The Management of Zygomatic Complex Fractures: A Review

The face symmetry has prominent role in the human body after injuries and accident. The zygomatic region is important factor in the injuries face. Due to its location, its fracture is the 2nd frequent fractured bone of mid-facial. Zygomatic bone fractures are more abundant in young males and its incidence and etiology is different based on location. Post-traumatic facial deformity is the most incorrect reconstruction of the facial skeleton. Inadequate healing of the supported soft tissues lead to malposition of landmarks, shrinkage and thickening. The zygomatic bone fracture and coronoid process impingement lead to restricted mouth opening. Interruption in zygomatic position has psychological, aesthetic and functional effects which impairs the function of mandible and ocular tissue. Therefore, diagnose and properly management of the zygomatic bone injury is important. Healing displaced fragments of zygomatic bone after inadequate fixation and reduction of fracture consequences facial asymmetry. There is a lack of information about evaluation of benefits and costs of different zmc fracture methods. So, this literature review was done to characterize the etiology, incidence, clinical findings and results of different treatment trends of zygomaticomaxillary complex fractures. Surgeons have been utilized numerous approaches, but there are different ideas for the best one.

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ISOLATED ZYGOMATIC BONE FRACTURE

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.05.1576 ◽

2016 ◽

Vol 23 (05) ◽

pp. 526-530

Author(s):

Suneel Kumar Punjabi ◽

Kashif Ali Channar ◽

Munir Ahmed Banglani ◽

Naresh Kumar ◽

Ambreen Munir

Keyword(s):

Maxillofacial Surgery ◽

Mouth Opening ◽

Facial Asymmetry ◽

Fixation Method ◽

Facial Bones ◽

Limited Mouth Opening ◽

Zygomatic Bone ◽

Study Setting ◽

Infraorbital Rim

Introduction: Facial bones injuries results in functional disturbances. Patientsmay presents with flattening of normal malar prominence, lid drop, eye movement limited orwith double vision, numbness of cheek area and unilateral epitasis. Emphasizing upon incisiontype, fixation method and occasionally reconstruction, surgeons suggest different methods forrepairing complex fractures of Zygoma. Study Design: Descriptive study. Setting: Departmentof Oral & Maxillofacial Surgery, Liaquat University of Medical & Health Sciences, Jamshoro.Period: Mar 2013 to Feb 2014. Materials and methods: Total 20 patients were included.Patients with fracture more than 28 days old were excluded. Zygomatic bone can be approachedby lateral brow or subcilicary incisions and by subgingival buccal sulcus approach. When 3fracture sites were reduced and aligned satisfactorily, application of miniplates was performedat 3 points frontozygomatic suture, Zygomatico maxillary buttress and infraorbital rim, woundwere closed in 2 layers. At 2nd week follow-up patients were assessed for outcome. Results:There were 14 male and 6 female patients. Most were of age <25 years. 45% fractures weredue to RTA. Duration of fracture of 2 patients was 2 days, 7 days of 11 patients, 4 patients had14 days and 3 patients had 28 days. 5 fractures were reduced using Gilies temporal approach,6 with Keen approach, 4 with Hook approach and 5 with Dingman approach. Preoperatively,17 patients had facial asymmetry, 19 had limited mouth opening and postoperatively this wasreduced to 6 cases each for facial asymmetry and limited mouth opening. Conclusion: Itis concluded from this study that three point fixation is most effective and safe method forreduction of fracture of Zygomatic bone.

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

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v13i1.41033 ◽

2017 ◽

Vol 13 (1) ◽

pp. 71-74

Author(s):

Quazi Sindhi ◽

Golam Mohiuddin Chowdhury ◽

Md Abdur Rab ◽

Md Emdadul Haque ◽

Manjur E Mahmud ◽

...

Keyword(s):

Traffic Accidents ◽

Road Traffic ◽

Mouth Opening ◽

Operation Time ◽

Facial Asymmetry ◽

Armed Forces ◽

Road Traffic Accidents ◽

Zygomatic Bone ◽

Temporal Bones ◽

Postoperative Improvement

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. Objective: To analyze the aetiology, clinical presentations, surgical intervention and complications associated with zygomatic complex (ZC) fractures in a tertiary level healthcare facility. 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. 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%). 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. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 71-74

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Orthopedically Induced Condylar Growth in a Patient with Hemifacial Microsomia

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2003_040_0645_oicgia_2.0.co_2 ◽

2003 ◽

Vol 40 (6) ◽

pp. 645-650 ◽

Cited By ~ 1

Author(s):

S. Sidiropoulou ◽

K. Antoniades ◽

G. Kolokithas

Keyword(s):

Soft Tissues ◽

Early Stage ◽

Three Dimensional ◽

Mandibular Condyle ◽

Mouth Opening ◽

Facial Asymmetry ◽

Dental Occlusion ◽

Hemifacial Microsomia ◽

Functional Therapy ◽

Bone Apposition

Objective Hemifacial microsomia is a congenital abnormality that causes three-dimensional facial asymmetry, affection of the dental occlusion, and failure of growth of the midface in the growing child. This report outlines orthopedically induced condylar growth in a patient with hemifacial microsomia. Patient A 7-year-old girl with hemifacial microsomia, complete absence of the left mandibular condyle, and severe facial asymmetry was treated orthopedically in an early stage by means of a functional appliance. Functional therapy was instituted to stretch the deficient soft tissues to guide and promote skeletal growth and stimulate the affected areas. The treatment was completed with fixed appliances. Results The effect of the therapy was an excessive change in condylar growth in the affected side. Facial asymmetry was corrected and a symmetric mouth opening was established. Conclusions The treatment of patients with hemifacial microsomia should be initiated early enough so that the stimulus could in some degree normalize the deficient tissues and induce bone apposition, and in some cases surgical intervention could be avoided.

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Isolated Zygomatic bone fracture: assessment of outcome by two point fixation.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.02.3183 ◽

2020 ◽

Vol 27 (02) ◽

pp. 246-250

Author(s):

Khushboo Abdullah ◽

Muhammad Shahzad ◽

Abdul Wahid Bhangwar ◽

Syed Ghazanfar Hassan ◽

Suneel Kumar Panjabi

Keyword(s):

Bone Fracture ◽

Road Traffic ◽

Bone Fractures ◽

Maxillofacial Surgery ◽

Mouth Opening ◽

P Value ◽

Zygomatic Bone ◽

Significant Difference ◽

Qualitative Variables ◽

Fracture Study

Objectives: The purpose of the present study was to assess the outcome of two-point fixation in isolated zygomatic bone fracture. Study Design: Descriptive study. Setting: Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, LUMHS, Jamshoro/Hyderabad. Period: From 1/3/2018 to 31/8/2018. Material & Methods: Consisted of 46 patients with displaced isolated zygomatic bone fractures. All fractures were treated by reduction with transoral (Keen’s) approach & fixation was done by two point fixation with titanium miniplates. Patient was discharged from the hospital next day & advised follow-up after two weeks. Mean ± St & ard deviation was computed for qualitative variables. Diplopia was described in frequencies. Mouth opening was measured on 7th day or 1 month & measured in 1mm by metallic ruler. T-test was applied to find the P Value. Results: There were 34 male & 12 female patients. 56.5% injuries were caused by road traffic accident. Mean mouth opening at 1st week was 25.23±5.15mm & at 2nd week was 38.75±2.00 mm. At 1st week diplopia was found in 26.1% subjects while at 2nd week, diplopia was found in 10.9% subjects. There was significant difference in mean mouth opening at 1st week with 2nd week. The results also showed significant association of diplopia at 1st week with 2nd week. Conclusion: isolated zygomatic fractures can be reduced & immobilized by two-point fixation with screws & titanium mini bone plates at frontozygomatic & the zygomatic buttress area. Post-operative complications i.e. opening of mouth & diplopia were suggestively decreased afterward 15 days of treatment.

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Aesthetic approaches in complex fractures of the zygomatic bone

Minerva Stomatologica ◽

10.23736/s0026-4970.18.04079-7 ◽

2019 ◽

Vol 68 (1) ◽

Author(s):

Pedro H. da Hora Sales ◽

Raquel B. Vasconcelos ◽

Raíssa F. Papaléo ◽

Leonardo de Freitas Silva ◽

Daniel F. da Silveira Santos

Keyword(s):

Zygomatic Bone ◽

Complex Fractures

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Magnetic Resonance Imaging in the Diagnosis of Disruption of the Posterior Tibial Tendon

Foot & Ankle ◽

10.1177/107110078700800307 ◽

1987 ◽

Vol 8 (3) ◽

pp. 144-147 ◽

Cited By ~ 26

Author(s):

Ian J. Alexander ◽

Kenneth A. Johnson ◽

Thomas H. Berquist

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Soft Tissues ◽

Diagnostic Technique ◽

Clinical Findings ◽

The Body ◽

Posterior Tibial Tendon ◽

Resonance Imaging ◽

Posterior Tibial ◽

Magnetic Resonance Imaging Mri

Magnetic resonance imaging (MRI), a useful technique of studying soft tissues of the body, can be very effective in assessing the integrity of tendons. Usually a patient with a complete tear of the posterior tibial tendon has characteristic physical findings. In the patient presented, MRI demonstrated a complete disruption of the posterior tibial tendon, despite the absence of the commonly associated clinical findings. In view of the difficulties encountered with attempted tenography of the completely torn posterior tibial tendon, MRI provides a sensitive alternative diagnostic technique.

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Atypical Form of Cervicofacial Actinomycosis Involving the Skull Base and Temporal Bone

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418808541 ◽

2018 ◽

Vol 128 (2) ◽

pp. 152-156 ◽

Cited By ~ 2

Author(s):

Adam McCann ◽

Sameer A. Alvi ◽

Jessica Newman ◽

Kiran Kakarala ◽

Hinrich Staecker ◽

...

Keyword(s):

Soft Tissue ◽

Skull Base ◽

Temporal Bone ◽

Soft Tissues ◽

Trauma Surgery ◽

Oral Antibiotic ◽

Facial Skeleton ◽

Atypical Form ◽

Unsuccessful Treatment ◽

The Right

Background: Cervicofacial actinomycosis is an uncommon indolent infection caused by Actinomyces spp that typically affects individuals with innate or adaptive immunodeficiencies. Soft tissues of the face and neck are most commonly involved. Actinomyces osteomyelitis is uncommon; involvement of the skull base and temporal bone is exceedingly rare. The authors present a unique case of refractory cervicofacial actinomycosis with development of skull base and temporal bone osteomyelitis in an otherwise healthy individual. Methods: Case report with literature review. Results: A 69-year-old man presented with a soft tissue infection, culture positive for Actinomyces, over the right maxilla. Previous unsuccessful treatment included local debridement and 6 weeks of intravenous ceftriaxone. He was subsequently treated with conservative debridement and a prolonged course of intravenous followed by oral antibiotic. However, he eventually required multiple procedures, including maxillectomy, pterygopalatine fossa debridement, and a radical mastoidectomy to clear his disease. Postoperatively he was gradually transitioned off intravenous antibiotics. Conclusions: Cervicofacial actinomycosis involves soft tissue surrounding the facial skeleton and oral cavity and is typically associated with a history of mucosal trauma, surgery, or immunodeficiency. The patient was appropriately treated but experienced disease progression and escalation of therapy. Although actinomycosis is typically not an aggressive bacterial infection, this case illustrates the need for prompt recognition of persistent disease and earlier surgical intervention in cases of recalcitrant cervicofacial actinomycosis. Chronic actinomycosis has the potential for significant morbidity.

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Conservative Approach to Unilateral Condylar Fracture in a Growing Patient: A 2.5-Year Follow Up

The Open Dentistry Journal ◽

10.2174/1874210601206010001 ◽

2012 ◽

Vol 6 (1) ◽

pp. 1-4 ◽

Cited By ~ 8

Author(s):

Elif Bahar Tuna ◽

Aysun Dündar ◽

Abdülkadir Burak Çankaya ◽

Koray Gençay

Keyword(s):

Conservative Treatment ◽

Mouth Opening ◽

Facial Asymmetry ◽

Mandibular Growth ◽

Fractures In Children ◽

Facial Swelling ◽

Direct Pressure ◽

Condylar Head ◽

Condylar Fractures

Condylar fractures in children are especially important because of the risk of a mandibular growth-center being affected in the condylar head, which can lead to growth retardation and facial asymmetry. The purpose of this article is to follow up the two and half year clinical and radiological evaluation of the conservative treatment of a 10 year-old patient, who had a unilateral green-stick type fracture. The patient presented with painful facial swelling localized over the left condylar region, limited mouth-opening and mandibular deviation to the left. Panoramic radiography and computed tomography confirmed the diagnosis of incomplete fracture on the left condyle with one side of the bone fractured and the other bent. Closed reduction was chosen to allow for initial fibrous union of the fracture segments and remodeling with a normal functional stimulus. A non-rigid mandibular splint was applied in order to remove the direct pressure on the fracture side of the mandible. Clinical and radiologic examination after 30 months revealed uneventful healing with reduction of the condylar head and remodeling of the condylar process following conservative treatment.

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Giant unicystic ameloblastoma of maxilla-successful endoscopic management

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20213908 ◽

2021 ◽

Vol 7 (10) ◽

pp. 1696

Author(s):

Sanjeev Mohanty ◽

Manu Vergis ◽

Devipriya V. ◽

Haripriya G. ◽

Lakshmi Shree Nallapaneni ◽

...

Keyword(s):

Complete Resolution ◽

Organ Preservation ◽

Mouth Opening ◽

Facial Asymmetry ◽

Standard Of Care ◽

Endoscopic Management ◽

Rare Tumour ◽

Unicystic Ameloblastoma ◽

The Right

<p>This 32-year-old male patient presented with complaints of restricted mouth opening and gross facial asymmetry owing to the massive jaw swelling on the right side. After a thorough examination, a diagnosis of unicystic ameloblastoma of maxilla. Although, the standard of care surgical approach was through Weber-Fergusson incision, a concerted attempt to excise the tumour with the minimally invasive endoscopic route was made successfully. The patient was symptom free now with complete resolution of swelling on a regular follow up post operatively. This case report highlighted the modern day protocol of organ preservation concepts in surgical management of a rare tumour in otolaryngology practice</p>

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

10.21203/rs.3.rs-44138/v2 ◽

2020 ◽

Author(s):

Juncar Raluca Iulia ◽

Paul Andrei Tent ◽

Juncar Mihai ◽

Arghir Ioan Anton ◽

Arghir Cristina Oana ◽

...

Keyword(s):

Soft Tissue ◽

Bone Fractures ◽

Maxillofacial Surgery ◽

Fracture Pattern ◽

Oral And Maxillofacial Surgery ◽

Facial Soft Tissue ◽

Nominal Data ◽

Correct Treatment ◽

Zygomatic Bone ◽

Zygomatic Fracture

Abstract Background: The 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. Methods: A 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.Results: The 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%). Conclusions: Patients 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.

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