Management of Isolated Zygomatic Arch Fractures and a Review of External Fixation Techniques

Introduction: Fractures of the zygomatic bone can present with complicated aesthetic and neurological pathology. Specifically, management of isolated zygomatic fracture has been sparsely discussed in the literature, and most studies are based upon older techniques. Here, we compare the results of 2 critical operative techniques as well as review the available literature in the setting of isolated zygomatic fractures. Methods: A retrospective chart review was performed at our institution from 2010 to 2018 examining for patients who had sustained an isolated zygomatic fracture confirmed by computed tomography scan. Patients were excluded if they sustained additional maxillofacial fractures. Demographical information, symptoms on presentation, fracture management modality, and postoperative course were all collected and examined. Results: A total of 218 patients were identified for inclusion. The average age of this cohort was 45.5 ± 18 years, with 77.5% being male. Assault (55%) was most the frequent cause of injury with accidents being the least common (17.9%). Most patients (78.8%) underwent nonoperative management. Patients who underwent operation more often presented with zygomatic deformity (97.7% vs 18.4%), paresthesia (29.5% vs 2.9%), and trismus (29.5% vs 6.9%) when compared to their nonoperatively managed counterparts. In all, 44 operatively managed patients underwent open reduction with or without eternal fixation (Gillies Approach vs Keen Approach). There were no significant differences in the presence of zygomatic deformity, paresthesia, and trismus between the 2 operative techniques. Conclusions: Isolated zygomatic arch fractures can present with discerning symptoms. Unfortunately, the literature on appropriate management is not well described. We find external fixation to provide reestablishment of both form and function with minimal required exposure, although the outcomes may be similar without the use of external fixation.

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Closed reduction with minimal accesses for treating isolated zygomatic arch fractures: Case Series

Research Society and Development ◽

10.33448/rsd-v10i6.15792 ◽

2021 ◽

Vol 10 (6) ◽

pp. e30810615792

Author(s):

Maelly Vicente Lôbo ◽

Yasmin Lima Nascimento ◽

Taysnara Ismaeley de Andrade ◽

Kaiane Tavares Pontes ◽

Joelma Silva de Andrade ◽

...

Keyword(s):

Closed Reduction ◽

Therapeutic Option ◽

Case Series ◽

Zygomatic Arch ◽

Rigid Fixation ◽

Maxillofacial Fractures ◽

Choice Of Treatment ◽

Aesthetic Results ◽

And Function ◽

Nasal Fractures

Following nasal fractures, zygomatic fractures (ZF) are the second most prevalent of maxillofacial fractures. Isolated fractures of the zygomatic arch (IZAF) are rare, corresponding to less than 10% of all fractures involving the zygomatic-maxillary complex (ZMC). The choice of treatment for IZAF is controversial, and there is no defined consensus in the literature. We seek to evaluate the advantages of closed reductions with minimal accesses over open reductions through a case series and a 10-year literature review. All patients in our study obtained a satisfactory final result in terms of aesthetics and function of the zygomatic arch, with no complications involved. There are criteria established in the current literature on the indication of open surgery or closed reduction. Open reduction with rigid fixation has the most significant number of studies proving its clinical efficacy. However, closed reduction with minimal accesses has proven to be a suitable therapeutic option for IZAF, presenting satisfactory aesthetic results and fewer surgical risks.

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Keen's Approach: A Dynamic Approach for Zygomatic Arch Fracture Management

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1708684 ◽

2016 ◽

Vol 06 (04) ◽

pp. 92-94

Author(s):

Muralee Mohan ◽

Tripthi P. S. ◽

Pratiksha Shetty ◽

Akash Menon

Keyword(s):

Bone Fractures ◽

Head Injuries ◽

Mouth Opening ◽

Road Accident ◽

Zygomatic Arch ◽

Open Approach ◽

Intraoral Approach ◽

Aged Woman ◽

Fracture Management ◽

Maxillofacial Fractures

AbstractMaxillofacial fractures are often associated with blunt head injuries of which the outward projection of the Zygomatic Arch exposes it to frequent injury. Isolated Zygomatic arch fractures account for 10% of all Zygomatic bone fractures. Depressed Zygomatic arch fractures causes restricted mouth opening due to the partial or total obstruction of the movement of mandibular coronoid and condylar processes. Numerous techniques have been used to approach the site and reduce the fractured fragments, such as the Gillie's temporal approach, Keen's intraoral approach, anterior cheek skin incision and direct open approach.Below is a case report of an isolated Zygomatic arch fracture following a road accident in a middle aged woman that was surgically treated by open reduction through the Keen's intraoral approach. Successful reduction of the fractured segments and restoration of function was achieved with no scarring, minimal post-operative pain and satisfactory aesthetics.

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Repair of Mandibular Fractures: Plating vs. Traditional Techniques

Otolaryngology ◽

10.1177/019459989210600308 ◽

1992 ◽

Vol 106 (3) ◽

pp. 245-249 ◽

Cited By ~ 4

Author(s):

C. Elliott Morgan ◽

Julius N. Hicks ◽

Thomas L. Eby ◽

Thomas E. Borton

Keyword(s):

Head And Neck ◽

Structure And Function ◽

Mandibular Fracture ◽

Mandibular Fractures ◽

Rigid Fixation ◽

Fracture Management ◽

Fixation Techniques ◽

And Function ◽

Compression Plating ◽

Indications For Use

The treatment of mandibular fractures is a challenge for the otorhinolaryngologist-head and neck surgeon. Recent technologic advances have resulted in the development of rigid fixation techniques that hold promise for the early and optimal restoration of mandibular structure and function. The purpose of this article is to review the dental and orthopedic principles used in our mandibular fracture management, describe compression plating methodology, and discuss optimal techniques for its use. Results using rigid fixation procedures were compared with those using a variety of more traditional techniques in a retrospective analysis of 57 cases. The advantages, limitations, and indications for use of plating technology are discussed, and prevention of complications is emphasized.

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Scanning tunneling microscopy (STM) of DNA and RNA

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100152148 ◽

1989 ◽

Vol 47 ◽

pp. 34-35

Author(s):

Patricia G. Arscott ◽

Gil Lee ◽

Victor A. Bloomfield ◽

D. Fennell Evans

Keyword(s):

Molecular Structures ◽

Inorganic Materials ◽

Resolving Power ◽

Scanning Tunneling ◽

Tunneling Microscopy ◽

Form And Function ◽

Dna And Rna ◽

Calf Thymus ◽

And Function ◽

The Relationship

STM is one of the most promising techniques available for visualizing the fine details of biomolecular structure. It has been used to map the surface topography of inorganic materials in atomic dimensions, and thus has the resolving power not only to determine the conformation of small molecules but to distinguish site-specific features within a molecule. That level of detail is of critical importance in understanding the relationship between form and function in biological systems. The size, shape, and accessibility of molecular structures can be determined much more accurately by STM than by electron microscopy since no staining, shadowing or labeling with heavy metals is required, and there is no exposure to damaging radiation by electrons. Crystallography and most other physical techniques do not give information about individual molecules.We have obtained striking images of DNA and RNA, using calf thymus DNA and two synthetic polynucleotides, poly(dG-me5dC)·poly(dG-me5dC) and poly(rA)·poly(rU).

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