondary OZC reconstruction.

Coronal Incision: An Approach to Facial Fractures

Background: The coronal incision with its various modifications provides the most versatile approach to various areas in the cranio-maxillofacial region coupled with excellent exposure. The aesthetic advantage of a hidden scar in the hairline, accounts for its continued popularity. In maxillofacial it can be used for fractures in the frontal bone, nasal bone and extensive fractures involving zygomatic arch and complex Methods: In this clinical and observational study, we operated 5 patients with complex cranio-maxillofacial injuries involving frontal bone, zygomatic arch and zygomatic complex, nasal bone and supra-orbital region. All the five cases were trauma cases between ages of 20 to 60 years with no facial nerve injury per-operatively. These cases for followed for post-operative complications namely sensory and motor nerve deficits, haematoma, wound dehiscence and ptosis Result: Two patients each had sensory and motor nerve deficits and one patient had minimal wound dehiscence, all settled conservatively Conclusion: The incision provides excellent access, has reduced complications and produces an acceptable scar. This incision is advised in treating complex cranio-facial trauma, tumors and le-fort esthetic surgeries. DOI: 10.21276/AABS.1430

ACESSO TRANSCONJUNTIVAL NA ABORDAGAGEM DE FRATURA DO ASSOALHO ORBITAL: RELATO DE CASO

Objective: Fractures in the face require approaches with predictable esthetic results, seeking access to minimize scars and to lower complication rates. Among the extraoral access to approach the infraorbital margin there are cutaneous accesses (subciliary, subtarsal and infraorbital) and Transconjunctival with some variations. The transconjuntivais access enable orbital floor display, infraorbital rim and medial orbital wall for placement of grafts, osteotomies and osteosynthesis, leaving imperceptible scars in the conjunctiva. The zygomatic complex is anatomically located in the midface and due to its anterior projection it is quite affected by trauma, and facial bone structure, after the nasal bones, more prone to fractures. Case Description: This paper discusses a clinical case on the transconjunctival access to orbitozygomatic fracture approach of a female patient JJC, 30, discussing their indications, techniques and complications. Conclusion: From the diagnosis, the recommended treatment was the transconjunctival access to approach orbitozygomatic fracture.

ACESSO TRANSCONJUNTIVAL NA ABORDAGAGEM DE FRATURA DO ASSOALHO ORBITAL: RELATO DE CASO

Objetivo: As fraturas na face necessitam de abordagens com resultados estéticos previsíveis, buscando acessos que minimizem cicatrizes e com baixos índices de complicações. Dentre os acessos extraorais para abordagem da margem infraorbital são descritos acessos cutâneos (subciliar, subtarsal e infraorbitário) e o transconjuntival com algumas variantes. Os acessos transconjuntivais possibilitam a exposição do assoalho da órbita, rebordo infraorbitário e parede medial da órbita para colocação de enxertos, osteotomias e ostessínteses, deixando cicatriz imperceptível na conjuntiva. O complexo zigomático está anatomicamente situado no terço médio da face e devido a sua projeção anteriorizada é bastante acometido por traumatismos, sendo a estrutura óssea facial, depois dos ossos próprios do nariz e da mandíbula, mais sujeita a fraturas. Descrição do caso: Este trabalho aborda caso clinico sobre o acesso transconjuntival para abordagem de fratura orbito-zigomatica de uma paciente gênero feminino JJC,30 anos, discutindo suas indicações, técnicas e complicações. Conclusão: A partir do diagnóstico, o tratamento proposto foi o acesso transconjuntival para abordagem da fratura orbito-zigomática.

Ophthalmic outcomes of fractured zygomas

In patients with fractures of the zygomatic complex, computed tomography (CT) often identifies extensive defects in the orbital floor. Some surgeons recommend routine exploration and repair of these defects during repair of the zygoma, while others advocate a more selective approach, but there is a paucity of evidence either way. We report a retrospective case series of 50 patients who had open reduction and internal fixation of zygomatic fractures by a single surgeon in the maxillofacial department at the John Radcliffe Hospital, Oxford, between 2011and 2014. The orbit was repaired only in those with severe diplopia, or restriction or malpositioning of the globe. Patients were evaluated by age, sex, aetiology, preoperative findings including diplopia and ocular malpositioning, fracture pattern, and morbidity. A total of 14 had preoperative ophthalmic signs. In five these were minimal so treatment was conservative. Nine (eight with diplopia and one with a malpositioned globe) had exploration and seven of them had the orbit repaired at the same time as the zygoma. This was not possible in the remaining two because of the complexity of the defect. There were no postoperative ophthalmic signs in the 41 who did not have orbit explored, or in the seven who had it repaired, and residual signs resolved after planned secondary reconstruction in the remaining two. We recommend that the orbit is explored only in patients with severe diplopia, or restriction or malpositioning of the globe.