Zygomatic Fractures Research Articles

The Effect of Lag Time Between Injury and Treatment of Zygomatic Complex Fractures on the Neurosensory Disturbances of the Infraorbital Nerve

The Effect of Lag Time Between Injury and Treatment of Zygomatic Complex Fractures on the Neurosensory Disturbances of the Infraorbital Nerve

Analysis of Gillies Temporal Approach vs Towel Clip Method for Reduction of Zygoma Fractures.

The purpose of this study was to analyse Gillies Temporal approach Vs Towel Clip method for reduction of zygoma fractures. A randomised comparative study was conducted on 30 patients having zygoma fractures confirmed with pre-operative NCCT face with 3 D reconstruction. Patients were divided into 2 groups, Group-1- Gillies temporal approach and Group-2- Towel clip method. Clinical observations were recorded in a predesigned proforma for all the patients and analysed statistically. Gillies Temporal Approach significantly p < 0.001 took longer time for reduction than Towel Clip Method. Post-operative pain was experienced more in Group 1 than Group 2. Intraocular pressure was compared at different time intervals and significant difference was noted. Also, Occulocardiac reflex was observed in Group 1. Mean trismus index was 16.87 ± 5.12mm in Group 1 and 13.33 ± 4.11mm in Group 2 preoperatively which significantly increased to 51.93mm in Group 1 and 51.73mm in Group 2 one month post-op. Reduction was maintained post-operatively with good quality of outcome in both the groups. Non-comminuted zygomatic complex fractures can be effectively treated using Towel Clip Method as this method is cost-effective, minimally invasive, safe, causing minimum or no damage to soft tissue and easy to perform based on surgeon's skill and requires less operating time, proving it equally efficient method with excellent aesthetic outcomes.

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.

Analyzing the Burden of Midface Fractures Due to Road Traffic Accidents in Vietnam: An Epidemiological Approach.

Road traffic accidents have significantly impacted public health in Vietnam. This study investigated the patterns of midface fractures in Vietnam and their correlation with road traffic accidents in the country. This retrospective cross-sectional study reviewed 2187 medical records of patients with midface fractures in Ho Chi Minh City. After applying exclusion criteria, the fractures were categorized. Statistical analyses, including chi-squared and logistic regression, were conducted to identify associations and relationships among the types and causes of fractures. The study found that 89.3% of midface fractures stemmed from road traffic accidents, with 55.2% and 14.4% zygomatic complex fractures and Le Fort type II fractures, respectively. Adults aged 19-39 accounted for 65.1% of patients, with males at 80.5%. Traffic accidents were significantly associated with an 18.7 times higher risk of concomitant mandibular fractures and a 10.5 times higher risk of Le Fort type II fractures, irrespective of age and gender. This study underscores the need for targeted prevention strategies to decrease the incidence of maxillofacial injuries resulting from road traffic accidents in Vietnam, particularly among high-risk groups such as males and young adults.

Patient satisfaction of computer guided reduction of Zygomatico-Maxillary Complex (ZMC) fractures using Patient Specific Guide (PSG) versus conventional reduction: a randomized clinical trial

Background and objectives. This study was conducted to evaluate of the patient satisfaction of computer guided reduction of Zygomatico-Maxillary Complex (ZMC) fractures using Patient Specific Guide (PSG) Versus Conventional reduction. Materials and methods. In this clinical trial patients were classified into two groups; each group consist of eight patients where the study group represented the use of patient specific guide for reduction and fixation of zygomatic fracture while the Control group represents conventional reduction and fixation of zygomatic fracture. The primary outcome is patient satisfaction while intraoperative time is the secondary outcome. Results. There was no statistical significancy in the overall satisfaction level between CR and GR, also there was no significancy between time consumed in CR and GR as guided reduction technique could save only about 8 minutes. Conclusions. Patient-specific guided reduction is an satisfactory technique for the reduction of Zygomatico-Maxillary Complex (ZMC) fractures. Moreover, this technique decreased the operation time without a statistically significant difference from the conventional technique.

Aesthetic Approaches to Zygomatic Fracture Management: Achieving Optimal Outcomes With Minimal Scarring.

The zygomaticomaxillary complex is integral to facial aesthetics and is frequently involved in facial fractures. These injuries often necessitate surgical intervention, with open reduction and internal fixation being the standard treatment. This article presents a novel philosophy for managing zygomatic fractures, emphasizing the "Scarless Surgery" technique. The authors' approach prioritizes minimal osteosynthesis material and fixation points while utilizing the least visible surgical access. For isolated zygomatic arch fractures, an intraoral technique is preferred, whereas the frontozygomatic suture is approached through an upper eyelid crease for optimal aesthetic outcomes. The zygomaticomaxillary buttress is accessed through a vestibular mucosal incision and the infraorbital rim benefits from a transconjunctival approach. The findings suggest that fewer fixation points can still yield satisfactory stability and cosmetic results, aligning with literature supporting the efficacy of 1 and 2-point fixations. This modern technique not only minimizes visible scarring but also conforms to the contemporary push for minimally invasive surgical methods. The authors' experience and the existing literature support the efficacy of this approach, reinforcing its viability as a standard practice in the surgical management of facial trauma.

Three-dimensional secondary reconstruction of mistreated zygomatic fractures using patient specific surgical guides and implants.

The zygomatic bone has a great impact on the anterior and lateral projection of the midface as well as the proper position of the globe. Primary alignment of zygomatic fractures is very important as secondary reconstruction is far more challenging. Treatment of misaligned zygoma requires refracturing of the bone to allow for repositioning. Due to the great impact of the zygoma on the projection of the midface, a precise 3D realignment is of great importance. Technology nowadays develops rapidly and allows for superior results in many surgical fields. The use of patient specific surgical guides and fixation plates is becoming more abundant. Using 3D segmentation and design software, we developed a sequence for using 3D planning and printing both for the refracturing stage, avoiding a coronal approach, and for precise repositioning and fixation of the zygoma in the new position. The method is described as well as a unique advanced 3D analysis, allowing for objectively assessing the results. Two cases are presented, including the design and post operative changes. Pre-op, planned and final positions were compared and showed exceptional accuracy allowing for the elimination of human errors which are common in a 3D sensitive procedure such as refracturing of the zygoma. This method can easily be applied to other secondary reconstruction procedures requiring realignment.

Head and Neck Airbag Penetrating Injuries.

Airbags have significantly decreased fatalities in frontal vehicle accidents, but their deployment can lead to more severe injuries and rarely death. The authors present a case of a penetrating injury causing tissue loss in the left cheek, an "explosion" of the zygomatic arch, and facial nerve damage, discussing the management in the contest of literature examining similar injuries in the head and neck region. Reviewing English literature from 1995 to 2023, 9 patients experienced severe airbag-related penetrating head and neck injuries, in 3 cases resulting in death. In addition, we describe the case of a young male reporting a deep cheek laceration with facial nerve damage, tissue loss, and comminuted maxilla-zygomatic fracture; 48 hours after trauma, he underwent surgical reconstruction using a bilobed flap, direct suture of the resected masseter muscle, closed reduction of the comminuted zygomatic arch fracture, and direct neurorrhaphy of the lacerated facial nerve. Five months after surgery, facial nerve function recovery was observed. Mouth opening was restored, but a mixed low-medium hearing loss persisted for high frequencies. In another case marginal nerve damage was reported, but management is not described. The use of seat belts and airbags has led to a significant reduction in the incidence of facial fractures and fatalities after motor vehicle accidents, but at the same time, in some cases, complex facial trauma and/or penetrating injury can be observed. In case of suspected or certain facial nerve damage, it is mandatory to perform exploration and eventual reconstruction within 72 hours.

Polyfracture and Cranial Injuries Drive the Cost and Inpatient Burden of Zygoma Fractures.

Facial trauma makes up a significant number of emergency room visits, with morbidity costs in excess of 1 billion dollars each year. Few studies have evaluated the economic outcomes of management and inpatient burden of facial trauma, most focusing solely on the mandible and isolated midface fractures. The authors aim to evaluate characteristics associated with increased cost and length of hospitalization of zygoma fracture management. Cross-sectional study. Level 1-trauma academic medical center. Patients with zygoma fractures who presented to our institution from 2008 to 2021. Demographics, injury mechanisms, associated injuries, treatment information, and associated costs were collected. Univariate and multivariate analyses were performed to identify the patient and fracture characteristics associated with increased cost and length of hospitalization. Our 14-year experience identified 689 patients with zygoma fractures who presented from 2008 to 2021. Seventy percent were male, and 40% occurred in Caucasian patients. The mean cost, adjusted for inflation, was $21,799.34, and the mean length of hospitalization was 5.5 days. Four or more fractures, associated cranial or intracranial injuries, and length of stay were associated with significantly higher cost, and 4 or more fractures, associated cranial or intracranial injuries, and female gender were associated with significantly longer length of hospitalization. This study represents one of the largest comprehensive databases of zygoma fractures and one of the first to provide a descriptive cost and inpatient burden analysis. To improve outcomes and reduce hospital cost and inpatient burden, protocols should be implemented to address the factors that the authors identified as contributing to increased cost and length of hospitalization.

Recovery of the Infraorbital Nerve Following Open Reduction and Fixation Surgery of Zygomaticomaxillary Complex Fractures-A Prospective Cohort Study Based on Quantitative Sensory Testing.

This study aimed to assess the sensory function of the infraorbital nerve in patients with fractures of the zygomatic complex who underwent open reduction and internal fixation at different time points using quantitative sensory testing, which was established by the German Neuropathic Pain Research Network, comprising a 7-item mechanical and thermal sensory test. A total of 21 patients (age range 17-46y, 14 males) with unilateral zygomatic complex fractures were included. Quantitative sensory testing was conducted before the operation and at 1 week, 3 months, and 6 months operatively, with cold detection threshold, warmth detection threshold, cold pain threshold, heat pain threshold, mechanical detection threshold, mechanical pain threshold, pressure pain threshold, and vibration detection threshold being measured in bilateral infraorbital regions. Notable changes in sensitivity were observed in all values except for the mechanical pain threshold. In the majority of patients with zygomaticomaxillary complex fractures, infraorbital hypoesthesia was significantly improved within 3 months postoperatively, and almost complete recovery could be achieved by 6 months postoperatively.

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.

Comparative Study of Computerized Tomography Imaging of Facial Trauma Using 2D and 3D Reconstruction Scans.

Background The article intends to compare the efficacy of detecting fractures of facial bones in terms of the number of fractures detected, single or multiple involvement, displaced or undisplaced, segmental involvement, and comminuted or non-comminuted using 2D computerized tomography (CT) versus 3DCT for planning optimum treatment. Methodology One hundred patients with suspected facial bone fractures sustained either by assault, road traffic accident, or self-fall on arrival to casualty were examined clinically. Subsequently, palpation was done to detect facial bone fractures. On suspicion, they were subjected to a CT scan of the face in both coronal and axial views. The results were interpreted in the form of bones involved and detection of fractures of the same on both 2D and 3D scans. The acquired images of fractures obtained by 2D scan were reconstructed using software to obtain virtual images of the same by 3D scan to help further delineate which fractures or combination of them are better appreciated on both scans. Result Out of 100 patients, 52 had maxilla fractures, which were better delineated by 3D scans. The detection of zygomatic arch fractures was almost equal on both scans. Mandibular and orbital fractures were better delineated by 3D scans. Conclusion To conclude, we believe that in maxillofacial trauma, 3DCT provides better information than 2DCT, especially with regard to the delineation of fractures and the involvement of single or multiple bones, as it gives a real-time picture of the same. This helpsin planning the management of patients, whether surgical intervention is required or can be managed conservatively.

Epidemiology of maxillofacial trauma in elderly patients receiving oral anticoagulant or antithrombotic medication; a Swiss retrospective study

BackgroundThe percentage of elderly trauma patients under anticoagulation and antiplatelet agents has been rising lately. As newer agents are introduced, each comes with its own advantages and precautions. Our study covered elderly patients admitted to the ED with maxillofacial trauma while on anticoagulation (AC) or antiplatelet therapy (APT). We aimed to investigate the demographic characteristics, causes, and types of maxillofacial trauma, along with concomitant injuries, duration of hospitalisation, haemorrhagic complications, and the overall costs of care in the emergency department (ED).MethodsData were gathered from the ED of Bern University Hospital. In this retrospective analysis, patients over 65 of age were included, who presented at our ED with maxillofacial trauma between 2013 and 2019 while undergoing treatment with therapeutic AC/APT.ResultsThe study involved 188 patients with a median age of 81 years (IQR: 81 [74; 87]), of whom 55.3% (n=104) were male. More than half (54.8%, n=103) were aged 80 years or older. Cardiovascular diseases were present in 69.7% (n=131) of the patients, with the most common indications for AC/APT use being previous thromboembolic events (41.5%, n=78) and atrial fibrillation (25.5%, n=48). The predominant cause of facial injury was falls, accounting for 83.5% (n=157) of cases, followed by bicycle accidents (6.9%, n=13) and road-traffic accidents (5.3%, n=10). The most common primary injuries were fractures of the orbital floor and/or medial/lateral wall (60.1%, n=113), zygomatic bone (30.3%, n=57), followed by isolated orbital floor fractures (23.4%, n=44) and nasal bone fractures (19.1%, n=36). Fractures of the mandible occurred in 14.9% (n=28). Facial hematomas occurred in 68.6% of patients (129 cases), primarily in the midface area. Relevant facial bleeding complications were intracerebral haemorrhage being the most frequent (28.2%, n=53), followed by epistaxis (12.2%, n=23) and retrobulbar/intraorbital hematoma (9%, n=17). Sixteen patients (8.5%) experienced heavy bleeding that required emergency treatment. The in-hospital mortality rate was 2.1% (4 cases).ConclusionsThis study indicates that falls are the leading cause of maxillofacial trauma in the elderly, with the most common diagnoses being orbital, zygomatic, and nasal fractures. Haemorrhagic complications primarily involve facial hematomas, especially in the middle third of the face, with intracerebral haemorrhage being the second most frequent. Surgical intervention for bleeding was required in 8.5% of cases. Given the aging population, it is essential to improve prevention strategies and update safety protocols, particularly for patients on anticoagulant/antiplatelet therapy (AC/APT). This can ensure rapid diagnostic imaging and prompt treatment in emergencies.

Association of fracture type with enophthalmos and intraorbital volume correction in orbital fractures: A computed tomographic study.

To determine the influence of different types of orbital fractures on the radiographic post-treatment outcomes. The investigation was a retrospective cohort study involving CT data of all patients who underwent delayed primary or secondary surgery for orbital/zygomatico-orbital trauma between 2019 and 2021. The sample was divided into three groups 1, 2, and 3: isolated floor, floor and medial wall, and combined orbit and zygomatic complex fractures. The type of orbital fracture was the exposure, while the outcome measures were reduction in enophthalmos and intraorbital volume and linear relationship between the two variables. Data were analyzed for variance between groups and association. Statistical significance was set at < 0.05. Forty-four patients (3 females and 41 males) with a mean age of 28.6 years were included in the study. Reductions in enophthalmos (P < 0.001) and intraorbital volume (P = 0.003) demonstrated significant variance between the groups. For every cubic centimeter of reduction in volume, the reduction in enophthalmos was 0.78 mm (P < 0.001) in isolated floor fractures, 0.60 mm (P = 0.013) in combined fractures involving the floor and medial walls, and 0.24 mm (P = 0.456) in combined fractures of the orbit and zygoma. Correction of enophthalmos strongly depends on the type of orbital fracture. There exists a significant linear relationship between enophthalmos and intraorbital volume in fractures involving the internal orbit.

Coronal Approach (Cadaver)

For treatment of facial trauma such as a frontal sinus fracture, orbital fractures, or zygoma fractures, the coronal or bi-temporal approach is used. The approach can also be used for superficial temporal artery biopsy. This approach exposes the anterior cranial vault, forehead, and upper and middle regions of the facial skeleton including the zygomatic arch. It provides access to these areas with minimal complications and cosmetically acceptable hidden scars. The subperiosteal or subgaleal planes are commonly used for coronal flap dissection. Here, we present a demonstration of the coronal approach to exposing the upper or middle facial skeleton in a cadaver.

Frequency of Zygomatic Complex Fracture in Patients Presenting to Ayub Teaching Hospital

Zygomatic complex fractures are a prevalent type of facial injury. It often results from road traffic accidents (RTA). It poses significant clinical challenges. Objective: To find out the frequency of zygomatic complex fractures among patients introduced at the Ayub Teaching Hospital. Methods: This cross-sectional study was carried out in the Department of Oral and Maxillofacial Surgery at Ayub Teaching Hospital, Abbottabad, Pakistan after approval from IRB (Institutional Review Board) of the Ayub Teaching Hospital Abbottabad, (IRB-F5/Dent/AMC&amp;ATH) from September 1, 2019, to March 1, 2020. A total of 146 patients, including both genders and revealing oral and maxillofacial injury, were essential parts of the research. Before performing meticulous intra and extra-oral clinical examinations and computed tomography (CT) scans in the Department of Radiology to diagnose zygomatic complex fractures. Results: Out of the total number of 146 patients, 33.6% had ZMC fractures. The study involved patients aged 18-60 years. This is consistent with an average age of 31.993 ± 8.00 years and a mean weight of 74.664 ± 9.26 kg. Male patients represented 74.7% of cases and female comprised 25.3%. The primary causes of fractures were road traffic accidents, falls, and sports injuries. Conclusions: The research concluded that zygomatic complex fractures occurred due to road traffic accidents (RTA), which are more common in this region. Thus, the examination highlights the basic requirement for procedures to alleviate street mishaps to abridge such terrible facial injuries.

Diagnosis and complications of late treated Zygomatic complex fractures – Case series

Zygomatic complex is the term used for Zygomatic bone, parts of maxilla, frontal bone, temporal bone and sphenoid bone. It forms the infrastructure of anterolateral part of the face and prominence of cheek.[1] Majority of zygomatic complex fracture occur due to road traffic accidents, other causes include fall, sports injury and assaults.[2] It transmits the occlusal stress to the base of skull along its vertical and horizontal struts. In majority of the cases of zygomatic complex fractures, the fractured part displaces inward. In cases of inwardly displaced zygomatic complex fractures trismus, epistaxis and diplopia are commom finding. [3] Subconjunctival haemorrhage is also one of the common features of the zygomatic complex fracture. Subconjunctival haemorrhage has no posterior limit and remains bright red owing to the ability of oxygen to diffuse through the conjunctiva to the collection of blood. This article presents a case series of management of malunited Zygomatic fractures at our centre.

Clinical Significance of Diplopia and the Orthoptic Examination in Zygomatic Maxillary Complex Fractures.

Literature describes variable rates of diplopia of associated with zygomatic maxillary complex (ZMC) fractures (6% to 40%). The aim of this study was to retrospectively assess the prevalence of diplopia in ZMC fracture patients, the usefulness of the orthoptic evaluation compared with the clinical finger-tracking examination, and to seek possible relations of this symptom with clinical parameters. Data of patients attending the Maxillofacial Surgery Units of the University of Messina and University of Naples "Federico II", between January 2012 and December 2022 were retrieved. Statistical analysis of positive versus negative diplopia at both the clinical examination and the orthoptic evaluation and subgroup analysis were performed. 320 patients were included in the analysis. 50 (15.6%) patients reported diplopia at the clinical examination, whereas 70 (21.9%) resulted positive at the orthoptic evaluation. Statistical analysis for every determinant and subgroup did not show statistical significance ( P >0.05). Performing routine preoperative orthoptic evaluation allowed an increase of 6.3% in positive reports. Although it seems that no basic clinical parameter can predict diplopia, results suggest that the orthoptic evaluation is superior in the assessment of this symptom. Clinical analysis was shown to be a moderate/low efficient test and should not be used as a decisional standard.

Enhancing Surgical Approach: Breakthrough Markerless Surface Registration With Augmented Reality for Zygomatic Complex Fracture Surgeries.

Innovative technologies with surgical navigation have been used for enhancing surgical accuracies for zygomaticomaxillary complex (ZMC) fractures and offers advantages in precision, accuracy, effectiveness, predictability, and symmetry improvement. Moreover, augmented reality (AR) navigation technology combines virtual reality, 3-dimensional (3D) reconstruction, and real-time interaction, making it ideal for bone tissue operations. Our study explored the usefulness and clinical efficacy of AR technology in intraoperative guidance for reducing ZMC fractures. We retrospectively studied 35 patients with zygomatic complex fractures, comparing outcomes of AR-guided and conventional methods. Furthermore, the AR system provided real-time visualization and guidance. The evaluation included reduction accuracy using root mean square (RMS) value and symmetry analysis using a mirror image of 3D models. Results demonstrated the feasibility and effectiveness of the AR-guided method in improving outcomes and patient satisfaction. In 35 patients (25 males, 10 females), AR-guided (n = 19) and conventional (n = 16) approaches were compared. Age, sex, and fracture type exhibited no significant differences between groups. No complications occurred, and postoperative RMS error significantly decreased ( P < 0.001). The AR group had a lower postoperative RMS error ( P = 0.034). Augmented reality-guided surgery improved accuracy and outcomes in zygomatic complex fractures. Real-time visualization enhanced precision during reduction and fixation. This innovative approach promises enhanced surgical accuracy and patient outcomes in craniofacial surgery.

Lateral Rectus Muscle Entrapment in Complex Orbital Fracture in a Child.

A 6-year-old boy presented with a lateral rectus muscle entrapment in a complex orbital fracture sustained during bicycle riding. He was diagnosed with a skull-base fracture with pneumocephalus and zygomatic and inferior orbital wall fractures at another hospital. The zygomatic fracture and pneumocephalus were treated conservatively. Although a detailed ocular motility examination could not be performed due to pain and inability to open the eyelid, the inferior wall fracture was surgically repaired. Postoperatively, persistent extraocular movement limitation prompted a referral to our clinic. Orbital CT imaging demonstrated a fracture at the greater wing of the sphenoid with a hypoattenuated area in the adjacent middle cranial fossa. Orbital MRI taken thereafter revealed lateral rectus and orbital fat prolapse into the middle cranial fossa, indicating entrapment of these structures through the lateral wall fracture. The incarcerated lateral rectus was released using an endoscopic transorbital approach via an upper lid crease, resulting in the recovery of extraocular movement.