Fractures of the zygomatic complex in the south-east region of Scotland

Evaluation of one-point fixation for zygomaticomaxillary complex fractures using a three-dimensional photogrammetric analysis

BACKGROUND

The goal of treatment for zygomaticomaxillary (ZM) complex (ZMC) fractures is to achieve stability and restore aesthetic appearance through three-dimensional reduction and rigid fixation. The purpose of this study was to evaluate the stability and aesthetic appearance outcomes of one-point fixation using a three-dimensional photogrammetric analysis.

METHODS

From March 2014 to December 2014, 34 patients with ZMC fractures were treated by one-point fixation in the ZM buttress using unsintered hydroxyapatite (u-HA)/poly-L-lactide (PLLA) plates. Differences in soft tissue inter-malar height between the fractured side and unfractured sides were evaluated using photogrammetric analysis with a three-dimensional camera (Morphius®) at the preoperative and 1 week, 1 and 3 months after surgery. The differences in bony inter-malar height between the fractured and unfractured sides were evaluated using computer tomography at the pre-operative and 6 months after surgery. The paired t-test was used to compare differences in malar height.

RESULTS

Six months after surgery, 34 patients achieved satisfactory bony stability and symmetric malar appearances. Comparisons of differences in soft-tissue inter-malar height revealed statistically significant differences between the pre-operative period and 1 week and 1 month after surgery (p < .01). There was no statistically significant difference between 1 and 3 months after surgery. Comparison of differences in bony inter-malar height revealed a statistically significant difference between before and 6 months after surgery (p < .01).

CONCLUSIONS

When we conducted a three-dimensional photogrammetric analysis, although it has restricted surgical indications, one-point fixation of the ZM buttress using an u-HA / PLLA plate yielded reliable, satisfactory, and safe clinical results in patients with ZMC fractures.

CLINICAL QUESTION / LEVEL OF EVIDENCE

Therapeutic, III.

Zygomaticomaxillary Complex Fractures: A Review of 101 Cases

AIM

ZMC fractures are the common facial injuries. The main causes of fractures are trauma due to RTAs, assaults, falls, sports related injuries, and the civilian warfares. This study is to evaluate and review the etiology, incidence, clinical findings and treatment of ZMC fractures. A sincere effort has been put forward in the management of ZMC fractures and their efficacy is evaluated in the larger interest of the patients.

MATERIALS AND METHODS

In this study 101 patients having displaced ZMC fractures with insignificant medical history were reviewed to evaluate the versatility of its management, with the main emphasis on post operative stability, restoration of mouth opening, wound healing, esthetic restoration of the prominence of cheek and the complications encountered.

RESULTS

A total of 101 patients were reviewed for the management of ZMC fractures. All the cases included were managed during the period from August 2007 to August 2009 in the Department of Oral and Maxillofacial Surgery, Mamata Dental College and Hospital, Khammam. The extremes of ages in this study ranged from 17 to 60 years with the mean of 43. RTA was the most common cause of injury. Seventy-eight patients (77 %) were managed with surgical treatment.

CONCLUSION

Attention should be paid to improvement in automobile safety devices and compliance by motor vehicle occupants in addition to the improvement of the rules and regulations in sporting activities.

Surgical treatment of zygomatic bone fracture using two points fixation versus three point fixation--a randomised prospective clinical trial

BACKGROUND

The zygoma plays an important role in the facial contour for both cosmetic and functional reasons; therefore zygomatic bone injuries should be properly diagnosed and adequately treated. Comparison of various surgical approaches and their complications can only be done objectively using outcome measurements which in turn require protocol management and long-term follow up. The preference for open reduction and internal fixation of zygomatic fractures at three points has continued to grow in response to observations of inadequate results from two point and one point fixation techniques.The objectives of this study were to compare the efficacy of zygomatic bone after treatment with ORIF using 2 point fixation and ORIF using 3 point fixation and compare the outcome of two procedures.

METHODS

100 patients were randomly divided equally into two groups. In group A, 50 patients were treated by ORIF using two point fixation by miniplates and in group B, 50 patients were treated by ORIF using three point fixation by miniplates. They were evaluated for their complications during and after surgery with their advantages and disadvantages and the difference between the two groups was observed.

RESULTS

A total of 100 fractures were sustained. We found that postoperative complication like decreased malar height and vertical dystopia was more common in those patients who were treated by two point fixation than those who were treated with three point fixation.

CONCLUSIONS

Based on this study open reduction and internal fixation using three point fixation by miniplates is the best available method for the treatment zygomatic bone fractures.

A Retrospective Analysis of 101 Zygomatico-Orbital Fractures

A 5-year review of 101 cases of zygomatico-orbital fractures is presented. The epidemiology, fracture patterns, treatment modalities, and complications were evaluated in this retrospective study. A majority of fractures were sustained by males and resulted from trauma inflicted during altercations and traffic accidents. The most common fracture pattern was tripod fracture and the most common associated facial fractures were mandibular fractures. Open reduction and rigid fixation was the most frequently employed treatment modality. Depending on the stability of reduced zygoma, one, two and three-point fixations were applied. Orbital floor exploration was performed in 41 cases. Ten out of 16 orbital floor bone defects required reconstruction. In these cases orbital floor was reconstructed with 1.5-mm porous polyethylene implant. Although we encountered a few complications related to the incisions for open reduction, the rate of complication in which correction was difficult (e.g. facial asymmetry) was lower with this approach when compared with the literature.

Zygomatic complex fractures in a suburban Nigerian population

A retrospective analysis of 128 zygomatic complex fractures was undertaken. There were 109 males (85.2%) and 19 females (14.8%), aged 3-74 years (mean +/- SD, 33 +/- 12.6 years). Patients in the third decade of life (38.3%) recorded the highest incidence. Road traffic accidents (74.2%) mainly from automobile (61.7%) and motorcycle (9.4%) involvement were the predominant etiology. While 38.8% of them presented within the first 24 h, males were relatively earlier than their female counterparts, although this was not statistically significant (P > 0.05). Class 3 fractures were the commonest (50%), followed by classes 2 (zygomatic arch) and 4, respectively. Most class 6 fractures (6.3%) resulted from gunshot injuries. There were 116 unilateral (left 63, right 53) and 12 bilateral fractures with the right side of the face recording more zygomatic arch fractures. In addition, statistical significance was observed between etiology, class and type of fracture (P < 0.05). One hundred and twenty-four (136 fractures) patients were available for treatment as four declined. Twelve cases did not require treatment while others were managed by either closed or open reduction under general anesthesia. Gillies' temporal approach was the commonest (57.1%) surgical technique employed. However the unstable nature of the fractures necessitated open reduction and transosseous wiring in 33 cases. The high prevalence of zygomatic complex fractures arising from vehicular accidents reflects the poor status of the road network in rural and suburban Nigerian communities. Hence government should improve on existing infrastructures, decongest the highways and enforce traffic laws amongst road users. In addition, the need to encourage massive investments in safer alternative transport systems is emphasized.

Fractured zygomas

BACKGROUND

The purpose of this paper is to provide a review, based on collected data, on the topic of "fractured zygoma". The review is presented under the headings of epidemiology, fracture patterns, treatment modalities and complications. Throughout the paper comparison is made with published data from around the world.

METHODS

A 10-year retrospective audit was undertaken of all hospitalized patients, at the Royal Hobart Hospital, Tasmania, who had sustained a fractured zygoma. All Le Fort fractures involving the zygoma were excluded.

RESULTS

A total of 263 fractures was sustained, largely due to assault. Alcohol was a significant contributing factor. Tetrapod fractures were the most frequent type of fractures witnessed. Plating was the most frequently employed fixation. Inferior orbital nerve dysfunction and other complications were seen in 24.6% and 20.7% of follow-up cases, respectively. Open reductions were nearly 4 times more likely to be accompanied by complications if inferior orbital nerve dysfunction was excluded.

CONCLUSIONS

Both closed and open reductions are good treatment modalities and were used in near equal numbers of patients. There is a higher incidence of postoperative facial deformity in the closed reduction group, but more complications related to the incisions in the open reduction group. Open reduction and internal fixation is advocated for the unstable, markedly displaced or comminuted fractures. Silastic sheeting is a favoured graft for repair of the associated orbital floor defects and is associated with few complications.

Fractures of facial bones in benghazi

Four hundred and thirty three patients with various types of fractures of facial bones were studied and analysed together with statistics related to the etiology, site, age and sex. Sixty per cent of the cases were below 30 years of age. The male to female ratio was 5.5:1.

Sixty four per cent had fracture of the mandible alone, with fracture of the body of the mandible accounting for a quarter of the total number of cases. Only twenty per cent had fractures of the middle third of the face.

Injuries from road traffic accidents were the major causes of fractures in 258 patients (59.6%), followed by fights in 99 cases (22.9%) and falls in 69 cases (16%).

Pattern, severity and aetiology of injuries in victims of assault

Although the incidence of assault and other violent crime is increasing in the UK, the cause and overall pattern of injury, and the need for admission have not been defined in adult victims who attend hospital. In a prospective study, all 539 adult victims of assault attending a major city centre Accident & Emergency department in 1986 were therefore interviewed and examined. Facial injury was extremely common: 83% of all fractures, 66% of all lacerations and 53% of all haematomas were facial. The upper limb was the next most common site of injury (14% of all injuries). Twenty-six per cent of victims sustained at least one fracture and nasal fractures were the most frequently observed skeletal injuries (27%) followed by zygomatic fractures (22%) and mandibular body (12%), angle (12%) and condyle (9%) fractures. Seventeen per cent of victims required hospital admission. Overall, the type of injury observed correlated with the alleged weapon used (P = less than 0.001) though 20% of victims who reported attacks with sharp weapons sustained only haematomas or fractures. Injury most often resulted from punching (72% of assaults) or kicking (42% of assaults). Only 6% of victims reported injury with knives but 11% were injured by broken drinking glasses. Those who were kicked were most likely to need hospital admission.

Surgical, socio-economic and forensic aspects of assault: a review

The incidence of violent crime is increasing and assault is now the most frequent cause of maxillofacial trauma to patients seen at many British Hospitals. Many victims have exclusively facial injuries. Though these are often minor compared to those from other causes, they are important signs of underlying social pathology. Oral and maxillofacial surgeons should understand the aetiology and social background of racial and other innercity violence, family violence and football hooliganism, particularly in relation to alcohol and unemployment. Surgical records are accurate, but largely untapped sources of information concerning violent crime.

Sports-related maxillofacial fractures in a hospital material

Sports-related maxillofacial fractures were analysed in 80 patients, accounting for 5.6% of all patients with facial bone fractures, treated during the 5-year period 1981-1985. 55% of the patients had 1 or more mandibular fractures and 45% had midface fractures. 6% of the patients had multiple injuries. The most common causes of injury were collision and fall. Soccer and ice hockey turned out to be the most hazardous sports, although sports-related maxillofacial fractures were less severe than those related to other causes. The need for oral and facial protection among athletes involved in contact sports is discussed.

Assault and facial soft tissue injuries

A hypothesis that facial wounds are the most common soft tissue injuries resulting from assault has been tested by examining the records of 225 consecutive victims of assault (169 males, median age 22 years; 56 females, median age 24 years) attending the Accident and Emergency Department of the Bristol Royal Infirmary during 1984/85. Demographic factors including age and sex of patients and time, day and month of attendance were recorded. Results supported the hypothesis but significantly more men (72%) than women (57%) had facial injuries (chi 2 = 12.2, p = less than 0.01). Chest, abdominal and limb injuries were proportionately more frequent in women (p = less than 0.001). Middle third wounds were the commonest facial injuries (affecting 59% of patients) followed by upper third (25%) and lower third (16%). Left-sided facial injury was more common than right-sided (chi 2 = 14.6; p = less than 0.01). Young adult males most commonly attended, but very few elderly patients. "Risk" of assault appeared highest at weekends, between 10 pm and 2 am and between July and October. The involvement of plastic and oral surgeons in the treatment of assault victims is likely to be considerable.

Morbidity associated with the use of antral packs and external pins in the treatment of the unstable fracture of the zygomatic complex

One hundred and forty-seven patients with unstable fractures of the zygoma are discussed. Complications encountered during the treatment of such patients with antral packs and external pins are compared. These results are evaluated.

Aetiology and incidence of facial fractures in adults

The incidence, aetiology and trends in fractures of the facial bones occurring in the years 1965, 1970, 1975 and 1980 in the Grampian Region of Scotland are reported. A 2.7 fold increase in incidence occurred during this period. Males are seen to be most at risk and an increase in assault and sports-related trauma is seen. Offshore oil exploration developed during this period and its effects are discussed. Attention is drawn to the differences in the aetiology of right and left malar fractures.