Comparison of Functional Recovery of Infraorbital Nerve Paresthesia Following Open and Closed Reduction of Zygomaticomaxillary Complex Fractures

Objective: To compare the functional recovery of infraorbital nerve paresthesia following open reduction as compared to closed reduction in zygomaticomaxillary complex fracture management. Study Design: Randomized controlled trial. Place and Duration of Study: Oral and Maxillofacial Surgery Dept. Dentistry Section, Ayub Medical College & Teaching Hospital, Abbottabad from 1st April 2016 to 30th September 2016. Methodology: Eighty two patients of infraorbital nerve recovery were included. They were divided in two groups; group A was treated by closed reduction technique, and group B was treated by open reduction with internal fixation technique using mini plates. Permuted blocks of 6 were used to ensure equal representation in both groups. All patients were underwent surgical management within 1-7 days following trauma. Patients were assessed post-surgery for infraorbital nerve recovery. Results: There were 63.4% males and 36.6% females in group A while 60.9% males and 39.1% females were included in group B with mean age was 28.44±7.15 years in group A and 27.93±7.33 in group B respectively. 51.2% patients have infraorbial nerve recovery in group A while 65.8% have infraorbital nerve recovery in group B. Conclusion: Closed reduction approach was found to be the best reduction technique and open reduction was effective in terms of stability, prevention of relaps and functional recovery of infraorbital nerve injuries. Key words: Functional recovery, Infraorbital nerve, Paresthesia, Closed reduction, Zygomaticomaxillary complex fracture

The Application of Augmented Reality in Craniofacial Bone Fracture Reduction: Study Protocol For a Randomized Controlled Trial.

Background: Augmented reality (AR) is a new technology that increases users’ perception of the real world. The purpose of this study is to evaluate the efficacy and safety of augmented reality navigation system in treatment with craniofacial fracture reduction.Methods: This will be a single-center prospective randomized controlled trial. Twenty-two patients will be assigned to two groups of 11 and those with zygomaticomaxillary complex fractures will undergo preoperative three-dimensional CT modeling and have operational plans designed. The control team will use traditional optical navigation to perform the surgery and the experimental team will use an AR navigation system. The primary outcome measures will be the accuracy of the key points of surgical area between the preoperational surgical plan and post-operation. The secondary outcome measures will be the blood loss, operation time, bone reduction time, hospital time and complication rate. The findings obtained through this study are expected to evaluate efficacy and safety of the augmented reality navigation system in the treatment of zygomaticomaxillary complex fractures.Discussion: This controlled trial of augmented reality navigation system in treatment with zygomaticomaxillary complex fracture reduction is expected to clarify the efficacy and safety of this technology by measuring the accuracy of the key points of surgical area and blood loss, operation and bone reduction times, hospital stay duration and complication rates. This is a single-center study, and the results are expected to promote the application of augmented reality in craniofacial fracture reduction to improve surgery accuracy and efficacy.Trial registration: Trial registration: Chinese Clinical Trial Registry: No. ChiCTR1900022626. Registered on April 19, 2019.

Contemporary Management of Zygomaticomaxillary Complex Fractures

Zygomaticomaxillary complex fracture is one of the most commonly treated facial fractures. Accurate reduction and stable fixation of the zygoma are required to restore facial symmetry and projection and avoid functional sequalae from changes in orbital volume. Achieving optimal outcome is challenging due to the complex three-dimensional anatomy and limited visualization of all affected articulations of the zygoma. This article provides an updated overview of the evaluation and management of zygomaticomaxillary complex fractures based on available evidence and clinical experience at our center. The importance of soft tissue management is emphasized, and approaches to internal orbital reconstruction are discussed. While evidence remain limited, intraoperative imaging and navigation may prove to be useful adjuncts in the treatment of zygomaticomaxillary fractures.

Retrospective study about the postoperative stability of zygomaticomaxillary complex fracture

Background The aim of this study is to evaluate the postoperative stability of zygomaticomaxillary complex (ZMC) fractures according to the number of fixation sites and to investigate the direction of postoperative displacement of the unfixed part of the fractured segment. Methods This study was retrospectively performed on 38 patients who were treated by open reduction and internal fixation of ZMC fractures and were taken postoperative computed tomography (CT) between February 2012 and July 2019. The patients were classified into 3 groups: 1-point fixation, 2-point fixation, 3-point fixation according to the number of fixations. The postoperative displacement of the fractured segment was evaluated by the superimposition between postoperative CT and follow-up CT, and the postoperative stability according to the fixation sites was investigated through the amount of postoperative displacement. In addition, it was investigated in which direction the location of the fractured segment was changed in the unfixed fractured segment according to the fixation sites. Results The amount of postoperative displacement of the fractured segment was 0.75 ± 1.18 mm on average. In the postoperative displacement of the distal area according to the number of fixation of the fracture, there was no statistically significant difference in the amount of displacement of the fracture (p = 0.574). As for the direction of the change in the location of the fractured segment, 12 patients among 38 patients with the change in the location of the fractured segment were investigated, and the displacement in the medial direction (n = 11, 91.67%) was the most common in all three fixation methods. Conclusion In patients with a ZMC fracture who were treated by open reduction and internal fixation, the number of fixations did not make the difference in the postoperative displacement of the fracture. In addition, the fractured segment mainly changes in the medial direction after surgery, and this fact can be used as a reference for the reduction direction during surgery for the stable prognosis.

Management of Unilateral Zygomaticomaxillary Complex Fracture - A Case Report

Zygomaticomaxillary complex (ZMC) fractures are relatively common. Zygomatic complex fractures with functional or aesthetic impairments often require surgical intervention. Treatment of ZMC fractures consists of reduction and fixation of the dislocated bone fragments to their original location. The zygomaticomaxillary complex functions as a major buttress for the face and because of its prominent convex shape, is frequently involved in facial trauma.1 ZMC fractures are also called tripod, tetrapod, quadripod, malar or trimalar fractures. They account for approximately 15 % - 23.5 % of maxillofacial fractures.2,3 The aetiology of zygomatic complex fractures primarily includes road traffic accidents (RTA), violent assaults, falls and sports injuries. They are the second most common facial fracture after nasal bone fractures.3-6 ZMC fractures are more common in men than women, and most commonly occur in the third decade of life.7-10 The main clinical features of zygomatic complex fractures include diplopia, enophthalmos, subconjunctival ecchymosis, extraocular muscle entrapment, cosmetic deformity, malocclusion and neurosensory disturbances of the infra-orbital nerve.10 The gold standard radiological investigation for evaluation of ZMC fractures is computed tomography (CT) scan. Surgical intervention is effective in cases of displaced and comminuted fractures involving functional and aesthetic defects, whereas a nonsurgical approach is often used for non-displaced fractures.11 Various surgical approaches and treatment strategies have been proposed to obtain a successful treatment outcome. Based on review of literature, it has been observed that the open reduction with internal fixation using mini plates and screws is the most commonly preferred treatment for displaced and comminuted fractures.10-12 Here, we report a clinical case of right zygomaticomaxillary complex fracture and its management.