Zygomaticomaxillary Research Articles

Effects of melatonin on postoperative pain and sensory recovery following zygomaticomaxillary complex fractures — A randomized controlled trial

Posttraumatic and postsurgical sensory disturbance is a known complication of almost all zygomaticomaxillary (ZMC) complex fractures involving the infraorbital nerve, for which few treatments are effective. Our study used neurosensory assessments to evaluate the efficacy of melatonin on pain and nerve healing following ZMC surgery.Sixty-four randomly allocated ZMC fracture patients were prophylactically administered either oral melatonin or an identical placebo for 15 consecutive days. Pre- and postsurgical clinical parameters included subjective pain, numbness, and objective neurosensory function.Melatonin significantly reduced subjective pain perception in the early postoperative days, with a significant difference in VAS scores between the groups from postoperative day 3 (p = 0.048) until day 7 (p = 0.002). The VAS assessment of subjective numbness perception showed significantly lower self-perceived neurosensory disturbance for patients in the interventional group from the first month (p = 0.039) until the third month (p = 0.005). Objective neurosensory assessment using the pinprick test and two-point discrimination showed statistically significant improvement to almost normal sensation by the first month (p = 0.014) to fully normal sensation by the third month (p = 0.001).The study findings suggest that the prophylactic administration of melatonin confers significant clinical benefits in terms of reduced postoperative pain and improved sensory recovery.

Frequency of Infra Orbital Nerve Recovery after Open Reduction Internal Fixation of Zygomatico Maxillary Fracture

Objective: The current research aimed to assess the repossession frequency of infraorbital nerve paresthesia after open reduction internal fixation in the treatment of ZMC fractures. Methodology: Randomized control trial was conducted in department of Oral and Maxillofacial Surgery, Ziauddin hospital and Medical University, Karachi from Jan 2020 to July 2021. Data was collected after ethical approval. Patients with unilateral zygomatico maxillary bone fracture satisfying the exclusion and inclusion criteria, and who were ready to give knowledgeable approval after the given explanation about study procedure, how data taken from their cases will be used for research purpose, and after discussion on risk as well as benefits of the procedure, were involved in our study. Results: Data of 150 patients were collected. Out of these 150, 82 were and females 68 were male. The mean age (SD) was 31.48 (5.67 SD) years. Other socio-demographic characteristics are represented in table 1. 106 (71%) of ZMC patients recovered from infra orbital nerve after Open Reduction Conclusions: On the basis of this study it is recommended that open reduction as chosen mode of management whose outcomes in enhanced recovery of functional nerve amongst paresthesia patients after linked to closed reduction approaches. Keywords: Infra Orbital Nerve, Zygomatico Maxillary Complex (ZMC)

C-Arm a Useful Tool for Surgeons in Reduction of Zygomatic Complex Fracture: A Comparative Study: Article Type-Original Research.

Reduction of zygomaticomaxillary (ZMC) fracture is often difficult to evaluate intraoperatively because of it peculiar anatomy and limited accessibility. The purpose of this study is to evaluate the efficacy of use of C-arm as a tool for intraoperative monitoring of ZMC fracture reduction. Group I (C-Arm) and Group II (control group) comprised of patients with isolated unilateral displaced Zygomatic complex (ZMC) fractures and having orbital volume change. The efficacy of use of C-arm intra-operatively was evaluated to analyse the reduction of fracture. It was observed that mean change in ocular volume was around 1.07cm2 for Group I and 1.51cm2 in Group II. Thus post-operative eye volume was near to normal in Group I than Group II. The change in ocular volume post-operatively was observed to be statistically significant (p-value < 0.05) in both the groups. Post HOC Tukey statistical analysis determined the intergroup relation in change in eye volume between normal, pre- and post-operative and was found to be statistically significant (p-value < 0.05). The intergroup comparison between Group I and Group II was done using ANOVA statistical analysis and was found to be statistically significant (p-value < 0.05). Our study revealed that C-arm is definitively an effective tool in the oral and maxillofacial surgery armamentarium, giving better results with minimal surgical exposure and by eliminating operator related error. The online version contains supplementary material available at 10.1007/s12070-022-03221-y.

Evaluation of one-point fixation for zygomaticomaxillary complex fractures using a three-dimensional photogrammetric analysis

BackgroundThe goal of treatment for zygomaticomaxillary (ZM) complex (ZMC) fractures is to achieve stability and restore aesthetic appearance through three-dimensional reduction and rigid fixation. The purpose of this study was to evaluate the stability and aesthetic appearance outcomes of one-point fixation using a three-dimensional photogrammetric analysis.MethodsFrom March 2014 to December 2014, 34 patients with ZMC fractures were treated by one-point fixation in the ZM buttress using unsintered hydroxyapatite (u-HA)/poly-L-lactide (PLLA) plates. Differences in soft tissue inter-malar height between the fractured side and unfractured sides were evaluated using photogrammetric analysis with a three-dimensional camera (Morphius®) at the preoperative and 1 week, 1 and 3 months after surgery. The differences in bony inter-malar height between the fractured and unfractured sides were evaluated using computer tomography at the pre-operative and 6 months after surgery. The paired t-test was used to compare differences in malar height.ResultsSix months after surgery, 34 patients achieved satisfactory bony stability and symmetric malar appearances. Comparisons of differences in soft-tissue inter-malar height revealed statistically significant differences between the pre-operative period and 1 week and 1 month after surgery (p < .01). There was no statistically significant difference between 1 and 3 months after surgery. Comparison of differences in bony inter-malar height revealed a statistically significant difference between before and 6 months after surgery (p < .01).ConclusionsWhen we conducted a three-dimensional photogrammetric analysis, although it has restricted surgical indications, one-point fixation of the ZM buttress using an u-HA / PLLA plate yielded reliable, satisfactory, and safe clinical results in patients with ZMC fractures.Clinical question / level of evidenceTherapeutic, III.

Comparison of One Point Fixation Vs Two Point Fixation in the Treatment of Zygomatico Maxillary Complex Fractures.

Background: Zygomatic fractures constitute of 20-40% of all facial fractures, most common among the males between the second and fourth decades of life. The ratio of the incidence between females and male is 1: 4. The zygomatic bone occupying a prominent position in the face determines the facial width. It also acts as a major buttress for the mid face between the maxilla and cranium and it is this prominent location which makes it more prone to injury.

The Role of Postoperative Imaging after Orbital Floor Fracture Repair.

Obtaining postoperative images of maxillofacial fractures does not affect the clinical management of asymptomatic patients; however, few studies have evaluated the role of postoperative imaging in the context of orbital floor fractures. In this study, we evaluate current practice techniques and the role of postoperative imaging in the management of orbital floor fractures in isolation and with concomitant facial fractures. Retrospective review of patients who underwent open reduction and internal fixation of orbital floor fractures between 2005 and 2015 at a single medical institution. Operative and perioperative records were reviewed to characterize postoperative imaging as routine or as indicated by concerning clinical symptoms, and to correlate clinical outcomes to postoperative imaging patterns across all identified orbital floor fractures. A total of 139 patients underwent open reduction and internal fixation of orbital floor fractures. Of these, 75 (54%) had zygomaticomaxillary (ZMC) involvement. The remaining 64 (46%) were isolated orbital floor fractures. Overall, 54 (39%) patients underwent postoperative imaging. Of these, 38 (70%) had postoperative imaging in the absence of concerning clinical symptoms. There was no observed difference in complication rates in those who underwent postoperative imaging, and those who did not. Patients with orbital + ZMC fractures underwent a significantly higher number of postoperative imaging studies ( p < 0.001); however, there was no observed difference in complications between isolated orbital and orbital + ZMC fractures. Routine postoperative imaging is not warranted in the absence of persistent clinical symptoms following open reduction and internal fixation of orbital floor fractures.

Evolution of The Efficiency of Various Methods of Fixation for Zygomatico Maxillary Complex Fractures

Evolution of The Efficiency of Various Methods of Fixation for Zygomatico Maxillary Complex Fractures

Sinus Tract Formation with Chronic Inflammatory Cystic Mass after Beta Tricalcium Phosphate Insertion.

Beta tricalcium phosphate (β-TCP) is one of allogenic bone substitute which is known to have interconnected pores that draws cell and nutrients for bone generation. It has been resulted in good outcomes for bone defect coverage or augmentation. However, several studies have also reported negative outcomes and associated complications including unexpected formation of cystic mass, continuous pain and secretion. We present the case of a 36-year-old man with a right cheek cystic mass who had a history of right zygomaticomaxillary (ZM) complex fracture and surgical correction with β-TCP powder insertion to ZM bone defect. Excisional biopsy under local anesthesia revealed calcified mass in a sinus tract which was found to be connected to the ZM bone defect site in postoperative computed tomography image. Further excision under general anesthesia was performed to remove the sinus tract and fine granules which filled the original defect site. Pathologic report revealed bony spicules and calcification materials with chronic foreign body reaction. Postoperative complications and recurrence were not reported.

Surgical anatomy relevant to the transpalpebral subperiosteal elevation of the midface.

The surgical anatomy of the midface relevant to its subperiosteal elevation and repositioning is assessed. The aim of this study is to give more details on the anatomy relevant to the midface lift. Twenty hemifacial dissections were performed. The location of the zygomatic branches of the facial nerve (ZBFN) and the terminal branches of the infraorbital nerve (ION) were dissected. The location of the masseteric and zygomatic ligaments and the elevation of midface following their release were documented. On average, there were 3 branches of the facial nerve innervating the zygomatic major muscle and 1.8 branches entering the muscle superior to the caudal origin of the zygomaticomaxillary (ZM) suture. The most superior ZBFN was found to lie at an average of 6.2 ± 1.6 mm cranial to ZM suture and 1.4 ± 0.4 mm superficial to the bone. The most inferior branch was at a mean of 4.8 ± 3.3 mm inferior to ZM suture. On average the ION had 5.2 branches that traveled for 10.2 mm above the periosteum before they passed into a superficial plane. Division of the zygomatico-masseteric retaining ligaments allowed for elevation of the midface by 4.8 ± 1.0 mm medially and 5.5 ± .9 mm laterally. Branches of the ZBFN and ION lie in close proximity to the subperiosteal plane in the midface. These branches are at risk for damage during release of the upper zygomatic ligaments and placement of the periosteal suspension sutures during midface elevation procedures.

Evaluation of intra ocular pressure in zygomatico maxillary complex fractures.

To study effects of zygomatico maxillary fractures and fracture reduction on intra ocular pressure (IOP). IOPs of 20 patients with unilateral zygomatico-maxillary complex (ZMC) fractures (divided into 2 groups of 10 undisplaced, 10 displaced) were measured at various time intervals. The relationship between IOPs between the two groups at various time intervals was recorded and evaluated using independent T-tests. 20 subjects were divided into two equal groups (10 each of displaced and undisplaced fractures). Mean age of patients was 33.8years with 90% males and 10% females. The change in IOP at the time of reporting, after 24h and 7days for patients with undisplaced ZMC fractures (Group I) was recorded and was found to be significant. The change in IOP at the time of reporting, before and after surgery, after 24h and 7days for patients with displaced ZMC fractures (Group II) was recorded and was also found to be significant. The IOPs of the two groups was compared at various time intervals and was found to be significant. Also, a significant increase in IOP was noted just after fracture reduction, which could be attributed to oculocardiac reflex, which has been proven to cause bradycardia, and in some cases, even death. A cautious eye needs to be kept over IOP while reducing ZMC fractures at regular intervals and the anaesthetist has to be informed to look for any bradycardia that can occur. Tonometers should be a part of standard armamentarium while reducing and fixing ZMC fractures.

The Clinical Usefulness of Ultrasound-Aided Fixation Using an Absorbable Plate System in Patients with Zygomatico-Maxillary Fracture

BackgroundUltrasound-aided fixation is a recently developed alternative method of treatment of zygomatico-maxillary (ZM) fracture, and it can resolve the problems of excessive torsion force and subsequent fractures of screws. We conducted this study to evaluate the clinical usefulness of ultrasound-aided fixation as compared with the conventional fixation method using a drill and an expander in patients with ZM fracture.MethodsWe conducted a retrospective study in 35 patients with ZM fracture who had been treated at our hospital during a period ranging from March of 2008 to December of 2010. We divided them into two groups: an ultrasound-aided fixation group, comprising 13 patients who underwent ultrasound-aided fixation (SonicWeld Rx, KLS Martin), and a conventional group, comprising 22 patients who underwent conventional fixation (Biosorb FX, Linvatec Biomaterials Ltd.). We compared such variables as sex, direction, age at operation, follow-up period, operation duration, number of fixed holes, and time to discharge between the two groups.ResultsThe ultrasound-aided fixation reduced the operation duration by about 30 minutes as compared with that of conventional fixation. There was no significant difference in follow-up period, number of fixed holes, or time to discharge between the two groups. Furthermore, there were no complications in either group.ConclusionsThe ultrasound-aided fixation of fractured ZM bone using an absorbable implant system is safe and effective in promptly reducing the bone fracture and providing satisfactory cosmetic outcomes over time.

Contemporary Trends in Procedural Volume for Adult Facial Trauma, 1996‐2006

To determine how rates of operative facial fractures may have changed between 1996 and 2006 and to determine the potential impact of such change on otolaryngology residency surgical key indicator cases. Historical cohort study. Academic medical center. The National Hospital Discharge Survey (NHDS) and National Survey of Ambulatory Surgery (NSAS) 1996 and 2006 cases were reviewed, extracting all cases of adult nasal, malar/zygomatic, maxillary, and mandibular fracture reductions in inpatient and outpatient settings, respectively. Procedure rates for each facial fracture were tabulated and compared between 1996 and 2006. Overall in 1996, there were an estimated 113,041 ± 3740 operative facial fracture repairs performed. Among the 3 key indicator fracture repairs most relevant to otolaryngologists, there were 15,810 ± 2143 open nasal fracture reductions, 9360 ± 1742 open zygomaticomaxillary (ZMC) fracture reductions, and 20,214 ± 2585 open mandibular fracture repairs. Overall in 2006, there were 120,463 ± 7554 total facial fracture procedures, with 11,613 ± 2846 open nasal fracture reductions, 10,216 ± 2881 open ZMC fracture reductions, and 17,965 ± 3171 open mandibular repairs. Comparing cohorts, there was no significant change in number of open nasal, ZMC, or mandibular fracture repairs (P = .24, P = .58, P = .80, respectively). Facial fracture procedure rates have remained largely stable over the past 10 years. These data have implications for otolaryngology training programs and could help guide resident education in facial trauma.

Trends in Facial Fracture Repairs, 1996 to 2006

Objective: 1) Learn how rates of operative facial fractures may have changed between 1996 and 2006. 2) Determine potential impact of such change on otolaryngology residency surgical key indicator cases. Method: The National Hospital Discharge Survey (NHDS) and National Survey of Ambulatory Surgery (NSAS) 1996 and 2006 cases were reviewed, extracting all cases of nasal, malar/zygomatic, maxillary, and mandibular fracture reductions, in inpatient and outpatient settings, respectively. Procedure rates for each facial fracture were tabulated and compared between 1996 and 2006. Results: Overall in 1996, there were an estimated 113,041 ± 3,740 operative facial fracture repairs performed. Among the 3 key indicator fracture repairs most relevant to otolaryngologists, there were 15,810 ± 2,143 open nasal fracture reductions, 9,360 ± 1,742 open zygomaticomaxillary (ZMC) fracture reductions, and 20,214 ± 2,585 open mandibular fracture repairs. Overall in 2006, there were 120,463 ± 7,554 total facial fracture procedures, with 11,613 ± 2,846 open nasal fracture reductions, 10,216 ± 2,881 open ZMC fracture reductions, and 17,965 ± 3,171 open mandibular repairs. Comparing cohorts, there was no significant change in number of open nasal, ZMC, or mandibular fractures repairs ( P = .24, P = .58, P = .80, respectively). Conclusion: Despite perceptions, facial fracture procedure rates have remained largely stable over the past 10 years. These data have implications for otolaryngology training programs and could help guide resident education in facial trauma.

Comparison of 1-Point Fixation With 2-Point Fixation in Treating Tripod Fractures of the Zygoma

Zygomatic tripod fracture is relatively common and generally requires open reduction-internal fixation through several incisions. However, lateral eyebrow incisions have sometimes left unsightly scars, and thus we have used 1-point fixation through a buccogingival incision so as not to leave scars in selected cases. The aim of this study was to compare 1-point fixation in the zygomaticomaxillary (ZM) area with 2-point fixation in the ZM and frontozygomatic (FZ) areas in tripod fractures. This study is retrospective and was approved by the institutional review board of our hospital. From November 2005 to March 2010, 30 patients were enrolled in this study. We investigated 14 patients with 1-point fixation in the ZM area (group 1), 1 of whom had bilateral tripod fractures, and 16 patients with 2-point fixation in the ZM and FZ area (group 2). We postoperatively checked for 1) unfavorable scars; 2) bony movement, pain, and palpability in the FZ area; 3) satisfaction with surgical outcomes; 4) presence or absence of surgeries for plate removal; and 5) anxiety about no fixation of the FZ area. Of 16 patients in group 2, 10 (63%) complained of unsightly scars in the lateral eyebrow incision site, whereas none of the patients in group 1 complained of external scarring. None of the patients complained of bony movement and pain in the FZ area in either group. In group 2, 4 of 16 patients (25%) complained of palpability in the FZ area, whereas none in group 1 complained of palpability. The satisfaction score for surgery was 9.4 ± 1.6 in group 1 and 7.7 ± 2.6 in group 2 (P < .05). Two patients underwent surgery for plate removal in group 2. None of the patients in group 1 complained of any cosmetic problems, with no fixation in the FZ area. One-point fixation in the ZM area in zygomatic tripod fractures can avoid unsightly scars and give high satisfaction with surgical outcomes in selected patients with tripod fractures.

Localization of the supraorbital, infraorbital, and mental foramina using palpable, bony landmarks

The purpose of this study was to locate the infraorbital, supraorbital, and mental foramina by using palpable anatomical landmarks that are conducive to surgical use. Fourteen embalmed cadavers (27 sides) were dissected to expose the supraorbital, infraorbital, and mental foramina. Measurements were made from the lateral orbital rim at the zygomaticofrontal (ZF) suture to both the supraorbital and infraorbital foramina. The distance from the inferior orbital rim at the zygomaticomaxillary (ZM) suture to both foramina was also measured. The distance to the mental foramen was measured from the angle and the inferior border of the mandible. The supraorbital foramen was located 26.2 +/- 2.8 mm medial and 13.5 +/- 3.7 mm superior to the ZF suture. The infraorbital foramen was located 23.8 +/- 3.1 mm medial and 30.9 +/- 3.8 mm inferior to the ZF suture, on average. Vertical measurements made from the ZM suture to the supraorbital foramen averaged 34.4 +/- 3.6 mm and from the ZM suture to the infraorbital foramina averaged 7.6 +/- 2.2 mm. The mental foramen was 64.2 +/- 6.4 mm medial to the angle of the mandible and 12.9 +/- 1.6 mm superior to the inferior border of the mandible. This study provides data that may be useful in predicting the location of the supraorbital, infraorbital, and mental foramina using palpable landmarks. These data may be particularly helpful for surgery in patients with missing teeth or fractures of the maxillary bone. Clin. Anat., 2010. (c) 2009 Wiley-Liss, Inc.