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

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.

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

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.

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.

TEMPORARY DISABILITY OF PATIENTS WITH INJURIES OF MAXILLOFACIAL REGION

Introduction: Temporary disability cases in patients with maxillofacial injuries treated in dental medical organizations for 11 years. Objective: to study the group of traumatic maxillofacial injuries affecting the duration of temporary disability cases in the Republic of Tatarstan (RT) in 2007-2017. Material and methods: accounting-and-reporting forms 16-ВН, 036/у, 035/у, 043/у in dental medical organizations for the period 2007-2017. Results: The traumatic maxillofacial injuries leading to temporary disability are in the second place in the structure of diseases with temporary disability and make up 14%; the authors established the type of maxillofacial injuries with temporary disability. When comparing the patients’ age with maxillofacial injuries, it was revealed that the patients with open unilateral mandibular fracture, closed zygomatic fracture, as well as maxillary fracture are significantly young. A bilateral mandibular fracture (both open and closed), an angular mandibular fracture, a wound and hematoma, as well as other injuries are characteristic of older people. The maxillofacial injuries leading to temporary disability are divided as follows, depending on gender: male patients - 58.1%, female patients - 41.9%. The greatest number of temporary disability cases associated with a group of injuries was detected in 2013, the smallest number - in 2008. The average duration of temporary disability cases ranged from 6.69±1.62 to 22.43±2.38 days. The authors established the statistically significant differences in the hospitalization rate depending on the type of maxillofacial injury (p