Zygomatic complex fractures

The zygoma is commonly fractured in facial trauma. The zygoma forms the anterolateral prominence of the face as well as contributing to the orbit and maxillary buttress. The assessment and management of zygomatic fractures are described in this chapter.

Management of orbital floor fractures-A case series

Orbital floor fractures are the most challenging fractures to be managed in maxillofacial region. They are diagnosed in isolation or in combination with mid face fractures, Lefort fractures and zygomatic fractures. The treatment depends on the displacement of the fractured bones and the manifestations of muscle entrapment elicited by clinical examination and radiographic assessment. The timing of repair is of paramount importance and decided on the case to case basis. Proper surgical approach along with appropriate implant placement is the key to success. This paper describes a series of 11 patients operated in IGMC&RI, Puducherry for orbital floor fractures from 2010 to 2019.

Intra-operative application of ultrasonoghaphy (USG) for reduction of zygomatic arch fracture

Zygomatic arch fractures are the most common facial fractures or second in frequency after the nasal fractures. The high incidence of zygomatic fractures probably relates to its prominent position in the facial skeleton hence it is frequently exposed to fractures.

Inferomedially impacted zygomatic fracture reduction by reverse vector using an intraoral approach with Kirschner wire

Background In inferomedially rotated zygomatic fractures sticking in the maxillary sinus, it is often difficult to achieve complete reduction only by conventional intraoral reduction. We present a new intraoral reduction technique using a Kirschner wire and its clinical outcome.Methods Among 39 inferomedially impacted zygomatic fractures incompletely reduced by a simple intraoral reduction trial with a bone elevator, a Kirschner wire (1.5 mm) was vertically inserted from the zygomatic body to the lateral orbital rim in 17 inferior-dominant rotation fractures and horizontally inserted to the zygomatic arch in nine medial-dominant and 13 bidirectional rotation fractures. A Kirschner wire was held with a wire holder and lifted in the superolateral or anterolateral direction for reduction. Following reduction of the zygomaticomaxillary fracture, internal fixation was performed.Results Fractures were completely reduced using only an intraoral approach with Kirschner wire reduction in 33 cases and through an additional lower lid or transconjunctival incision in six cases. There were no surgical complications except in one patient with undercorrection. Postoperative 6-month computed tomography scans showed complete bone union and excellent bone alignment. Four patients experienced difficulty with upper lip elevation; however, these problems spontaneously resolved after manual tissue lump massage and intralesional steroid (Triamcinolone) injection.Conclusions We completely reduced infraorbital rim fractures, zygomaticomaxillary buttresses, and zygomaticofrontal suture fractures in 84% of patients through an intraoral approach alone. Intraoral Kirschner wire reduction may be a useful option by which to obtain effective and powerful reduction motion of an inferomedially rotated zygomatic body.

The Use of magnetic-laser Therapy in the Rehabilitation period for patients with Infraorbital nerve Damage

Aim: The aim of the study was to assess the effectiveness of magnetic-laser therapy in complex treatment of patients with zygomatic fractures accompanied by the infraorbital nerve damage. materials and methods: The study included 32 patients with single fractures of the zygomatic bone accompanied by infraorbital nerve injury. Patients were divided into two groups: the main group (n=17) and the control one (n=15). In both groups the complex treatment was used, which included: the fragment reposition operation, broad-spectrum antibiotic, nonsteroidal anti-inflammatory drug, anti-edematous therapy, vitamin B complex. In the main group of patients in the postoperative period the magnetic-laser therapy was applied. Assessment of qualitative and quantitative indices of pain was carried out on the 1st, 7th and 14th days of treatment. Results: In the main group of patients the magnetic-laser therapy significantly reduced the intensity of nociceptive pain, led to moderate regression of all types of neuropathies associated with infraorbital nerve damage. When comparing 2 groups the best pain relief had patients of the main group. At the end of treatment a significant positive dynamics of improving the electrical sensory of infraorbital nerve has been noted, as indicated by recovery of sensory threshold, pain threshold and pain tolerance almost to the level of intact contralateral side. Conclusions: The use of magnetic-laser therapy in the combined treatment of infraorbital nerve damage allows to improve the recovery of infraorbital nerve sensory changes following zygomatic fractures, reduce the pain, increase the effectiveness of treatment and provide rapid postoperative rehabilitation of patients.