The short answer is that your zygoma can be put into a better position without the use of an implant but it is a bit of an ordeal and you will need plates and screws to hold the bones in place. Shaving, however, as a single simple method of zygoma reduction, has not overcome the limitations. The high incidence of zygomatic complex fracture relate slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Such landmarks are shown and discussed in sequence with the key surgical steps. Download fulltext pdf download fulltext pdf delayed treatment of zygomatic tetrapod fracture article pdf available in clinical and experimental otorhinolaryngology 32.
Zygoma is the second most common site of facial bone fracture. The zygoma forms a significant portion of the floor and lateral wall of the orbit and forms a portion of the zygomatic arch, otherwise known as the malar eminence, which plays a key role in the determination of facial morphology. The vast majority of zygomatic fractures occur in men in their third decade of life. Surgical management of zygomatic complex fractures in a major. The zygomatic bone occupies a prominent and important position in the facial skeleton. The zygomatic arch is formed by the union of the temporal process of the zygomatic bone and the zygomatic process of the temporal bone at the zygomaticotemporal suture. Twenty two patients with isolated zygomatic fractures over a period of one year were. Interesting case series zygomatic arch fracture with coronoid impingement gerhard s. The zygomatic process, a bony protrusion of the human skull. The zygoma is the main buttress between the maxilla and the skull, but, in spite of its sturdiness, its prominent location makes it prone to fracture.
Gillies elevation and percutaneous kirschner wire fixation. The zygoma or zygomatic bone forms the lateral part of the face and the prominence of the cheek. The body of the zygoma is sturdy, but its articulations are frequently the site of fracture. Moreover the importance of zygomatic complex in facial skeleton lies inprotecting globe of eye and absorbing and redistributing masticatory andexternal load. Complications of zygomatic bone and zygomatic arch plastic. Repair of zygomatic fractures can be classified into the early closed reduction or the more recent open reduction and rigid internal fixation orif methods. Head and facial trauma the atlas of emergency medicine. Zygomatic arch reduction gillies approach springerlink. Fractures of the zygomatic complex and arch pocket.
Fortyfive randomly selected patients with tripod type zygoma fractures were classified into a medial rotation group and a lateral rotation group, depending on preoperative deviation patterns. Displaced fractures of the zygoma require reduction to prevent malunion. Strong buttress of lateral midface lying between zygomatic process of frontal bone and maxilla. The main factor of zygoma dislocation in zygoma fracture is rotation around the is axis. Inferior and posterior displacements of the zygoma produce varying degrees of disorganization of the soft tissue of the orbital cavity with bone expansion see figure 7. If you have any other questions that the leaflet does not answer, or if you would like further information, please ask us. On the left the noninjured side overlying structures give the impression of a. Other fracture patterns, include isolated zygomatic arch fractures, or zmc fractures with associated panfacial fractures, such as le fort ii and iii. Half of the occurrences of fracture happened between 2 and 8 years after implantation. Analysis of treatment for isolated zygomaticomaxillary complex. The complication rate of zygomatic boen and zygomatic arch plastic surgery is lower than other principles of surgeries. The fracture line extends posterolaterally through ethmoid bones, orbits, and pterygomaxillary suture into the sphenopalatine fossa. Following fractures of the nasal bone, zygomatic fractures are the second most common fractures of the face and predominantly occur in males during their twenties and thirties.
An electronic fracture case collection complements the tutorial papers. A basilar skull fracture is basically a linear fracture of the skull base. Economic analysis of open approach versus conventional methods of zygoma fracture repair. The term zygoma generally refers to the zygomatic bone, a bone of the human skull commonly referred to as the cheekbone or malar bone, but it may also refer to. Evaluation of treatment of zygomatic bone and zygomatic. Temporal gillies approach to a zygomatic arch fracture. The zygomatic arch is the third most common fractured facial bone, with a high majority of those cases being male. Surgical management of zygoma fractures in patients with. Factors influencing the fracture of dental implants.
Anesthetic challenges and management of maxillofacial trauma. Trauma resulting in fractures to this area typically does not have localizing symptoms. Head and facial trauma the atlas of emergency medicine, 4e. Mildly displaced comminuted fracture of the left zygomatic arch shows up to 37 degrees of inwards angulation.
Pdf zygomaticomaxillary complex fracture researchgate. Fracture zygoma due to middle energy injury causes fractures of all its supporting buttresses. The purpose of this study is to evaluate the functional and esthetic outcome following this lateral orbital approach in the management of zygoma fracture. The mechanism of injury usually involves a blow to the side of the face from a fist, from an object, or secondary to motor vehicle accidents. When the zygoma undergoes an impact, the location of the resulting fracture depends on which of these supporting regions collapse. We present a fourpart study of the cosmetic results of common zygomatic fracture reduction techniques. Determining the optimal method for zygoma fracture reduction is a common challenge. Face zygomatic arch fracture om30 view same patient as image above the zygomatic arch fracture is more easily seen on the om30 occipitomental 30 image. Using free navigation reference points and prefabricated bone. Treatment of zygomatic complex fractures with surgical or. Therefore for cosmetic and functional reasons it is imperative to diagnoseand treat zygomatic fractures adequately.
The evaluation of efficacy of postoperative antibiotics in the open reduction of the zygomatic and mandibular fracture. A zygoma fracture is often the result of facial trauma such as violence, falls or automobile accidents. Sacks, md department of plastic and reconstructive surgery. The complication is believed having some connections with the improper selection of surgical method or surgical procedure and deformity or weakening of the zygomatic bone and zygomatic arch. Indirect signs of the injury may include visible evidence of bleeding from the fracture into surrounding soft tissue, such as a battle sign or raccoon eyes. Surgical management of zygoma fractures in patients with pre. Infraorbital sensory disturbance was hypoesthesia 24%, having aesthetic concern gradeiii 86% and gradeiv 14% with limited mouth opening of 25 to 30 mm in 19 patients 38% followed by 31 to 40 mm. Trauma to the midface may cause fractures affecting the maxilla, the zygoma, and the nasoorbital ethmoid complex. The temporal process, which forms zygomatic arch a1frontal process, which forms lateral orbital wall a2maxillary process, which forms infraorbital rim a3category bfracture of all three processes, detaching zygomatic bone from facial skeleton i. Evaluation of treatment of zygomatic bone and zygomatic arch. Postoperative radiographs of a complex zygomatic fracture. Pdf management of zygomaticmaxillary fracture the principles.
Parker, md, phd, and marcin czerwinski, md, phd introduction. The zygoma is supported by the following 4 regions. The zygomatic bone is attached to the maxilla at the zygomaticomaxillary zm suture and alveolus forming the zygomaticomaxillary buttress. This plays a key role in the structure and function of. Tripod fracture consists of a zygomatic arch fracture, b fracture of the lateral orbital wall, and c fracture of the inferior orbital floor.
Classic tripod fracture, but anatomically these fractures are actually. The zygomaticomaxillary complex fracture, also known as a quadripod fracture, quadramalar fracture, and formerly referred to as a tripod fracture or trimalar fracture, has four components. On the left the noninjured side overlying structures give the impression of a fracture, but careful scrutiny shows the cortex is intact. Zygoma is a very crucial component which maintains facial contour. In this case report, the clinical and radiological. It requires a prompt and skillful response from the anaesthesia team. This finding is helpful for effective performance to reposition fractured zygomas. The ages of the patients ranged from 10 to 76 years old, mean age was 32. The zygomatic process, a bony protrusion of the human skull, mostly composed of the zygomatic bone but also. The severity of the injury is directly proportional to force of the impact.
For example, a hairline fracture in the cheekbone may simply require time to heal. This is a different bone than the zygomatic arch, which is formed by a prominence of the zygomatic bone in combination with the frontal bone. A zygoma fracture zygomatic fracture is a form of facial fracture caused by a fracture of the zygomatic bone. This is a different bone than the zygomatic arch, which is formed by a prominence of the zygomatic bone. Late correction following zygoma fracture thanks for your question. Zygoma fractures are easy to miss and displaced fractures require treatment within 10 days. Xray diagnosis of posterior displacement of zygoma. There are risks and complications with this procedure. Evaluation of the orbital floor in zygoma fractures jama. An ice pack and pain relievers may be recommended to manage pain and swelling as the fracture heals.
Dec 28, 2011 fracture of the zygomatic bone is a common fracture of the facial skeleton. We applied these principles to repair zygomatic fractures with the aid of a 4 mm, 30 degree telescope inserted through a small temporal incision. Once the zygoma is reduced, the orbital floor should be reevaluated for potential repair. Related pathology le fort type 3 fracture zygomaticomaxillary complex fra. The fracture fragments are held in position while rigid internal fixation is performed using small plates and screws fig. Application of endoscope in zygomatic fracture repair journal of. Symptoms include flattening of the face, trismus reduced opening of the jaw and lateral subconjunctival hemorrhage. According to the site of fracture, the patients were divided into three groups. Pdf delayed treatment of zygomatic tetrapod fracture. Isolated zygomatic arch fractures comprise 5% of all facial fractures and 10% of zygomatic bone fractures.
The indications for concomitant orbital floor exploration are controversial. Using free navigation reference points and prefabricated. In order for a fracture to occur in the zygomatic bone, kinetic force is required. The mean standard deviation time for fracture to occur was 95. This is most commonly seen after assault, but any blow to the cheek may give rise to a fracture. Reduction of fractured zygoma is done by manipulating the broken cheek bone to restore the contour and appearance of the face. Evaluation of the lateral orbital approach in management of. Fractures involving zygoma is very common, in fact it is the second most common facial bone to the fractured following facial trauma next only to nasal bones. The optimal surgical technique represents a balance between accurate fracture reduction and softtissue morbidity. Management of zygomaticomaxillary complex zmc fractures should be based on injury patterns and not on training background. The incidence of isolated bilateral zygomatic fractures has not been reported secondary to rta apart from one such report of a bilateral zygomatic arch fracture.
These fractures occur most commonly as the result of assaults or motor vehicle collisions. Jan 02, 2015 the zygoma forms part of the floor and lateral wall of the orbit and the zygomatic arch is an important feature in the structure and appearance of the face. The fixture at the infraorbital site is a 1 mm localising plate. Zygomatic bone and zygomatic arch plastic surgery is a common plastic and cosmetic surgery. Lefort iii fracture or craniofacial disjunction is a separation of all of the facial bones from the cranial base with simultaneous fracture of the zygoma, maxilla, and nasal bones. The objective of zygoma fracture repair is to restore preinjury function and appearance. Management of zygomatic fractures pocket dentistry. The zygoma articulates with the temporal, sphenoid, frontal, and maxillary bones and is a roughly quadrilateral mass with projections figure 75. Abstractthe present study aims to elucidate the relationship between preoperative deviation patterns of fractured zygomas and treatment outcomes. Fractures involving zygoma is very common, in fact it is the second most common facial bone to the fractured following facial. The cheekbone, or zygoma, can be fractured or completely broken, and the appropriate treatment can vary widely. The relatively severe complication of the zygoma reduction plastic surgery is the zygomatic bone and zygomatic arch displacement or defect. Purpose the purpose of this study was to evaluate the adequacy of reduction and stability of fixation of isolated zygomaticomaxillary complex zmc fractures. However like other surgeries this surgery do have some risks of surgical complication and unsatisfactory rate.
It explains the features and options of the ao cmf classification system the case examples are grouped according to the tutorial papers, which account for the anatomical regionssubregions and the three precision levels. Fragments can be held together with plate fixation to simplify comminuted fractures. The zygoma forms part of the floor and lateral wall of the orbit and the zygomatic arch is an important feature in the structure and appearance of the face. Clinical and epidemiological presentation of patients with. Zygomatic fractures are common facial injuries, representing the most common facial fracture 214 or the second in frequency after nasal fractures. Fracture zygoma and its management our experience core. The stability of the reduction determines the type and number of fixation sites.
Management of zygomaticmaxillary fracture the principles of. The patients hair was shaven for clarity and for proper marking of key anatomic landmarks. Untreated fractures may cause a cosmetic deformity flattening of the cheek or limited mandibular movement caused by the depressed zygoma impinging on the. For many years, 2point fixation at the frontozygomatic suture and the infraorbital rim using interosseus wiring was the mainstay for treating zygoma fractures. The incidence, cause, age, and gender predilection of zygomatic. By virtue of its attachments to adjacent bones, the zygoma forms the lateral wall and floor of the orbital cavity and the roof and lateral. Concerning the zygomatic arch, the left side was involved in 43 cases 48% and the right side in 47 cases 52%.
Spitz ja, bradford p, hwang l, ellis mf 2018 surgical management of zygoma fractures in patients with preinjury facial asymmetry. This study was conducted to address this particular aspect in the management of fractures of zygoma, so as to formulate an operative strategy that will achieve the sur gical objective of stable fixation while minimizing the morbidity of the procedure. The zygomatic arch, a structure in the human skull formed primarily by parts of the zygomatic bone and the temporal bone. Treatment of zygomatic complex fractures with surgical or nonsurgical. Using free navigation reference points and prefabricated bone plates for zygoma fracture model surgeries tienhsiang wang1,2,4 hsu ma1,4 chingshiow tseng2 yihong chou3,4 kunlin cai2 received. Cheek bone fracture tx depends on the extent of the fracture. Zygoma arch fracture an overview sciencedirect topics. Jun 07, 20 zygoma plays an imp role in facial contour. This video documents the steps typically followed during open reduction of isolated, depressed zygomatic arch fractures. Zimmerer, in maxillofacial surgery third edition, 2017. Bilateral parasymphsial fracture, condylar fracture, fracture of zygoma, flattening of face, moderate bleeding and derranged occlusion are the main cautionary pointers of difficult airway. It affords an excellent opportunity to study fractures of the maxilla, maxillary sinuses, orbits, zygomatic bones and arches, and nasal bones. Trauma xray axial skeleton gallery 1 face zygomatic.
Materials and methods this pdf is available for free download from. Management of maxillofacial trauma is a challenging task for an anaesthesiologist. Doctor answers on symptoms, diagnosis, treatment, and more. Zygomatic fractures american academy of ophthalmology. It also forms the lateral wall and floor of the orbit, where the eye is located. Dec 03, 2018 the zygomatic bone occupies a prominent and important position in the facial skeleton. A zygoma fracture is often the result of facial trauma such as violence, falls or automobile accidents symptoms include flattening of the face, trismus reduced opening of the jaw and lateral subconjunctival hemorrhage see also. The operating methods for malarplasty can mainly fall into the following. If displaced fracture, a surgeon does the wiring of the bone, which can be an ent surgeon, a plastic surgeon or general surgeon. The need for 7 screws at the fz region was due to the gross comminution at that site. Zygomatic arch fracture treatment answers on healthtap. Diagnosis and management of common maxillofacial injuries in.
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