Treatment of zygomatic fractures: internal wiring-antral-packing-reposition without fixation

Fifty-two patients with zygomatic fractures were examined clinically and roentgenologically 1 to 4 years after treatment. Of these patients, 15 were treated with wiring fixation, 26 with antral packing using plastic tubing, and 11 with reduction only, without fixation. In the last group, the hospital stay was the shortest. These patients had also less complications and roentgenological changes when compared with the other groups. This was considered to be due to the fact that fractures not requiring fixation are initially less difficult than fractures requiring other treatment. At clinical examination, internal wiring fixation proved to be better than antral packing when hospital stay, restoration of the function of the infra-orbital nerve, the position of the eye, symmetry of the palpebral fissure and the final cosmetic results are considered. In the antral packing group, the result was better when jaw movements and occurrence of permanent diplopia were compared. The roentgenological examination revealed that the reduction results were more exact with internal fixation than with antral packing.

The immediate care of eye injuries

The various types of injury which may occur to the eye are described. These may be easily missed altogether, or their extent not realised, unless great care and vigilance is exercised by those who first see the patient. Emphasis has been placed on the immediate care required and the urgency with which the different categories of injury must be referred to a specialist.

[Mini-plate osteosynthesis on the zygoma]

A method is described in which the principles of plate oseosynthesis at the zygoma are applied in the region of the zygomatico-frontal suture. A mini-plate in line with the spheric gliding principle of Arbeitsgemeinschaft für Osteosynthese is applied at the zygomatico-frontal suture after repositioning by means of a hook. The miniature plate enables screwing of the fragments and stabilization of the zygoma with regard to the possible direction of dislocation.