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[Options for reconstruction after injuries in the head and neck region]. HNO 2023; 71:57-62. [PMID: 36260106 DOI: 10.1007/s00106-022-01230-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 01/18/2023]
Abstract
Reconstruction of lesions in the head and neck region must be both functionally and esthetically adequate, as the exposed anatomic position can easily lead to social stigmatization after injury. Distortion of symmetry, e.g., by a crooked nose, enophthalmos, or a (partial) amputation of the outer ear, is easily visible. On the other hand, limitations to nasal breathing and olfaction or diplopia may significantly reduce quality of life, and restoration of form and function continues to be challenging. This review discusses the treatment options for trauma of the external nose and the lateral midface, including the orbital floor and the auricle.
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Kim R, Shokri T, Wang W, Ducic Y. Facial Protection to Prevent Facial Trauma and Allow for Optimal Protection after Facial Fracture Repair. Facial Plast Surg 2021; 37:781-789. [PMID: 33525032 DOI: 10.1055/s-0041-1723006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Facial skeletal fractures continue to affect humankind, and many methods to alleviate and prevent the injuries outright have been sought after. Prevention is desired, but the implementation and general compliance may contribute to missed opportunities to decrease the burden of facial skeletal trauma. In this article, we explore the preventative as well as postoperative options for the protection of the facial skeleton.
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Affiliation(s)
- Roderick Kim
- Department of Oral and Maxillofacial Surgery, John Peter Smith Health Network, Fort Worth, Texas
| | - Tom Shokri
- Department of Otolaryngology, Pennsylvania State University, Hershey, Pennsylvania
| | - Weitao Wang
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York
| | - Yadranko Ducic
- Department of Facial Plastics, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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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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YONTAR Y, TATAR S, BAYKAN H. Closed reduction of zygomatic arch fractures by using Tubbs-Logan mitral valve dilator. ENT UPDATES 2020. [DOI: 10.32448/entupdates.709516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Cohn JE, Othman S, Bosco S, Shokri T, Evarts M, Papajohn P, Zwillenberg S. Management of Isolated Zygomatic Arch Fractures and a Review of External Fixation Techniques. Craniomaxillofac Trauma Reconstr 2020; 13:38-44. [PMID: 32642030 DOI: 10.1177/1943387520905164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Fractures of the zygomatic bone can present with complicated aesthetic and neurological pathology. Specifically, management of isolated zygomatic fracture has been sparsely discussed in the literature, and most studies are based upon older techniques. Here, we compare the results of 2 critical operative techniques as well as review the available literature in the setting of isolated zygomatic fractures. Methods A retrospective chart review was performed at our institution from 2010 to 2018 examining for patients who had sustained an isolated zygomatic fracture confirmed by computed tomography scan. Patients were excluded if they sustained additional maxillofacial fractures. Demographical information, symptoms on presentation, fracture management modality, and postoperative course were all collected and examined. Results A total of 218 patients were identified for inclusion. The average age of this cohort was 45.5 ± 18 years, with 77.5% being male. Assault (55%) was most the frequent cause of injury with accidents being the least common (17.9%). Most patients (78.8%) underwent nonoperative management. Patients who underwent operation more often presented with zygomatic deformity (97.7% vs 18.4%), paresthesia (29.5% vs 2.9%), and trismus (29.5% vs 6.9%) when compared to their nonoperatively managed counterparts. In all, 44 operatively managed patients underwent open reduction with or without eternal fixation (Gillies Approach vs Keen Approach). There were no significant differences in the presence of zygomatic deformity, paresthesia, and trismus between the 2 operative techniques. Conclusions Isolated zygomatic arch fractures can present with discerning symptoms. Unfortunately, the literature on appropriate management is not well described. We find external fixation to provide reestablishment of both form and function with minimal required exposure, although the outcomes may be similar without the use of external fixation.
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Affiliation(s)
- Jason E Cohn
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Sammy Othman
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Samuel Bosco
- Marian University College of Osteopathic Medicine, Indianapolis, IN, USA
| | - Tom Shokri
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Marissa Evarts
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Paul Papajohn
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Seth Zwillenberg
- Department of Otolaryngology-Head and Neck Surgery, Einstein Medical Center, Philadelphia, PA, USA
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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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Intraoperative Ultrasound Control of Zygomatic Arch Fractures: Does Additional Imaging Improve Reduction Quality? J Oral Maxillofac Surg 2019; 77:769-776. [DOI: 10.1016/j.joms.2018.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/11/2018] [Accepted: 11/12/2018] [Indexed: 01/23/2023]
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Kim H, Yoon J, Lee BI. "Radiological morphometric analysis of the zygomatic arch: Application of osteosynthesis on the upper arch border for rigid fixation". J Plast Reconstr Aesthet Surg 2018; 72:831-841. [PMID: 30503372 DOI: 10.1016/j.bjps.2018.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/18/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study was designed to introduce a novel method of applying osteosynthetic materials to the upper zygomatic arch border for fracture fixation through a temporal incision, and analyze the radiologic morphometric dimensions of the arch to verify its validity. METHODS Radiological morphometry was analyzed in 51 adult patients with unilateral isolated zygomatic arch fractures. Frequent fracture sites, sites of minimal thickness and height, and their correlation were evaluated, as were the locations and dimensions of fixation vantage points. The novel surgical method based on the results was implemented in 17 clinical cases. RESULTS Frequent fracture sites, occurring 4.40, 16.47 and 30.48 mm posterior to the arch origin, did not correlate to sites of minimal height and thickness. Arch minimal thickness and height locations were 12.23 and 27.09 mm behind its origin, respectively. Fixation vantage point dimensions varied from point to point, with upper thickness ranging from 1.67 to 4.86 mm and mid-portion thickness ranging from 2.06 to 7.36 mm, and height ranging from 8.99 to 22.53 mm. Arch vertical axis inclination ranged from 6.51° to 16.47°, which increased as the arch stretches posteriorly. These results suggested the use of 1.5 mm-wide plates and 1 mm-diameter screws with 6-8 mm length. Patients received surgery based on these morphometry results for satisfactory stabilization. CONCLUSIONS This study introduces a new method for open reduction and internal fixation of arch fractures, with morphometric analysis of the arch verifying the validity of tangential plate application to the upper border.
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Affiliation(s)
- Hyonsurk Kim
- Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31116, Republic of Korea
| | - Jeongmin Yoon
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Korea University College of Medicine 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Byung-Il Lee
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Korea University College of Medicine 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea.
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Buller J, Zirk E, Kreppel M, Grandoch A, Maus V, Zirk M, Zöller JE. Radiomorphometric analysis of isolated zygomatic arch fractures: A comparison of classifications and reduction outcomes. J Craniomaxillofac Surg 2018; 46:1252-1257. [PMID: 29884318 DOI: 10.1016/j.jcms.2018.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/05/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022] Open
Abstract
PURPOSE Although different proposals have been made to categorize isolated zygomatic arch fractures (ZAF), an investigation about fracture type and clinical outcome has not been published. In this study, we analyzed the geometric fracture morphology in isolated ZAF and provide a survey of reduction outcomes in accordance with 4 independent classifications. MATERIALS AND METHODS Geometric measurements were performed in radiologic images of 94 patients with isolated ZAF, which were consecutively treated by closed reduction over transbuccal approach. Fracture types were allocated to the classifications of Rowe and Williams, Honig and Merten, Yamamoto et al., and Ozyazgan et al. The odds of achieving a satisfactory outcome were calculated for all categories. RESULTS Wide preoperative dislocation angles of more than 22° presented in M-type fractures (77.1%) more frequently compared to 2 fragments without the M-shape (33.3%) and one fragment (14.8%, p < 0.001). Favorable reduction outcome was significantly higher for M-shaped fractures than for differently configured fractures (83.3% vs. 30.4%, odds ratio 11.43, confidence interval 4.27-30.61). The rate of reduction in 100%-75% was most frequent for the Honig and Merten type I as well as Ozyazgan type IBV (both 85.4%, p < 0.001) and Yamamoto type II (84.2%, p < 0.001). CONCLUSION The classifications of Honig and Merten, Yamamoto et al., and Ozyazgan were quite applicable, and subgroups showed significant increments in reduction outcome. Our analysis emphasizes that the differentiation of two clinical relevant groups, M-shaped and variable arch fractures, is feasible to manage and efficient to determine the odds of reduction outcome.
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Affiliation(s)
- Johannes Buller
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany.
| | - Elisa Zirk
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Andrea Grandoch
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Volker Maus
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany; Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Matthias Zirk
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | - Joachim E Zöller
- Department of Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
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