Management of midfacial fractures

Prospective blind comparative clinical study of two point fixation of zygomatic complex fracture using wire and mini plates

BACKGROUND

The zygomatic maxillary complex (ZMC) fractures are one of the most frequent injuries of the facial skeleton due to its position and facial contour. Assaults, road traffic accidents and falls are the principal etiologic factors that may cause fractures of zygomatic bone. The different fixation methods are applied to treat the zygomatic bone fractures, with many more classifications which have been described in the literature for the ease of management. The type of the fracture, its severity and associated facial fractures usually interferes the treatment modality.

PURPOSE OF STUDY

The aim of this paper is to show the results of 18yrs prospective blind comparative study using wire and plate osteosynthesis which needed open reduction and internal fixation involving Type II to Type IV Spissel and Schroll ZMC fractures.

MATERIALS AND METHODS

Total 80 cases included in the study out of 1780 ZMC cases which were treated using wire and plate osteosynthesis over a period of 18 yrs, involving only Type II to Type IV Spissel and Schroll ZMC fractures. Other types excluded from study to prevent observer bias. All the fixations carried out through Standard Dingman's incision using stainless steel 26 gauze wire and titanium 1.5 mm mini plate system under general anesthesia by single maxillofacial surgeon and evaluated by another maxillofacial surgeon who is blinded for surgical procedure after 2 and 4 wks of follow-up for facial symmetry, wound healing, functional assessment (mouth opening, diplopia), and sensory disturbance. All the data tabulated in Excel software (Microsoft) for statistical analysis. P-value calculated to know the Significance of treatment modality in all aspects.

RESULTS

Result shows no significant p-values indicating both the operating techniques are equally efficient in the surgical management of ZMC fracture.

CONCLUSION

Osteosynthesis by mini plates is simple, logical and effective treatment compared to wire osteosynthesis in regard to stability of fracture fragments. Wire osteosynthesis will be helpful in emergency surgeries or where the mini plates are not available. Even though the wire osteosynthesis is economical compared to mini plate fixation; but the time and skill is required for fixation of wires.

Treatment of isolated lateral midface fractures

In the management of recent fractures of the zygomatic bone and arch we prefer transcutaneous repositioning with a sharp hook. If additional fixation is necessary, wire sutures are used. The advantages of osteosynthesis with wire suturing and the treatment of simultaneous fracture of the orbital floor are presented and discussed.

Fractures of the orbital floor: indications for exploration and for the use of a floor implant

Fractures of the orbital floor are frequently treated by exploratory surgery and by the insertion of a floor implant, because of the possibility of late diplopia and enophthalmos. The findings of this study would suggest that this fear is not justified and that there is no indication for an early diagnostic exploration of the fractured orbital floor, if there are no clinical or radiological signs of orbital floor fracture within 14 days of the accident. The significance of the status of the periorbita in the method of treatment of the fractured orbital floor is stressed. The suggestion is made, contrary to what is generally found in the literature, that a linear or a comminuted floor fracture and an orbital floor with a defect do not require a floor implant, if the periorbita is intact.