Fractures of the zygomatic complex in Nigerian patients

A survey of 337 Nigerian patients with fractures of the zygomatic complex disclosed that almost 96% involved males, more than 80% were between 21 and 40 years old, and 82.2% were caused by traffic accidents. The incidence of fractures caused by traffic accidents, falls, and sports was not significantly higher on the left side of the face than on the right, but those resulting from fights occurred significantly more often on the left side of the face. The highest incidence of fractures occurred during the rainy season and the month of December. Delay in reporting for treatment contributed considerably to the problems of management and to complications. About 47% of the patients required no active treatment, whereas approximately 41% had simple elevation; the overall complication rate was 8.9%.

Facial fractures. A review of 368 cases

The medical records of 368 patients, hospitalized for facial fractures, were analyzed according to sex, age, etiology, etc. To get the long-term results, the patients were given a questionnaire which was answered by 271 patients (73.6%). In the total material there is an overrepresentation for younger males and the main reasons for the fractures are traffic accidents (34.8%) and fights (27.1%). The most common fracture is the zygomaticomaxillary one (202 cases), followed by the fractures of the mandible (121 cases). The results 1 week postoperatively were good from a clinical point of view. The results from the X-ray examination with its exact demands were poorer. This discrepancy is discussed. The questionnaire covers a postoperative period of 6--99 months. Altogether, 40.1% of the patients operated on and 57.1% of those not operated on were satisfied and considered themselves as good as before the lesion. The results improve in the course of time, especially the functional ones. The reactivation of the function in the infraorbital nerve seems to be a more drawn-out process than previously supposed.

The initial evaluation in maxillofacial trauma

Evaluation in maxillofacial trauma is primarily an extension of the art of the physical examination, with inspection, palpation, and evaluation of loss of normal function as the primary requisites. X-ray evaluation is critical, and best results are usually obtained by taking films as soon following the injury as possible, before opacification of the sinus with blood, swelling, or hematoma obscures critical bone landmarks. Primary reduction and surgical management of these fractures can usually be delayed for a reasonable period; however, the most accurate findings on both physical examination and x-ray studies are those obtained as soon as possible after the injury.

The reduction of zygomatic fractures using a straight mouth gag

A technique is described for the elevation of depressed fractures of the zygoma using the straight mouth gag of Terrier, which is especially suitable for treatment of partly healed fractures.

Significance of the orbital floor in zygomatic injuries

Fifty years after the publication of Harold Gillies' work, an assessment of zygomatic injuries is made, in the light of a half century of medical advances. Recent experience suggests that the fractured orbital floor is the commonest and most significant component of all zygomatic injuries. Exploration of 582 floors in the last 5 years revealed that over 20% had true blowout fractures, without damage to the orbital rim. A further 5% had torn periosteum with only minimal bony damage. Only two cases (0.3%) had fractures of the rim without a blown-out floor. The significance of floor damage is considered. This is usually more severe than expected. Even minimal damage--torn periosteum alone--may be followed by severe late sequelae, out of proportion to the magnitude of the apparent injury. If such sequelae develop late, their relationship to the injury is not suspected. The related soft tissues are very vulnerable. Vigorous manipulation of the malar (or maxilla in LeFort II injuries) does as much damage to them, as did the original trauma. Our therapy should be designed to protect these tissues during necessary manipulation.

Resorption of the zygomatic arch after elevation of a depressed fracture and subsequent osteomyelitis: report of case

A case of osteomyelitis of the zygomatic arch with complete resorption has been presented. The cause of osteomyelitis of the facial bones was discussed. Infection of the soft tissue after intraoral elevation of fractured zygomas does occur, but rarely leads to osteomyelitis and subsequent bony resorption of the underlying bone. Antibiotics have reduced the incidence of osteomyelitic infections in the past 20 years; however, a vigorous regimen of preoperative and postoperative attention to aseptic technique, proper antibiotics, and close follow-up is required to control these problems.

Upper buccal sulcus approach to reduction of zygomatic fractures

Thirty selected patients with simple zygoma fractures over a 15-year period have been treated by elevation and reduction with the use of a zymgomatic elevator from an intraoral upper buccal sulcus approach. No patient suffered a recurrence of the fracture of deformity or required an open reduction. This little publicized procedure is easy, fast, and effective in carefully chosen cases of zygoma and zygomatic arch fractures in the first 72-96 hours postinjury. It should be considered by the surgeon along with the more complex procedures.

[Metal plate osteosynthesis and wire osteosynthesis for the treatment of periorbital fractures in an experimental study]

With consideration of the special situation in periorbital fractures, the fundamental differences between wire and metal plast osteosynthesis was demonstrated on the basis of mathematical calculations, mechanical considerations and tension optical experiments. We further report on the different behaviour of both methods of osteosynthesis in tension experiments which demonstrate the distinct superiority of the metal plate.

Management of facial fractures

Maxillofacial fractures are usually diagnosed easily by history, clinical findings, and standard roentgenograms. Emergency treatment centers around airway management; the conscious patient should be allowed to clear his own airway whenever possible. Treatment of lower and upper jaw fractures focuses on reducing the fragments so that dental occlusion is normal. Other midface fracture reductions require additional exact orbital rim alignment. Immobilization of fractures can require various combinations of intermaxillary fixation, interosseous wiring, suspensory wires from intraoral arch bars, transfacial Kirschner wires, occasional maxillary antral packs, and rare external fixation with headframes or external pins. Patients who may be comatose or seriously ill for several weeks should have a simple and safe compromise reduction and K-wire fixation done at the bedside. Management of blow-out fractures of the orbit and frontal sinus fractures is somewhat controversial. Naso-orbital central factial fractures are especially difficult to maintain in proper reduction. Listed are possible late postoperative complications after treatment of facial fractures.

[Late reconstruction of the orbital floor and zygomatic prominence with a readily vascularized plastic]

An implant made from a new artificial substance "Proplast" consisting of polytetrafluoroethylene and carbon is suitable for the secondary treatment of fractures of the orbital floor and zygoma. Histomorphological studies in animal experiments show rapid vascularisation and tissue ingrowth, which lead to permanent fixation of the implant. Clinical experiments confirm its suitability for the correction of displacement of the eyeball and enophthalmos as well as in the re-establishment of the zygomatic arch. For cosmetic reasons a new operative approach through a combined cantho-conjunctival incision is recommended.