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Alshalah ME, Enezei HH, Aldaghir OM, Khalil AA, Aldelaimi TN, Al-Ani RM. Direct or Indirect Surgical Approach of Zygomatic Complex Fracture: A Comparative Study. J Craniofac Surg 2023; 34:2433-2436. [PMID: 37646342 DOI: 10.1097/scs.0000000000009712] [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: 04/17/2023] [Accepted: 06/29/2023] [Indexed: 09/01/2023] Open
Abstract
Zygoma is considered the main support of the midface. Zygoma is frequently fractured owing to its prominent site on the face. Treatment of zygomaticomaxillary complex fractures can be performed through either conservative or surgical measures (closed or open reduction). The study was a cross-sectional retrospective observational investigation done at 4 hospitals in Ramadi and Baghdad cities, Iraq. This investigation covered a duration of 6 years (2016-2021). We reviewed the medical records of patients with ZCFs. The participants were divided into 2 groups according to the approach used for their management (direct versus indirect approach). Data regarding the demographic and clinical characteristics were recorded for each subject. Of 265 patients with ZCFs, 209 (78.9%) were males. The highest age group affected was 18 to 40 years (51.7%). The majority of the ZCFs were caused by road traffic accidents (31.7%). Most of the cases belong to single fractures (72.1%). Cheek flattening (73.6%) was the commonest sign of the ZCFs. The majority of the fractures were treated by direct approach, 65.4% of the isolated fractures and 62.2% for multiple fractures. Excellent patient satisfaction was seen in the majority of the cases. There were no statistically significant differences between the 2 approaches regarding the abovementioned variables ( P -value > 0.05). The majority of the cases were with excellent patient satisfaction (n = 149) while only 7 patients with poor satisfaction. The age groups below 18 years and 18 to 40 years were associated with excellent patient satisfaction than good and poor satisfaction. All (n = 7) of the cases with poor satisfaction belong to the age group above 40 years. The majority of male (n = 113) and female (n = 36) patients were with excellent satisfaction, while all patients with poor results were males (n = 7). There were statistically significant differences between the results of the patient satisfaction and age group and complications ( P -value < 0.05). The ophthalmic complications were the most complications seen after ZCF surgical treatment (2.56%). Direct and indirect approaches can be used safely in the treatment of ZCFs owing to excellent patient satisfaction in the majority of the cases and a low complication rate. This study aims to evaluate the demographic and clinical characteristics and to compare different surgical procedures to treat patients with zygomaticomaxillary complex fractures in a country overwhelmed by violence.
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Affiliation(s)
- Muamer E Alshalah
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Al Kunooz University College, Basrah
| | - Hamid H Enezei
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Anbar, Ramadi
| | - Osamah M Aldaghir
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Al-Muthanna University, Muthanna
| | - Afrah A Khalil
- Department of Oral Diagnosis, College of Dentistry, University of Anbar
| | - Tahrir N Aldelaimi
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Anbar, Ramadi
| | - Raid M Al-Ani
- Department of Surgery/Otolaryngology, College of Medicine, University of Anbar, Ramadi, Iraq
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Jiang T, Zhou S, Yu Z, Cao D. Changes in Facial Symmetry Following Computer-Assisted Secondary Correction of Craniofacial Fractures. J Craniofac Surg 2023; 34:1672-1676. [PMID: 37427923 DOI: 10.1097/scs.0000000000009423] [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: 09/08/2022] [Accepted: 03/30/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE For patients without dysfunctions, the main purpose of secondary correction for craniofacial fractures is restoring facial symmetry. Computer-assisted surgery techniques including virtual surgical planning and intraoperative navigation provide the help to restore the bony symmetry as much as possible. The authors retrospectively quantitatively analyzed patients who received computer-assisted secondary correction for craniofacial fractures on facial symmetry pre and postoperation. METHODS This observational study reviewed the medical records of 17 patients requiring secondary correction for craniofacial fractures. Pre and postoperative computed tomography data were used to quantitatively analyze the changes in facial symmetry and enophthalmos. RESULT All patients enrolled in this study showed mid-facial asymmetry but without dysfunctions except for enophthalmos, and 5 patients had bone defects in the frontal-temporal area. The corrective surgical techniques were different for each patient according to their specific condition. Virtual surgical planning with or without intraoperative navigation was performed for all patients. Compared with the preoperative condition, their facial symmetry was significantly improved. The maximum discrepancy value between the affected side and the mirrored unaffected side decreased from 8.10 ± 2.69 to 3.74 ± 2.02 mm postoperatively, and the mean discrepancy value decreased from 3.58 ± 1.29 to 1.57 ± 0.68 mm. In addition, the Enophthalmos Index decreased from 2.65 to 0.35 mm. CONCLUSION This observational study objectively demonstrated that computer-assisted secondary correction for craniofacial fractures can significantly improve facial symmetry. And the authors recommend that virtual surgical planning and intraoperative navigation should be a must step in craniofacial fracture correction.
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Affiliation(s)
- Taoran Jiang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
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Riekert M, Lentzen MP, Tiddens J, Zöller JE, Kreppel M, Schick V. Prophylactic removal of titanium osteosynthesis miniplates in patients after midface fractures - A retrospective cohort study. J Craniomaxillofac Surg 2023; 51:454-459. [PMID: 37453892 DOI: 10.1016/j.jcms.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/11/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
The aim of the study was to evaluate prophylactic removal of titanium osteosynthesis miniplates in patients after midface fractures. Complaints after fracture treatment and complications after plate removal were analyzed, retrospectively. A total of 205 patients were included. Plate removal was performed in 99 cases. Complaints related to the osteosynthesis material resulted in more frequent plate removal (p < 0.001). Complications were noted in 22 patients after plate removal. Duration of plate removal did not correlate with postoperative complications. In 69 patients, plates were removed without previous symptoms. Of these patients, postoperative complications were recorded in 15 cases. In patients with complaints after osteosynthesis, complications after plate removal occurred in seven (23.3%) patients. Ectropia developed significantly more often with increasing age (p < 0.05). CONCLUSION: Within the limitations of the study it seems that prophylactic plate removal is a treatment option that is not associated with an increased complication rate.
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Affiliation(s)
- Maximilian Riekert
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany.
| | - Max-Philipp Lentzen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany
| | - Jelle Tiddens
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany
| | - Joachim E Zöller
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany
| | - Matthias Kreppel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany
| | - Volker Schick
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Germany
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Datta N, Tatum SA. Reducing Risks for Midface and Mandible Fracture Repair. Facial Plast Surg Clin North Am 2023; 31:307-314. [PMID: 37001933 DOI: 10.1016/j.fsc.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
The midface skeleton provides structural scaffolding to the middle third of the face. Complications associated with fracture repair in these regions can result from incomplete, inaccurate, or delayed assessment, poor initial and subsequent reduction and fixation, infection, uncontrolled hemorrhage, hardware failure and associated soft tissue injuries. A systematic approach to managing the patient with facial trauma that includes Acute Trauma Life Support principles, early reconstruction, and precise reduction and fixation is essential to reducing the short-term and long-term risks of complications.
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Affiliation(s)
- Néha Datta
- Department of Otolaryngology-Head and Neck Surgery, Upstate Medical University, State University of New York, 750 East Adams Street, Syracuse, NY 13210, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sherard A Tatum
- Department of Otolaryngology-Head and Neck Surgery, Upstate Medical University, State University of New York, 750 East Adams Street, Syracuse, NY 13210, USA.
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Gong J, Zhang W, Zhao R, Zhang W, Wang B, Ma D. The role of intraoperative navigation in surgical treatment of unilateral zygomatic complex fractures: A systematic review and meta-analysis. J Oral Maxillofac Surg 2023:S0278-2391(23)00325-7. [PMID: 37084764 DOI: 10.1016/j.joms.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/02/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
PURPOSE The application of a computer-aided navigation system (CANS) in zygomatic complex (ZMC) fractures has been extensively reported, but individual results are heterogeneous. The purpose of this systematic review was to evaluate the role of CANS in the surgical treatment of unilateral ZMC fractures. METHODS Electronic retrieval of MEDLINE, Embase, and Cochrane Library (CENTRAL) and manual searching until November 1, 2022 were used to identify cohort studies and randomized controlled trials employing CANS in the surgical treatment of ZMC fractures. The identified reports contained at least 1 of the following outcome variables: accuracy of reduction, total treatment time, amount of bleeding, postoperative complications, satisfaction, and cost. Weighted or mean differences (MD), risk ratios, and corresponding 95% confidence intervals (CI) were calculated, where P<.05 and I2>50% random-effect model was adopted, and a vice versa fixed-effect model was adopted. Descriptive analysis was applied to qualitative statistics. The protocol was conducted in accordance with PRISMA guidelines and prospectively registered with PROSPERO (CRD42022373135). RESULTS A total of 562 studies were identified, of which 2 cohort studies and 3 randomized controlled trials with 189 participants were included. Meta-analysis indicated that employing CANS significantly decreased the reduction error (MD = -0.86, 95% CI -1.58 to -0.14; P = .02, random-effect model) compared with conventional surgery without using CANS. The differences in total treatment time (preoperative planning time: MD = 1.44, 95% CI -3.55 to 6.43; P = .57 and operative time: MD = 3.02, 95% CI -9.21 to 15.26; P = .63, fixed-effect model) and amount of bleeding (MD = 14.86, 95% CI -8.86 to 38.58; P = .22, fixed-effect model) were not statistically significant between the two groups. Descriptive analysis suggested that postoperative complications, postoperative satisfaction, and cost were also similar with or without CANS. CONCLUSION Within the limitations of the present review, the reduction accuracy of unilateral ZMC fractures using CANS is superior to that of conventional surgery. CANS presents limited influence on operation time, amount of bleeding, postoperative complications, postoperative satisfaction, and cost.
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Affiliation(s)
- Jiaming Gong
- Resident, Attending doctor, Professor, Director, Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; Resident, Department of Stomatology, Quzhou Hospital Affiliated to Wenzhou Medical University, Quzhou City, PR China
| | - Wenlong Zhang
- Resident, Attending doctor, Professor, Director, Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; Resident, Professor, Director, School of Stomatology, Lanzhou University, Lanzhou City, PR China
| | - Ruimin Zhao
- Resident, Attending doctor, Professor, Director, Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; Resident, Department of Stomatology, Quzhou Hospital Affiliated to Wenzhou Medical University, Quzhou City, PR China
| | - Wenkai Zhang
- Resident, Attending doctor, Professor, Director, Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China
| | - Bingwu Wang
- Resident, Attending doctor, Professor, Director, Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China
| | - Dongyang Ma
- Resident, Attending doctor, Professor, Director, Department of Oral and Maxillofacial Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou City, PR China; Resident, Professor, Director, School of Stomatology, Lanzhou University, Lanzhou City, PR China.
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Spalthoff S, Oetzel F, Dupke C, Zeller AN, Jehn P, Gellrich NC, Korn P. Quantitative analysis of soft tissue sagging after lateral midface fractures: A 10-year retrospective study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e619-e625. [PMID: 35202862 DOI: 10.1016/j.jormas.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/22/2021] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Lateral midface fractures occasionally require open reduction and internal fixation to restore function and facial symmetry. However, some patients retain facial asymmetry despite undergoing surgery due to hard tissue displacement or soft tissue sagging. This study aimed to determine the influence of soft tissue sagging on the postoperative facial symmetry. METHODS We examined the medical records of 590 patients who underwent planned plate removal after lateral midface or zygomatic bone fractures. After applying the inclusion and exclusion criteria, we analyzed 106 cases of lateral midface fractures for hard tissue displacement and soft tissue sagging using pre- and postoperative radiological imaging and postoperative face scanning. RESULTS We observed significantly larger soft tissue sagging (p < 0.001) and hard tissue displacement (p = 0.006) on the fractured side than on the non-fractured side. There was no correlation between differences in the soft tissue sagging and those in the hard tissue displacement (|rho|=0). Linear regression analysis showed no statistical influence of sex or age group on the soft tissue sagging and hard tissue displacement. CONCLUSION Therefore, we recommend treating soft tissue sagging as a discrete aspect of midfacial fracture treatment to achieve optimal postoperative facial symmetry. From a clinical perspective, we recommend better soft tissue management during open fracture treatment than focusing mainly on the reduction of bony hard tissues.
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Affiliation(s)
- S Spalthoff
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany.
| | - F Oetzel
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
| | - C Dupke
- Department of Biometry and Environmental System Analysis, University of Freiburg, Tennenbacher Straße 4, 79106 Freiburg, Germany
| | - A-N Zeller
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
| | - P Jehn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
| | - N-C Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
| | - P Korn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany
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Dubron K, Verbist M, Shaheen E, Dormaar TJ, Jacobs R, Politis C. Incidence, Aetiology, and Associated Fracture Patterns of Infraorbital Nerve Injuries Following Zygomaticomaxillary Complex Fractures: A Retrospective Analysis of 272 Patients. Craniomaxillofac Trauma Reconstr 2022; 15:139-146. [PMID: 35633769 PMCID: PMC9133524 DOI: 10.1177/19433875211022569] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE Zygomaticomaxillary complex (ZMC) fractures are common facial injuries with heterogeneity regarding aetiologies, fracture types, infraorbital nerve (ION) involvement, and treatment methods. The aim of this study was to identify associations between aetiologies, fracture types, and neurological complications. Additionally, treatment methods and recovery time were investigated. METHODS Medical files of 272 patients with unilateral and bilateral ZMC fractures were reviewed, whose cases were managed from January 2014 to January 2019 at the Department of Oral and Maxillofacial Surgery, University hospitals Leuven, Belgium. History of ION sensory dysfunction and facial nerve motoric dysfunction were noted during follow-up. RESULTS ION hypoaesthesia incidence was 37.3%, with the main causes being fall accidents, road traffic accidents, and interpersonal violence. Significant predictors of ION hypoaesthesia were Zingg type B fractures (P = 0.003), fracture line course through the infraorbital canal (P < .001), orbital floor fracture (P < 0.001), and ZMC dislocation or mobility (P = 0.001). CONCLUSION Of all ZMC fractures, 37.3% exhibited ION hypoaesthesia. Only ZMC Zingg type B fractures (74.0%) were significantly more associated with ION hypoaesthesia. ION hypoesthesia was more likely (OR = 2.707) when the fracture line course ran through the infraorbital canal, and was less dependent on the degree of displacement. Neuropathic pain symptoms developed after ZMC fractures in 2.2% patients, posing a treatment challenge. Neuropathic pain symptoms were slightly more common among women, and were associated only with type B or C fractures. No other parameters were found to predict the outcome of this post-traumatic neuropathic pain condition.
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Affiliation(s)
- Kathia Dubron
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Verbist
- Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Eman Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Titiaan Jacob Dormaar
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
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Lin L, Liu X, Gao Y, Aung ZM, Xu H, Wang B, Xie L, Yang X, Chai G. The application of augmented reality in craniofacial bone fracture reduction: study protocol for a randomized controlled trial. Trials 2022; 23:241. [PMID: 35351158 PMCID: PMC8962928 DOI: 10.1186/s13063-022-06174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Augmented reality (AR) is a new technology that increases users’ perception of the real world. The purpose of this study is to evaluate the efficacy and safety of augmented reality navigation system in treatment with craniofacial fracture reduction. Methods This will be a single-center prospective randomized controlled trial. Twenty-two patients will be assigned to two groups of 11, and those with zygomaticomaxillary complex fractures will undergo preoperative three-dimensional CT modeling and have operational plans designed. The control team will use traditional optical navigation to perform the surgery, and the experimental team will use an AR navigation system. The primary outcome measures will be the accuracy of the key points of surgical area between the preoperational surgical plan and post-operation. The secondary outcome measures will be the blood loss, operation time, bone reduction time, hospital time, and complication rate. The findings obtained through this study are expected to evaluate efficacy and safety of the augmented reality navigation system in the treatment of zygomaticomaxillary complex fractures. Discussion This controlled trial of augmented reality navigation system in treatment with zygomaticomaxillary complex fracture reduction will clarify the efficacy and safety of this technology by measuring the accuracy of the key points of surgical area and blood loss, operation and bone reduction times, hospital stay duration, and complication rates. This is a single-center study, and the results are expected to promote the application of augmented reality in craniofacial fracture reduction to improve surgery accuracy and efficacy. Trial registration Chinese Clinical Trial Registry ChiCTR1900022626. Registered on April 19, 2019.
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Cheng M, Zhu Y, Liu Q, Shen S, Qian Y, Yu H. Efficacy of surgical navigation in zygomaticomaxillary complex fractures: randomized controlled trial. Int J Oral Maxillofac Surg 2021; 51:1180-1187. [PMID: 34961645 DOI: 10.1016/j.ijom.2021.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/07/2021] [Accepted: 12/14/2021] [Indexed: 11/18/2022]
Abstract
Accurate reduction is of vital importance in the treatment of zygomaticomaxillary complex (ZMC) fractures. Computer-assisted navigation systems (CANS) have been employed in ZMC fractures to improve the accuracy of surgical reduction. However, randomized controlled trials on this subject are rare and the benefits of CANS remain controversial. The aim of this study was to compare reduction errors between navigation-aided and conventional surgical treatment for ZMC fractures. Thirty-eight patients with unilateral type B ZMC fractures were enrolled. Preoperative computed tomography data were imported into ProPlan software for virtual surgical planning. Open reduction and internal fixation was performed with CANS (experimental group) or without CANS (control group). Postoperative computed tomography scans were obtained to examine the difference between surgical planning and the actual postoperative outcome, namely reduction errors. The median translational reduction errors in the X, Y, and Z axes were 0.80 mm, 0.40 mm, and 0.80 mm, respectively, in the experimental group and 0.53 mm, 0.86 mm, and 0.83 mm, respectively, in the control group (P > 0.05). The median rotational reduction errors in pitch, roll, and yaw were 0.92°, 2.47°, and 1.54°, respectively, in the experimental group and 1.45°, 3.68°, and 0.76°, respectively, in the control group (P > 0.05). In conclusion, compared with conventional reduction surgery, navigation-aided surgery showed no significant improvement in reduction accuracy in the treatment of type B ZMC fractures (Chinese Clinical Trial Registry, registration number ChiCTR1800015559).
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Affiliation(s)
- M Cheng
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Y Zhu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Q Liu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - S Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Y Qian
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - H Yu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China.
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Wang HD, Dillon J. Contemporary Management of Zygomaticomaxillary Complex Fractures. Semin Plast Surg 2021; 35:256-262. [PMID: 34819807 DOI: 10.1055/s-0041-1735812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Zygomaticomaxillary complex fracture is one of the most commonly treated facial fractures. Accurate reduction and stable fixation of the zygoma are required to restore facial symmetry and projection and avoid functional sequalae from changes in orbital volume. Achieving optimal outcome is challenging due to the complex three-dimensional anatomy and limited visualization of all affected articulations of the zygoma. This article provides an updated overview of the evaluation and management of zygomaticomaxillary complex fractures based on available evidence and clinical experience at our center. The importance of soft tissue management is emphasized, and approaches to internal orbital reconstruction are discussed. While evidence remain limited, intraoperative imaging and navigation may prove to be useful adjuncts in the treatment of zygomaticomaxillary fractures.
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Affiliation(s)
- Howard D Wang
- The Craniofacial Center, Seattle Children's Hospital, Seattle, Washington.,Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, Washington
| | - Jasjit Dillon
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, Washington
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Abstract
Panfacial trauma refers to high-energy mechanism injuries involving two or more areas of the craniofacial skeleton, the frontal bone, the midface, and the occlusal unit. These can be distracting injuries in an unstable patient and, as in any trauma, Advanced Trauma Life Support (ATLS) protocols should be followed. The airway should be secured, bleeding controlled, and sequential examinations should take place to avoid overlooking injuries. When indicated, neurosurgery and ophthalmology should be consulted as preservation of brain, vision, and hearing function should be prioritized. Once the patient is stabilized, reconstruction aims to reduce panfacial fractures, restore the horizontal and vertical facial buttresses, and resuspend the soft tissue to avoid the appearance of premature aging. Lost or comminuted bone can be replaced with bone grafts, although adequate reduction should be ensured prior to any grafting. Operative sequencing can be performed from top-down and outside-in or from bottom-up and inside-out depending on patient presentation. All protocols can successfully manage panfacial injuries, and the emphasis should be placed on a systematic approach that works from known areas to unknown areas.
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Affiliation(s)
- Benjamin B Massenburg
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington
| | - Melanie S Lang
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, Washington
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12
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Zygomaticomaxillary Fractures. Facial Plast Surg Clin North Am 2021; 30:47-61. [PMID: 34809886 DOI: 10.1016/j.fsc.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Fractures of the zygomaticomaxillary complex and zygomatic arch are common athletic injuries. Fracture displacement can lead to midfacial retrusion and widening, causing noticeable deformity. Associated signs and symptoms include hypoesthesia of the infraorbital nerve distribution, trismus, and subjective malocclusion. Operative treatment is indicated in cases of significant displacement or functional disturbance. The approach and details of osteosynthesis are catered to the specific characteristics of the fracture. Technology, such as virtual surgical planning, intraoperative navigation, and intraoperative imaging, has the potential to improve accuracy of treating challenging fractures.
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The Volume Difference Along the External Surface of the Zygomatic Bone: A Novel Method of Measuring Zygomatic Bone Asymmetry. J Craniofac Surg 2021; 33:463-468. [PMID: 34538786 DOI: 10.1097/scs.0000000000008186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT This study introduced the volume difference along the external surface (VDAES) of the zygomatic bone as a novel approach to assess zygomatic bone asymmetry and was the first to describe a distinctive, 4-step method of measuring it. VDAES has a potential to be used as an objective tool to evaluate dislocation and can assist surgeons in predicting risks of long-term cosmetic complications in patients with zygomaticomaxillary complex fractures. After having measured 100 healthy study participants, the observed median VDAES was 1.48 cm3 for all study participants, 2.02 cm3 for males, and 1.09 cm3 for females, with the gender difference being significant (P = 0.003). Additional studies are needed to test the hypothesis of whether VDAES is more relevant than conventional methods of clinically evaluating zygomatic bone asymmetry.
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Raghoebar II, Rozema FR, de Lange J, Dubois L. Surgical treatment of fractures of the zygomaticomaxillary complex: effect of fixation on repositioning and stability. A systematic review. Br J Oral Maxillofac Surg 2021; 60:397-411. [DOI: 10.1016/j.bjoms.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
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Fifteen-Year Review of the American Board of Plastic Surgery Maintenance of Certification Tracer Data: Clinical Practice Patterns and Evidence-Based Medicine in Zygomatico-Orbital Fractures. Plast Reconstr Surg 2021; 147:967e-975e. [PMID: 34019507 DOI: 10.1097/prs.0000000000007955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND From 2005 to 2020, the American Board of Plastic Surgery collected data on 20 common plastic surgery operations as part of the Maintenance of Certification process. These data allow the authors to examine national trends in zygomatico-orbital fracture repair over a 15-year period. METHODS Tracer data for zygomatico-orbital fracture repair were reviewed in cohorts from 2005 to 2013 and 2014 to 2020. Results were categorized based on their presence in evidence-based medicine articles published during this period. Differences between years were assessed using the t test or chi-square test as appropriate. RESULTS Four hundred thirty patients were included as of March of 2020. Average age was 37 years (range, 6 to 85 years), and 76 percent were male. Operations took place on average 10 days from injury. There were significant decreases in the use of subciliary (31.9 percent versus 10.0 percent; p < 0.001), gingival buccal (84.3 percent versus 56.4 percent; p < 0.001), and lateral brow (45.2 percent versus 22.3 percent; p < 0.001) incisions, with an increase in lower lid external incisions (15.2 percent versus 30.9 percent; p < 0.001); 2.7 percent of patients had a complication requiring readmission and 4.5 percent required reoperation. The incidence of postoperative diplopia was 7.7 percent, and the infection rate was 1.7 percent. CONCLUSIONS This article reviews the American Board of Plastic Surgery tracer data for zygomatico-orbital fracture repair. The Maintenance of Certification tracer data provide a national database with longer follow-up and more specific information than comparable databases. Analysis of these data over time enables the authors to describe practice trends and gives surgeons the opportunity to compare their outcomes to national norms.
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Pessino K, Cook T, Layliev J, Bradley JP, Bastidas N. Excluding Antibiotics in the Management of Nonoperative Orbital and Zygomatic Fractures. Ann Plast Surg 2021; 86:424-427. [PMID: 33141770 DOI: 10.1097/sap.0000000000002572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Indications for prophylactic antibiotic therapy in nonoperative, closed fractures of the orbit and zygoma remain controversial and are based on anecdotal data. The purpose of this study was to report the incidence of infectious sequelae among patients who presented to our institution with stated fractures and who were not administered prophylactic antibiotic therapy. The authors hypothesized that an increase in infectious complications would not be seen in these patients. METHODS The authors conducted a prospective single site study from October 2015 to December 2019. Patients with closed, nonoperative fractures involving the orbit and/or zygoma were included. These patients did not receive prophylactic antibiotic therapy for their fracture patterns, and infectious complications including orbital cellulitis, meningitis, and bacterial sinusitis were noted if present during follow-up. RESULTS Of 301 patients with closed, nonoperative orbital and/or zygomatic fractures, 268 were included in the study and 33 were excluded because of administration of antibiotics. The average age was 60 years, and the most common mechanism of injury was a traumatic fall. Fracture types included 100 orbital wall, 133 orbital floor, 15 orbital rim, 23 orbital roof, 48 zygoma, and 44 zygomaticomaxillary compound fractures. Infectious sequelae were not identified in any patient. CONCLUSIONS Of the 268 patients included in the study, no infectious complications were identified during the follow-up period. This outcome further supports that the use of prophylactic antibiotics is not indicated for closed, nonoperative fractures involving the orbital and/or zygoma. Prospective randomized control studies would be useful to support this outcome and better guide clinical antibiotic prescribing practices.
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Affiliation(s)
- Kenneth Pessino
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead
| | - Tracey Cook
- Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, NY, USA
| | - John Layliev
- Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, NY, USA
| | - James P Bradley
- Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, NY, USA
| | - Nicholas Bastidas
- Division of Plastic and Reconstructive Surgery, Northwell Health, Great Neck, NY, USA
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Inferomedially impacted zygomatic fracture reduction by reverse vector using an intraoral approach with Kirschner wire. Arch Plast Surg 2021; 48:69-74. [PMID: 33503747 PMCID: PMC7861973 DOI: 10.5999/aps.2020.02173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/29/2020] [Indexed: 11/08/2022] Open
Abstract
Background In inferomedially rotated zygomatic fractures sticking in the maxillary sinus, it is often difficult to achieve complete reduction only by conventional intraoral reduction. We present a new intraoral reduction technique using a Kirschner wire and its clinical outcome. Methods Among 39 inferomedially impacted zygomatic fractures incompletely reduced by a simple intraoral reduction trial with a bone elevator, a Kirschner wire (1.5 mm) was vertically inserted from the zygomatic body to the lateral orbital rim in 17 inferior-dominant rotation fractures and horizontally inserted to the zygomatic arch in nine medial-dominant and 13 bidirectional rotation fractures. A Kirschner wire was held with a wire holder and lifted in the superolateral or anterolateral direction for reduction. Following reduction of the zygomaticomaxillary fracture, internal fixation was performed. Results Fractures were completely reduced using only an intraoral approach with Kirschner wire reduction in 33 cases and through an additional lower lid or transconjunctival incision in six cases. There were no surgical complications except in one patient with undercorrection. Postoperative 6-month computed tomography scans showed complete bone union and excellent bone alignment. Four patients experienced difficulty with upper lip elevation; however, these problems spontaneously resolved after manual tissue lump massage and intralesional steroid (Triamcinolone) injection. Conclusions We completely reduced infraorbital rim fractures, zygomaticomaxillary buttresses, and zygomaticofrontal suture fractures in 84% of patients through an intraoral approach alone. Intraoral Kirschner wire reduction may be a useful option by which to obtain effective and powerful reduction motion of an inferomedially rotated zygomatic body.
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Mahdian M, Talari H, Moussavi N, Hoseinzadeh A, Akbari H, Shaghaghi T. Wisconsin criteria and necessity for computed tomography in patients with maxillofacial trauma: A diagnostic value study. ARCHIVES OF TRAUMA RESEARCH 2021. [DOI: 10.4103/atr.atr_109_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gawande M, Lambade P, Bande C, Gupta MK, Mahajan M, Dehankar T. Two-point versus three-point fixation in the management of zygomaticomaxillary complex fractures: A comparative study. Ann Maxillofac Surg 2021; 11:229-235. [PMID: 35265490 PMCID: PMC8848716 DOI: 10.4103/ams.ams_75_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/24/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: 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 that require a protocol for management and long-term follow-up. The objectives of this study were to compare the efficacy of zygomatic bone after treatment with open reduction internal fixation (ORIF) using two-point fixation and ORIF using three-point fixation and compare the outcome of two procedures. Materials and Methods: Twenty patients were randomly divided equally into two groups. In Group A, ten patients were treated by ORIF using two-point fixation by miniplates and in Group B, ten patients were treated by ORIF using three-point fixation by miniplates. They were evaluated with their advantages and disadvantages and the difference between the two groups was observed. Results: We found that postoperative facial and neurological complications are minimum in two-point fixation group. Based on this study, open reduction and internal fixation using two-point fixation by miniplates is sufficient and the best available treatment of choice for the management of zygomaticomaxillary complex fractures. Discussion: Alignment of the fracture at three points and fixation at two stable points provide the most accurate and satisfactory postoperative results. Two-point interosseous fixation at the “buttress” fracture and the frontozygomatic (FZ) fracture is suitable for routine surgery. The results of these studies confirm with the present study that two-point fixation provided better stability in patients with clinical and radiological evidence of fracture in FZ and zygomaticomaxillary buttress area.
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An Exploration of Multidisciplinary Team Care With Digital Technology for Complicated Cranio-Maxillofacial Bone Defects and Fractures. J Craniofac Surg 2020; 31:1914-1919. [PMID: 32890150 DOI: 10.1097/scs.0000000000006674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Early treatment of fractures of the cranio-maxillofacial complex (CMFC) is challenging and likely to result in craniofacial deformity. Multidisciplinary team (MDT) care has developed very rapidly and has recently been accepted in cancer treatment. Therefore, the authors explored the application of MDT care with digital technology in CMFC fractures. STUDY DESIGN A 29-year-old man presented for treatment of CMFC fractures and bone defects. An MDT of oral surgeons, ophthalmic surgeons, neurological surgeons, and other experts was convened. After CT scan and three-dimensional reconstruction, the authors performed personalized surgery that included 9 specialists over an 8-hour period. RESULTS The operation was successful and all fractures achieved clinical stability. At 1-month follow-up, appropriate appearance and functional recovery had been achieved. CONCLUSION In this study, MDT care with digital technology was very effective and had low associated costs. The involvement of more disciplines in MDT care may result in fewer complications.
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A Comparative Analysis of Outcomes After Reduction of Zygomatic Fractures Using the Carroll-Girard T-bar Screw. Ann Plast Surg 2020; 85:33-37. [PMID: 32032111 DOI: 10.1097/sap.0000000000002239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Several approaches are available for managing zygomatic fractures; however, each approach has its complications. Use of the Carroll-Girard T-bar screw (CGTS) can reduce complications because it reduces the number of approaches needed for reduction. This study aimed to analyze the efficiency of the CGTS compared with the 3-point approach. METHODS A retrospective study was conducted by reviewing the computed tomography scans of 204 patients who underwent reduction surgery of Knight and North type 3, 4, or 5 zygomatic fractures from March 2009 to August 2017. Facial asymmetry, operative time, and complications were evaluated to compare 2 groups of patients: those who underwent CGTS and those who did not. Bilateral differences in the distance from the reference plane to the malar eminence in 3 dimensions based on computed tomography scans were used to calculate facial asymmetry. RESULTS Among 204 patients, 91 were treated with CGTS whereas 113 patients underwent a 3-point approach. Bilateral differences in the position of the malar eminence and facial asymmetry were not statistically different in both groups. Operative time was not different in both groups. However, when patients with type 4 fracture were independently compared, the mean operative time was significantly shorter for the CGTS group. Wound dehiscence occurred in 11 patients (9.7%) in the 3-point approach group, compared with none in the CGTS group. None of the patients in the CGTS group complained of postoperative cheek scars over their incision sites. CONCLUSIONS This study revealed that CGTS is a useful and feasible instrument that can reduce the number of approaches for zygomatic bone reduction and help clinicians achieve satisfactory outcomes.
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Treatment of Panfacial Fractures and Three-Dimensional Outcome Analysis: The Occlusion First Approach. J Craniofac Surg 2019; 30:1255-1258. [PMID: 30946230 DOI: 10.1097/scs.0000000000005528] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Successful management of panfacial fractures requires an understanding of the component fracture patterns and the ability to relate them anatomically to the stable elements of the skull. However, there is no widespread agreement on the ideal approach to treatment of panfacial fractures and several techniques have been proposed. Here, the authors suggest the "occlusion first" approach, a technique that involves larger segment reduction as the initial step to provide an appropriate occlusal plane.This retrospective study included data from patients undergoing open reduction and internal fixation of panfacial fractures between March 2005 and November 2017 by the occlusion first technique. The degree of reduction in the mid and lower face was evaluated using 3D CT. The causes of injury, combined fracture, and multidisciplinary consultation during postoperative management were reviewed.The study population comprised 61 patients (47 male, 14 female) with a mean age of 47.6 years (range, 9-76 years). Analysis of 3D CT scans obtained from 42 patients showed no significant difference in hemifacial volume in the postoperative period (left hemifacial volume: 206.48 ± 68.35 cm, right: 205.17 ± 66.27 cm, P = 0.436).The occlusion first approach, with initial reduction of larger segments, enables effective reconstruction of the multiple segments involved in panfacial fractures. The authors have demonstrated that this technique successfully restores the entire face, improves surgical reduction, acts as an orientation aid during surgery, and provides a template for the smaller segments. Therefore, this approach can facilitate the accurate and efficient reduction and fixation of panfacial fractures.
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Sato A, Imai Y, Muraki K, Tachi M. Reliability of Ultrasound-Guided One-Point Fixation for Zygomaticomaxillary Complex Fractures. J Craniofac Surg 2018; 30:218-222. [PMID: 30444771 DOI: 10.1097/scs.0000000000005133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to analyze the precision and postoperative stability of ultrasound guided 1-point fixation on the zygomaticomaxillary buttress for the treatment of zygomaticomaxillary complex (ZMC) fractures. The authors analyzed 24 consecutive patients who underwent ultrasound-guided 1-point fixation for ZMC fractures without separation of the fracture at the frontal process of the zygomatic bone. The authors used titanium plates in the first 6 cases, and biodegradable plates in the remaining 18 cases. The authors obtained computed tomography images preoperatively, and again the first day after surgery (T1) and 6 months after the surgery (T2). The authors calculated vertical change (VC) and horizontal change (HC) of the zygoma on computed tomography. Precision was evaluated with T1 images. Stability was evaluated from T1 to T2, and titanium and biodegradable plates were compared. From T1 images, the mean VC and HC was 0.22° (range, 1.60°-1.08°) and 0.33° (range, 1.86°-1.03°), respectively. From T1 to T2, the mean VC and HC was 0.08° and 0.28°, respectively. Comparing the types of plates, the mean HC in the biodegradable plate group was 0.39°, which was significantly greater than that in the titanium plate group (mean -0.10°). However, as the degree of change was relatively small, this did not pose any clinical problems. Our findings suggest that ultrasound-guided 1-point fixation on the zygomaticomaxillary buttress provides accurate reduction on ZMC fractures without the separation of the frontal process of the zygomatic bone fracture. Sufficient stability was obtained, even with the use of biodegradable plates.
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Affiliation(s)
- Akimitsu Sato
- Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Starch-Jensen T, Linnebjerg LB, Jensen JD. Treatment of Zygomatic Complex Fractures with Surgical or Nonsurgical Intervention: A Retrospective Study. Open Dent J 2018; 12:377-387. [PMID: 30202484 PMCID: PMC6129990 DOI: 10.2174/1874210601812010377] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/12/2018] [Accepted: 04/12/2018] [Indexed: 11/24/2022] Open
Abstract
Objective: Evaluate the 1-year treatment outcome of zygomatic complex fractures with surgical or nonsurgical intervention. Materials and Methods: One hundred and forty-two consecutive patients with a zygomatic complex fracture were enrolled. Sixty-eight patients underwent surgical intervention and 74 patients nonsurgical intervention. The 1-year examination evaluated cosmetic and functional outcome including malar symmetry, ocular motility, occlusion, mouth opening, neurosensory disturbances, and complications. Results: Forty-six patients allocated to surgical intervention responded to the 1-year follow-up examination. Satisfying facial contour and malar alignment was observed in 45 patients. All patients presented with identical position of the eye globe without enophthalmos and normal ocular movement. A habitual occlusion was seen in all patients with a mean interincisal mouth opening without pain of 49 mm. One patient presented with minor ectropion. Wound infection occurred in five patients. Persistent infraorbital neurosensory disturbance was described by 19 patients. The 1-year radiographic examination showed adequate fracture alignment in all patients with satisfying facial contour. However, dissimilar position of the orbital floor was seen in three patients having orbital reconstruction. None of the patients were re-operated or needed secondary correction of the zygomatic complex or orbital floor. Conclusion: Surgical intervention is an effective treatment modality of depressed zygomatic complex fractures, whereas a nonsurgical approach is often used for nondisplaced fractures. Most zygomatic complex fractures can be treated solely by an intraoral approach and rigid fixation at the zygomaticomaxillary buttress. Further exposure of the zygomaticofrontal junction or inferior orbital rim is necessary for severely displaced fractures, which require additional fixation.
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Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - Janek Dalsgaard Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
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Analysis of Facial Symmetry After Zygomatic Bone Fracture Management. J Oral Maxillofac Surg 2018; 76:595-604. [DOI: 10.1016/j.joms.2017.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/04/2017] [Accepted: 10/04/2017] [Indexed: 11/17/2022]
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Abstract
Facial fractures are a common source of emergency department consultations for the plastic surgeon. A working understanding of evaluation, assessment, management, and prevention of further injury when dealing with these fractures is vital. This two-part series detailing the management of midface fractures serves as a guide for the appropriate workup and management of the wide variety of fracture patterns that are commonly encountered.
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Affiliation(s)
- Matthew Louis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Nikhil Agrawal
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Matthew Kaufman
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Tuan A Truong
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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