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Gong J, Zhao R, Zhang W, Li J, Yuan Z, Ma D. Role of Intraoperative Imaging in Improving Closed Reduction of Zygomatic Arch Fractures: A Systematic Review and Meta-analysis. J Oral Maxillofac Surg 2023; 81:1504-1516. [PMID: 37775088 DOI: 10.1016/j.joms.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/08/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE The use of intraoperative imaging (IOI) to improve the reduction adequacy of zygomatic arch (ZMA) fractures has been reported, but few systematic reviews have examined this topic. The aim of this review was to investigate and compare the value of IOI with conventional methods without IOI (N-IOI) for the closed reduction of ZMA fractures. METHODS Electronic retrieval of MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, and citation search until December 2, 2022, was used to identify controlled clinical trials that employed IOI for improving adequacy in closed reduction of ZMA fractures. The predictor variable was the use of IOI-yes/no (IOI vs N-IOI). The covariates included imaging technique (ultrasound, C-arm, and cone beam computed tomography) and ZMA fracture type (M-shape fracture, mechanistic force in 1 direction; variable fracture, mechanistic force in 2 directions). The primary outcome variables were the reduction adequacy of ZMA fractures (the remaining cortical step and dislocation angle) compared with the ideal mirrored position. Weighted or mean differences, risk ratios, and corresponding 95% confidence intervals were calculated, where P >.05 and I2<50% fixed effect model was adopted, and a vice versa random effect model was adopted. RESULTS A total of 1250 studies were identified, of which 6 studies with 259 participants were included. The meta-analysis results indicated that compared with N-IOI, IOI yielded fewer cortical steps (-1.76 [-2.42, 1.10], P <.00001, fixed model) and dislocation angles (-5.60 [-8.08, 3.12], P<.00001, fixed model) in patients with variable ZMA fractures, while no significant difference was detected in the M-shape ZMA fracture (-0.72, [-2.93, 1.48], P = .52; -1.48, [-3.51, 0.55], P = .15). Although there was no significant difference in postoperative correction (0.35, [0.06, 2.01] P = .24, fixed model), all secondary revision cases occurred in the N-IOI group. Descriptive analysis showed that IOI yielded better symmetry and appearance satisfaction. CONCLUSION IOI improved the adequacy of the procedure and led to a better postoperative appearance, especially for patients with variable ZMA fractures. Furthermore, the use of IOI avoided the risk of secondary surgery. In future studies, researchers should standardize the scale and outcomes to facilitate the intuitive evaluation of reduction adequacy.
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Affiliation(s)
- Jiaming Gong
- Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; Department of Stomatology, Quzhou Hospital Affiliated to Wenzhou Medical University, PR China
| | - Ruimin Zhao
- Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; Department of Stomatology, Quzhou Hospital Affiliated to Wenzhou Medical University, PR China
| | - Wenlong Zhang
- Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; School of Stomatology, Lanzhou University, Lanzhou City, PR China
| | - Jianxue Li
- Department of Stomatology, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China
| | - Zhenfei Yuan
- Department of Stomatology, Quzhou Hospital Affiliated to Wenzhou Medical University, PR China
| | - Dongyang Ma
- Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; School of Stomatology, Lanzhou University, Lanzhou City, PR China.
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Nseir S, Frid H, Shilo D, Capucha T, Emodi O, Rachmiel A. THE RELATIONSHIP BETWEEN MORPHOMETRIC MEASURMENTS, SEVERITY AND SUCCESS OF ZYGOMATIC ARCH FRACTURE REDUCTION. J Oral Maxillofac Surg 2022; 80:1371-1381. [DOI: 10.1016/j.joms.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/02/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
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Nseir S, Frid H, Shilo D, Capucha T, Emodi O, Rachmiel A. The Relationship Between Morphometric Measurments, Severity and Success of Zygomatic Arch Fracture Reduction. J Oral Maxillofac Surg 2021:S0278-2391(21)01122-8. [PMID: 34656509 DOI: 10.1016/j.joms.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Zygomatic arch fractures are commonly treated by closed reduction. This kind of treatment is highly influenced by the treating surgeon and type of fracture. Thus, it is important to choose the optimal treatment for different fractures. Current treatment schemes for zygomatic arch fractures reduction are based on subjective assessments. We believe this approach should be refined. Create a new treatment algorithm for the solitary and combined zygomatic arch fractures based on radiological morphometric measurements. This will assist the clinician in tailoring a suitable treatment for each case and avoiding pitfalls, thus achieving best possible results. METHODS A total of 179 radiologic images of patients treated in our department for zygomatic arch fractures were morphometrically measured and analyzed. RESULTS Three variables showed a capacity to predict a large remaining defect; The presence of a preoperative esthetic defect and a large initial latero-lateral (LL) defect reduced the probability of a large remaining defect (OR = 0.289, P= .019; (OR = 0.78, P= .008; respectively). Patients with initial LL defect < 3.5 mm presented postoperative residual defect 3-times greater than patients with initial LL defect > 3.5 mm A large antero-posterior telescoping increased the probability of a large remaining defect (OR = 1.27 P= .003). Cases that had antero-posterior telescoping > 1.45 mm had a 72.4% probability of remaining with a poor residual defect > 84.1% (P= .003). CONCLUSIONS Based on our results we believe that the use of morphometric measurements is important when assessing zygomatic arch fractures. We found that there are measurements that can be used to predict esthetic and functional defects, as well as probability of resolving them. Morphometric measurements can be used to predict the reduction difficulty and can assist the clinician in choosing the optimal reduction method and thus increasing the success rate.
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Affiliation(s)
- Saleh Nseir
- Senior Surgeon, Department of Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel
| | - Hanna Frid
- Resident, Department of Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel.
| | - Dekel Shilo
- Senior Surgeon, Department of Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tal Capucha
- Resident, Department of Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Omri Emodi
- Deputy Head, Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Haifa, Israel and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Adi Rachmiel
- Department Head, Department of Oral and Maxillofacial Surgery, Rambam Medical Care Center, Haifa, Israel, and Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Giudice A, Cristofaro MG, De Cicco D, Barca I, Dell'Aversana Orabona G, Califano L. Percutaneous Reduction of Isolated Zygomatic Arch Fractures: A 5-Year Experience. J Oral Maxillofac Surg 2020; 78:973-978. [PMID: 32171599 DOI: 10.1016/j.joms.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE We evaluated the outcomes and differences in surgical time and hospitalization length for patients with an isolated zygomatic arch (ZA) fracture treated by percutaneous wire reduction with external fixation. PATIENTS AND METHODS We designed and developed a retrospective study of patients with isolated ZA fractures treated from 2014 to 2019. The predictor variable was the operative treatment, represented by percutaneous reduction with external fixation. The primary outcome variables were the surgical time and hospitalization length. Other variables, including functional and esthetic results (evaluated by clinical and radiologic assessments) and the rate of immediate and delayed complications during a 6-month minimum follow-up period, were considered. Descriptive statistics were computed and compared with the international reported data. RESULTS A total of 15 patients met specific inclusion and exclusion criteria. The 15 fractures were grouped using the classification reported by Kim et al as type 1A (n = 9) and type 1B (n = 6). No significant differences were found between the 2 groups, except for the fracture type. The operative treatment was performed with the patient under general anesthesia (n = 12) or local anesthesia with sedation (n = 3). Only 1 patient developed a complication (early hematoma). No other cases of early or delayed complications were reported. Two patients required a traditional surgical operation with the Gilles approach. The average hospitalization length and surgical time were 0.8 night and 18.4 minutes for the type 1A group and 0.7 night and 19.0 minutes for the type 1B group, respectively. Optimal esthetic and functional outcomes were obtained for all 15 patients. CONCLUSIONS The results of the present study suggest that optimal esthetic and functional results can be obtained, minimizing the effect on soft tissues and patient discomfort, with a short surgical time and low rate of complications.
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Affiliation(s)
- Amerigo Giudice
- Professor, Università degli Studi di Catanzaro "Magna Graecia", Catanzaro, Italy
| | | | - Davide De Cicco
- Resident, Department of Maxillofacial Surgery, Università degli Studi Federico II di Napoli, Naples, Italy
| | - Ida Barca
- Physician, Maxillofacial Surgery Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Giovanni Dell'Aversana Orabona
- Professor, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Università degli Studi Federico II di Napoli, Naples, Italy.
| | - Luigi Califano
- Head, Maxillofacial Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Sciences, Università degli Studi Federico II di Napoli, Naples, Italy
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Johner JP, Wiedemeier D, Hingsammer L, Gander T, Blumer M, Wagner ME. Improved Results in Closed Reduction of Zygomatic Arch Fractures by the Use of Intraoperative Cone-Beam Computed Tomography Imaging. J Oral Maxillofac Surg 2020; 78:414-422. [DOI: 10.1016/j.joms.2019.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
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Cinal H, Barin EZ, Çakmak MA, Kara M, Yilmaz K, Tan O. Novel Surgical Technique for Repair of Zygomatic Fractures: Lever Technique. Plast Surg (Oakv) 2019; 27:135-140. [PMID: 31106171 DOI: 10.1177/2292550319828791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Zygoma is a very crucial component for the anteroposterior positioning of the midface and for the maintenance of facial contours. Zygomatic fractures are considered as the second most common type of facial fractures following nasal fractures. We have developed a new reduction technique called "lever," which is based on the application of lifting force as an alternative to the methods in which the pulling force is applied. Patients Over a 12-year period, 90 patients were treated with minimal access approach and 130 patients were treated with open reduction internal fixation (ORIF), using the lever technique. Results In the follow-up period, no complications occurred in any of the patients who underwent minimal access approach. Miniplate removal operation was performed in 3 of the patients. Enophthalmos developed in one patient. Since 4 of the 7 suboptimal reduction patients did not experience any functional or cosmetic problems, no treatment was necessary and the remaining 3 patients underwent fat graft due to the presence of malar depression. Conclusion This minimally invasive surgical procedure we have developed can be successfully used both in the minimal access approach and in ORIF, especially in delayed cases. We recommend this method due to the reasons that it is safe to conduct, easy to learn, fast to apply, simple to perform, and also economical to deploy.
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Affiliation(s)
- Hakan Cinal
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Ensar Zafer Barin
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Mehmet Akif Çakmak
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Murat Kara
- Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Kerem Yilmaz
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Onder Tan
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
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Pedemonte C, Sáez F, Vargas I, González E, Canales M, Lazo D, Pérez H. C-arm as intraoperative control in reduction of isolated zygomatic arch fractures: a randomized clinical trial. Oral Maxillofac Surg 2016; 20:79-83. [PMID: 26546376 DOI: 10.1007/s10006-015-0531-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/26/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Isolated zygomatic arch fractures (IZAFs) are habitually reduced at a distance, via a temporal approach. Open reductions are not recommended due to the associated morbidity and complications. However, performing closed reductions makes it difficult to determine whether it was done satisfactorily. This study aims to determine whether the acquisition of intraoperative images with a C-arm to evaluate IZAF reductions is a useful technique in treating such fractures. METHODS Our hypothesis is that acquiring intraoperative images with a C-arm reduces the need for a second surgery. Between 2009 and 2012, 50 patients who were diagnosed with IZAF requiring surgery were randomly distributed into two groups: 25 patients were in the experimental group, where fracture reduction was performed and immediately corroborated intraoperatively for an adequate result using a C-arm, and 25 patients were assigned to a control group where the fracture reduction was controlled with post-surgery imaging. RESULTS The results did not reveal significant differences between both groups (p = 0.5). Nevertheless, the experimental group had the advantage of being able to immediately reduce the fracture again if the result was unsatisfactory. CONCLUSIONS Despite the fact that the results are not statistically significant (p = 0.5), the authors recommend undertaking an intraoperative imaging analysis in areas where we are not certain of the reduction.
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Affiliation(s)
- Christian Pedemonte
- Department of Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C, Av Libertador Bernardo O'Higgins, 4848, Santiago de Chile, Chile.
| | - Felipe Sáez
- Department of Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C, Av Libertador Bernardo O'Higgins, 4848, Santiago de Chile, Chile
| | - Ilich Vargas
- Department of Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C, Av Libertador Bernardo O'Higgins, 4848, Santiago de Chile, Chile
| | - Edgardo González
- Department of Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C, Av Libertador Bernardo O'Higgins, 4848, Santiago de Chile, Chile
| | - Marco Canales
- Department of Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C, Av Libertador Bernardo O'Higgins, 4848, Santiago de Chile, Chile
| | - Diego Lazo
- Department of Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C, Av Libertador Bernardo O'Higgins, 4848, Santiago de Chile, Chile
| | - Hernán Pérez
- Department of Maxillofacial Surgery, Hospital Clínico Mutual de Seguridad C.Ch.C, Av Libertador Bernardo O'Higgins, 4848, Santiago de Chile, Chile
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Chuang J, Barnes C, Wong BJF. Overview of Facial Plastic Surgery and Current Developments. Surg J (N Y) 2016; 2:e17-e28. [PMID: 28824978 PMCID: PMC5553462 DOI: 10.1055/s-0036-1572360] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/05/2016] [Indexed: 11/01/2022] Open
Abstract
Facial plastic surgery is a multidisciplinary specialty largely driven by otolaryngology but includes oral maxillary surgery, dermatology, ophthalmology, and plastic surgery. It encompasses both reconstructive and cosmetic components. The scope of practice for facial plastic surgeons in the United States may include rhinoplasty, browlifts, blepharoplasty, facelifts, microvascular reconstruction of the head and neck, craniomaxillofacial trauma reconstruction, and correction of defects in the face after skin cancer resection. Facial plastic surgery also encompasses the use of injectable fillers, neural modulators (e.g., BOTOX Cosmetic, Allergan Pharmaceuticals, Westport, Ireland), lasers, and other devices aimed at rejuvenating skin. Facial plastic surgery is a constantly evolving field with continuing innovative advances in surgical techniques and cosmetic adjunctive technologies. This article aims to give an overview of the various procedures that encompass the field of facial plastic surgery and to highlight the recent advances and trends in procedures and surgical techniques.
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Affiliation(s)
- Jessica Chuang
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, California
| | - Christian Barnes
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, California.,Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, California
| | - Brian J F Wong
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, California.,Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, California
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Czerwinski M. C-arm assisted zygoma fracture repair: a critical analysis of the first 20 cases. J Oral Maxillofac Surg 2014; 73:692.e1-8. [PMID: 25661505 DOI: 10.1016/j.joms.2014.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 11/10/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Currently used open reduction and internal fixation techniques of zygoma fracture repair are not optimal. Surgical exposure of those sites needed to allow for accurate reduction and for rigid fixation has a high possibility of negative consequences. The objective of the present study was to present a single-incision, single-fixation site zygoma fracture repair technique using a single zygoma c-arm view to quantitatively determine its accuracy, complication rate, and practical aspects in a clinical series. MATERIALS AND METHODS In a prospective study, consecutive patients with isolated, unilateral, displaced zygoma fractures not requiring orbital floor exploration treated using a c-arm-assisted repair technique at the author's institution from 2009 to 2011 were included. Objective outcomes assessed included accuracy of zygoma realignment (on postoperative computed tomogram), ocular globe projection symmetry (using a Naugle exophthalmometer), complication rate, and operative duration. Statistical analysis was performed using the Student t test. RESULTS Twenty patients were included. Differences in zygoma projection, width, and height between the uninjured and repaired sides of the face were clinically noteworthy (>3 mm) in the first patient only. Average differences of these parameters for all 20 patients were clinically and statistically insignificant. Differences in ocular globe projection between the uninjured and repaired sides of the face for each patient were no greater than 2 mm. The average difference in globe projection for all 20 patients was also clinically and statistically insignificant. No major complications occurred, and the average operative duration was 76 minutes. CONCLUSIONS The present study shows that the c-arm-assisted zygoma fracture repair technique is accurate, has a low complication rate, can be performed quickly, and has a relatively low level of difficulty.
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Affiliation(s)
- Marcin Czerwinski
- Assistant Professor, Texas A&M University, Baylor Scott & White Health, Temple, TX.
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Shinohara A, Fujii K, Kazaoka Y, Yokoo K, Yamada S, Tanigawa T. Minimally invasive endoscopic osteosynthesis for frontozygomatic fracture: a new approach. MINIM INVASIV THER 2011; 21:125-8. [PMID: 21574827 DOI: 10.3109/13645706.2011.573796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Miniplate fixation on the lateral face of the orbital rim using existing endoscopic methods for frontozygomatic fracture still has some disadvantages, such as cosmetic disturbance from the lateral brow incision for the trocar, and abnormal palpability of the miniplate. We applied a new method of endoscopic osteosynthesis by access through temporal incisions alone and miniplate fixation on the lateral temporal face of the frontozygoma. Postoperative courses were uneventful in all four cases treated, and we achieved cosmetic improvement (minimizing incision and scars) as well as decreased palpability of the miniplate.
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Affiliation(s)
- Atsushi Shinohara
- Department of Oral & Maxillofacial Surgery, Aichi Medical University Hospital, Nagakute, Japan.
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Kharkar VR, Rudagi BM, Kini Y. Modification of the hemicoronal approach to treat fractures of the zygomatic complex. J Maxillofac Oral Surg 2010; 9:270-2. [PMID: 22190803 DOI: 10.1007/s12663-010-0032-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 07/03/2010] [Indexed: 10/18/2022] Open
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Xie L, Shao Y, Hu Y, Li H, Gao L, Hu H. Modification of surgical technique in isolated zygomatic arch fracture repair: seven case studies. Int J Oral Maxillofac Surg 2009; 38:1096-100. [DOI: 10.1016/j.ijom.2009.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 04/11/2009] [Accepted: 05/11/2009] [Indexed: 11/29/2022]
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Li WZ, Zhang MC, Li SP, Zhang LT, Huang Y. Application of computer-aided three-dimensional skull model with rapid prototyping technique in repair of zygomatico-orbito-maxillary complex fracture. Int J Med Robot 2009; 5:158-63. [PMID: 19280585 DOI: 10.1002/rcs.242] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND With the advent of CAD/CAM and rapid prototyping (RP), a technical revolution in oral and maxillofacial trauma was promoted to benefit treatment, repair of maxillofacial fractures and reconstruction of maxillofacial defects. METHODS For a patient with zygomatico-facial collapse deformity resulting from a zygomatico-orbito-maxillary complex (ZOMC) fracture, CT scan data were processed by using Mimics 10.0 for three-dimensional (3D) reconstruction. The reduction design was aided by 3D virtual imaging and the 3D skull model was reproduced using the RP technique. In line with the design by Mimics, presurgery was performed on the 3D skull model and the semi-coronal incision was taken for reduction of ZOMC fracture, based on the outcome from the presurgery. RESULTS Postoperative CT and images revealed significantly modified zygomatic collapse and zygomatic arch rise and well-modified facial symmetry. CONCLUSIONS The CAD/CAM and RP technique is a relatively useful tool that can assist surgeons with reconstruction of the maxillofacial skeleton, especially in repairs of ZOMC fracture.
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Affiliation(s)
- Wei Zhong Li
- Department of Oral and Maxillofacial Surgery, NanFang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
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Abstract
Endoscopic approaches to maxillofacial trauma have included their use in temporomandibular joint arthroscopy, zygomatic arch repair, repair after orbital trauma, repair of frontal sinus fractures, and finally in the repair of subcondylar mandibular fractures. These techniques provide exciting new options for the management of facial fractures. Many of the techniques provide a steep learning curve and require specialized equipment. The approach to an orbital blowout fracture allows the use of a Caldwell-Luc approach and the use of a naturally occurring body space (the maxillary sinus) for the visualization and maneuvering of the endoscope, tools, and implants. The use of the endoscope in the management of fractures for facial structures such as mandibular subcondylar fractures, which do not have a naturally occurring body cavity, may present greater challenges when trying to obtain visualization, reduction, and fixation. When used for the treatment of subcondylar fractures, wide exposure and the use of right-angled drills and screw drivers may significantly help with this procedure. This may be considered by some surgeons as an endoscopically "assisted" procedure that can possibly be accomplished with direct visualization and the use of dental mirrors. It remains to be seen as to whether some of these diverse endoscopic applications will represent the standard of care in the future or remain a specialized technique practiced by a minority of surgeons in a few specialized centers. This article reviews various endoscopic applications to maxillofacial trauma and discusses some of the controversies of these techniques.
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Czerwinski M, Ma S, Williams HB. Zygomatic arch deformation: an anatomic and clinical study. J Oral Maxillofac Surg 2008; 66:2322-9. [PMID: 18940500 DOI: 10.1016/j.joms.2008.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 01/03/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE Trauma to the zygomatic arch classically leads to 1 of 3 injury patterns: fracture with medial displacement, fracture with posterior telescoping, or explosive burst with lateral displacement. We identified an additional injury pattern whereby the arch undergoes significant bending in the axial plane without fracture. PATIENTS AND METHODS In the anatomical part of the study, computed tomography (CT) scans of patients with arch deformation without fracture were analyzed for location, degree, and type of arch bending. In the clinical part, patients were divided into "arch deformation without fracture" and "arch fracture" groups and their demographic characteristics compared. Three patients from each group, all treated with the Gillies' technique, underwent postoperative CT scanning to compare accuracy of zygoma repair. RESULTS Bending occurred most commonly in the middle and posterior thirds of the zygomatic arch, with average deformation of 11 degrees . Post-Gillies' repair, average residual arch deformation was 2 degrees . Patients with arch deformation without fracture were significantly younger than those with arch fracture (24 yrs vs 42 yrs, P < .05). Unlike patients with arch fractures, all those with arch bending treated with the Gillies' maneuver had near anatomic zygoma realignment. CONCLUSION Zygomatic arch deformation without fracture occurs in 19% of zygoma injuries in our group and is likely elastic in nature. We believe this injury pattern is important clinically as it may decrease the need for coronal exposure, facilitate anatomic repair, and provide stability without hardware fixation.
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Abstract
PURPOSE OF REVIEW Many of the successes and controversies in endoscopic management of craniofacial trauma are exemplified in the management of frontal sinus trauma. RECENT FINDINGS The effort to reduce surgical morbidity and to optimize reconstruction of craniomaxillofacial injuries has resulted in the development of less invasive surgical approaches and in the use of computer image guidance in surgical planning and execution. Minimally invasive management of frontal sinus inflammatory disease has gained wide acceptance. The technology and techniques applied to surgery of the floor of the frontal sinus is now being applied to the management of frontal sinus trauma. A paradigm shift in the treatment of frontal sinus trauma may be underway. SUMMARY An increasing scope of less severe injuries is being managed expectantly with endoscopic frontal sinus surgery available for salvage. There may be an overall decrease in the most severe frontal sinus injuries owing to enforcement of seatbelt and airbag usage. And the most severe injuries are often best managed through cranialization with anterior skull base reconstruction. Thus, the role for frontal sinus obliteration purely to obviate fractures of the frontal sinus outflow tract may be vanishing.
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Abstract
PURPOSE OF REVIEW Endoscopic applications in otolaryngology continue to expand, most recently in the area of maxillofacial trauma. Endoscopic management of orbital blow-out, frontal sinus, zygomatic arch, and subcondylar fractures has been described. This paper reviews the current literature including new techniques, indications, and outcomes in endoscopic management of facial fractures. RECENT FINDINGS Very few large studies of endoscopic fracture repair exist. The current literature, however, suggests that, when compared with an open approach, smaller endoscopic incisions result in reduced patient morbidity with similar outcomes. Dedicated endoscopic instrumentation and novel surgical approaches continue to be developed. SUMMARY Endoscopic repair of facial fractures is a new and evolving technique that offers the potential for reduced patient morbidity and operating time, as well as quicker patient recovery. Current applications include the management of orbital blow-out, frontal sinus, zygomatic arch, and subcondylar fractures. It should be emphasized that endoscopy augments, rather than replaces, the 'time tested' principles of adequate skeletal exposure, accurate fracture reduction, and appropriate internal fixation.
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Affiliation(s)
- Annette M Pham
- Department of Otolaryngology, University of California, Davis School of Medicine, Sacramento, 95817, USA
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18
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the common signs, symptoms, and treatment options for zygomatic fractures. 2. Answer basic questions on therapy for zygomatic fractures. SUMMARY This maintenance of certification article on zygomatic fractures attempts to review the current approaches to the treatment of these fractures. Although the article does not deal with extended approaches to treatment, it does in a general sense present the preoperative, intraoperative, and postoperative thinking for the plastic surgeon approaching these patients in general practice. A further in-depth review can be obtained through the references at the end of the article.
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