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Goh EZ, Bullis S, Beech N, Johnson NR. Surgical management of naso-orbito-ethmoidal fractures: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 138:9-20. [PMID: 38697897 DOI: 10.1016/j.oooo.2024.02.021] [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: 12/31/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Naso-orbito-ethmoidal fractures (NOE) fractures are uncommon but critical injuries. This review aims to investigate the patient factors, procedural factors, and postoperative outcomes associated with the surgical management of NOE fractures. STUDY DESIGN PubMed and Scopus databases were systematically searched between 1993 and 2023 using the search strategy "(naso-orbito-ethmoidal OR nasoethmoid OR nasoorbitoethmoidal) AND fracture." Articles reporting clinical studies investigating the surgical management of NOE fractures were included. Articles that were duplicates, non-English, or non-full text; reported an unclear age range; reported insufficient data; and/or reported on a sample size less than 10 were excluded. Data on patient factors, procedural factors, and postoperative outcomes were extracted. RESULTS Of the 412 articles identified, 6 eligible articles (retrospective case series) representing 95 adult cases and 84 pediatric cases were included. The mean ages were 29.0 and 10.2 years, respectively. Most cases were male (65.3%; 73.9%). Motor vehicle accidents were the most common mechanism of injury (79.2% and 50.0%, respectively). Coronal incision was the most common approach. Epiphora (n = 33) and scar problems (n = 21) were the most common complications in adult and pediatric cases, respectively. CONCLUSIONS Further robust longitudinal studies with a clear description of fracture classification and surgical timing would be helpful. Gaps in knowledge include concomitant injuries, digitally-assisted applications, and risk factors for adverse outcomes.
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Affiliation(s)
- Elizabeth Z Goh
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Oral and Maxillofacial Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Oral and Maxillofacial Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Sam Bullis
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nicholas Beech
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nigel R Johnson
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Oral and Maxillofacial Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
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Goh EZ, Beech N, Johnson NR. Surgical management of frontal bone and naso-orbito-ethmoidal fractures: a 7-year multi-center retrospective review. Oral Surg Oral Med Oral Pathol Oral Radiol 2024:S2212-4403(24)00327-4. [PMID: 39127563 DOI: 10.1016/j.oooo.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE Frontal and naso-orbito-ethmoidal (NOE) fractures are rare but important injuries due to their anatomical complexity and proximity to vital structures. This study aims to describe the patient factors, procedural factors, and postoperative outcomes in the surgical management of these fractures. STUDY DESIGN Retrospective review of patients aged 18 years or older who were surgically treated for these fractures at two Australian tertiary hospitals (2014-2020). Patient factors (demographics, mechanism of injury, fracture pattern, concomitant injuries); procedural factors (operation timing, surgical approach); and postoperative outcomes (complications, revision surgeries) were recorded. RESULTS 60 cases were included (41 frontal; 29 NOE; 10 combined). Mean age was 37 (frontal) and 39 years (NOE). Most cases were male (87.8%; 75.9%). The most common mechanism was traffic accidents (29.3%; 34.5%). The most common associated facial fractures were Le Fort fractures (46.3%; 89.7%). The most common associated systemic injuries were brain injuries (36.6%; 34.5%). Mean operation timing was 13 days (frontal) and 11 days (NOE). Coronal flap was most commonly used (68.3%; 82.8%). Postoperative complication rates were 39.0% (frontal) and 37.9% (NOE). Three cases required revision surgeries. CONCLUSION Further larger longitudinal studies are required to build knowledge and improve patient outcomes.
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Affiliation(s)
- Elizabeth Z Goh
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Oral and Maxillofacial Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Oral and Maxillofacial Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Nicholas Beech
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nigel R Johnson
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Oral and Maxillofacial Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
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Yang C, Zhang C, Wu J, Xu X, Zhang Y, Zhang S. Three-Dimensional Printed Customized Surgical Guides for the Precise Correction of Complex Midfacial Post-Traumatic Deformities. J Craniofac Surg 2022; 33:1150-1153. [PMID: 36041109 DOI: 10.1097/scs.0000000000008329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The introduction of intraoperative computed tomography and image-guided navigation have demonstrated some advantages for the correction of midfacial post-traumatic deformities. However, these methods still do not achieve satisfactory results. The authors sought to describe a novel method for the precise correction of complex midfacial post-traumatic deformities using three-dimensional printing customized surgical guides. METHODS Ten patients with midfacial post-traumatic deformities admitted between January 15, 2018 and August 20, 2020 were included. To design the surgical guide for each patient, preoperative planning and simulation datasets were used as a virtual template. Each surgical guide comprised three-dimensional printing cutting guides and customized titanium plates to guide the osteotomy and repositioning of the fracture fragments intraoperatively. Reduction and fixation were confirmed by intraoperative navigation. Postoperative deviation chromatography analysis and clinical examination were conducted to evaluate the surgical outcome. All operations were successfully performed. RESULTS The average difference between the virtual plans and postoperative results was less than 1.5 mm. The 3- to 6-month follow-up evaluation demonstrated that symptoms were alleviated, and postoperative function and esthetics improved considerably. CONCLUSIONS Three-dimensional-printed customized surgical guides can accurately and effectively transfer the virtual surgical plan to the patient and could be considered an ideal and valuable option for this potentially complicated procedure.
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Affiliation(s)
- Chengshuai Yang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Chuxi Zhang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jinyang Wu
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - XiaoFeng Xu
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yong Zhang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Shilei Zhang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
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Lerner JL, Crozier JW, Scappaticci AA, Rao V, Woo AS. Comparing diagnosis of midfacial fractures by radiologists and plastic surgeons. Emerg Radiol 2022; 29:499-505. [PMID: 35266070 DOI: 10.1007/s10140-022-02036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/24/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Clinicians who manage facial fractures often rely on radiologist interpretations to help with assessment and management. Among treating physicians, facial fractures are categorized into clinically relevant patterns of injury. On the other hand, while radiologists are unsurpassed at identifying individual breaks in the bone, larger fracture patterns are not always conveyed in radiology reports. PURPOSE This study aims to assess the frequency with which the terminology describing midfacial fracture patterns is concordant among radiologists and treating clinicians. METHODS The authors identified patients with different patterns of midfacial injury including Le Fort I, Le Fort II, Le Fort III, naso-orbito-ethmoid (NOE), and zygomaticomaxillary complex (ZMC) fractures. Plastic surgery consult notes and radiological imaging reports were reviewed for concordance in documentation of injury patterns. Identification of individual fractures consistent with the diagnosed fracture pattern was also recorded. RESULTS Radiologists were noted to be highly successful in describing individual fractures of the facial bones, identifying at least two defining components of a fracture pattern in 96% of Le Fort, 88% of NOE, and 94% of ZMC injuries. However, when injury patterns were considered, only 32% of Le Fort, 28% of ZMC, and 6% of NOE fractures were explicitly identified in radiology reports. CONCLUSIONS Radiologists are highly skilled in discerning individual fractures in facial trauma cases. However, less reliability was seen in the identification of fracture patterns in midfacial injury, with particular weaknesses in descriptions of NOE and ZMC fractures. This data suggests that greater focus on patterns of midfacial injury would improve the clinical applicability of radiological reports.
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Affiliation(s)
- Julia L Lerner
- The Warren Alpert Medical School of Brown University, Brown University, Providence, RI, 02912, USA.
| | - Joseph W Crozier
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Vinay Rao
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Albert S Woo
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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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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The Association of Zygomaticomaxillary Complex Fractures with Naso-Orbitoethmoid Fractures in Pediatric Populations. Plast Reconstr Surg 2021; 147:777e-786e. [PMID: 33835093 DOI: 10.1097/prs.0000000000007836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Naso-orbitoethmoid fractures associated with ipsilateral zygomaticomaxillary complex fractures are more challenging injuries than zygomaticomaxillary complex fractures alone. However, there is a paucity of information on this complex fracture pattern in the pediatric population. This study investigated the cause, treatment, and outcomes of combined zygomaticomaxillary complex and naso-orbitoethmoid fractures versus isolated zygomaticomaxillary complex fractures in pediatric patients. METHODS This was a 25-year retrospective cohort study of pediatric patients who presented to a single institution with zygomaticomaxillary complex fractures. Baseline patient demographics and clinical information, and concomitant injuries, treatment/operative management, and postoperative complications/deformities were recorded and compared between patients with combined zygomaticomaxillary complex and naso-orbitoethmoid fractures and patients with isolated zygomaticomaxillary complex fractures. RESULTS Forty-nine patients were identified to have had zygomaticomaxillary complex fractures in the authors' 25-year study period, of whom 46 had adequate clinical documentation and follow-up. Seventeen patients had combined zygomaticomaxillary complex-naso-orbitoethmoid fractures, of whom six had panfacial fractures. Both patient groups (zygomaticomaxillary complex only and combined zygomaticomaxillary complex-naso-orbitoethmoid fractures) were similar in terms of demographics. However, a significantly greater proportion of combined fracture patients experienced postoperative complications compared to isolated zygomaticomaxillary complex fracture patients, even after excluding those with panfacial fractures (87.5 percent versus 35.3 percent; p < 0.001). Enophthalmos (37.5 percent) and midface growth restriction (37.5 percent) were the two most common complications/deformities in all combined fracture patients. CONCLUSIONS High-impact trauma can lead to zygomaticomaxillary complex fractures with associated naso-orbitoethmoid fractures in children. This injury pattern was found to cause significantly greater postoperative morbidity than isolated zygomaticomaxillary complex fractures alone. Thus, pediatric patients presenting with this complex facial fracture pattern should be closely monitored. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Juncar M, Tent PA, Juncar RI, Harangus A, Mircea R. An epidemiological analysis of maxillofacial fractures: a 10-year cross-sectional cohort retrospective study of 1007 patients. BMC Oral Health 2021; 21:128. [PMID: 33731083 PMCID: PMC7968332 DOI: 10.1186/s12903-021-01503-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Epidemiological data is providing vital indicators for organizing the financial resources related to a particular type of trauma, estimating expenses and training of dental practioners and ambulatory medical staff for collaboration with a certain pattern of patients. Knowing the etiology and epidemiology of a certain pathology is significant for approaching its means of prevention.
Methods
A 10-year retrospective statistical analysis of 1007 patients with maxillofacial fractures treated in a University Clinic of Oral and Maxillofacial Surgery in Romania was performed. The data were extracted from patients’ medical records. Statistical analysis was performed. A value of p < 0.05 was considered statistically significant. Results The incidence of maxillofacial fractures was high among patients in the 20–29 age group (35.9%). Male patients (90.57%, M:F = 9.6:1), having a low level of education (46.60%) and living in urban areas (53.50%) were more affected. The main cause of maxillofacial fractures was interpersonal violence (59.37%), both in the mandibular and midface topographic regions (p = 0.001, p = 0.002). In urban areas, fractures caused by interpersonal violence and road traffic accidents were predominant, while in rural areas, most of the fractures were due to interpersonal violence, domestic accidents, work accidents and animal attacks (p = 0.001). Conclusions Interpersonal violence is the main cause of maxillofacial fractures having epidemic proportions. Male patients aged 20–29 years with a low level of education represent the major risk category. Considering the wide area of interpersonal aggression, both the medical staff in the hospital and in the dental offices must be educated in order to collaborate with possible violent patients. Dentists must be prepared to work on a post-traumatic dento-periodontal field. Taking all measures to prevent inter-human aggression is imperative and will lead to a major decrease in maxillofacial fractures and an overall increase of oral health in a population. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01503-5.
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Affiliation(s)
- Mihai Juncar
- Department of Oral and Maxillofacial Surgery, University of Oradea, Romania, Str. Piața 1 Decembrie, no.10, 410073, Oradea, Romania
| | - Paul Andrei Tent
- Department of Oral and Maxillofacial Surgery, University of Oradea, Romania, Str. Piața 1 Decembrie, no.10, 410073, Oradea, Romania.
| | - Raluca Iulia Juncar
- Department of Oral and Maxillofacial Surgery, University of Oradea, Romania, Str. Piața 1 Decembrie, no.10, 410073, Oradea, Romania
| | - Antonia Harangus
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu" University of Medicine and Pharmacy, 400337, Cluj-Napoca, Romania
| | - Rivis Mircea
- Discipline of Oral Surgery, 2nd Department of Dental Medicine, "Victor Babeş" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041, Timisoara, Romania
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Juncar RI, Tent PA, Juncar M, Arghir IA, Arghir OC, Rivis M. Interrelation between facial soft tissue lessions, underlying fracture patterns and treatment of zygomatic bone trauma: a 10 year retrospective study. Head Face Med 2020; 16:30. [PMID: 33243244 PMCID: PMC7690189 DOI: 10.1186/s13005-020-00246-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/18/2020] [Indexed: 12/03/2022] Open
Abstract
Background The pattern of zygomatic bone fractures varies in the literature, their features being frequently masked by the presence of associated soft tissue lesions. In this context the clinical diagnosis and the therapeutic indications can be difficult. The aim of this study was to evaluate the clinical features of zygomatic bone fractures and their interrelation with concomitant overlying soft tissue injuries, as well as to assess the type of treatment methods applied depending on the fracture pattern and the results achieved depending on the incidence rate of postoperative complications. We will use these results in order to improve the diagnosis and the establishment of correct treatment of this pathology. Methods A 10-year retrospective evaluation of midface fractures was performed in patients diagnosed and treated in a tertiary Clinic of Oral and Maxillofacial Surgery. Statistical analysis was performed with the MedCalc Statistical Software version 19.2 (MedCalc Software bvba, Ostend, Belgium; 53 https://www.medcalc.org; 2020). Nominal data were expressed as frequency and percentage. The comparisons of the frequencies of a nominal variable among the categories of another nominal variable were made using the chi-square test. Multivariate logistic regressions were used in order to establish the independent association between variables and lacerations/excoriations. After using the Bonferroni correction for multiple comparisons, a value of p < 0.025 was considered statistically significant. Results The study included 242 patients with zygomatic bone fractures. The majority of the fractures were displaced n = 179 (73.9%), closed n = 179 (73.9%) and complete n = 219 (90.5%). Hematoma was the most frequent associated soft tissue lesion n = 102 (42.1%) regardless of the fracture pattern (p = 1.000). Complete zygomatic fracture (OR – 2.68; p = 0.035) and fractures with displacement (OR – 3.66; p = 0.012) were independently associated with the presence of laceration. Fractures with displacement (OR – 7.1; p = 0.003) were independently associated with the presence of excoriation. The most frequent type of treatment applied was Gillies reduction (61.9%), followed by ORIF (30.9%). The most frequent postoperative complication was malunion secondary to Gillies treatment (4,6%). Conclusions Patients presenting lacerations and excoriations on clinical soft tissue examination will most frequently have an underlying complete, displaced or comminuted zygomatic fracture. In the case of displaced, open or comminuted fractures we achieved the best results secondary to ORIF treatment method, while in the case of non-displaced and closed fractures, the best results achieved were secondary to conservative treatment.
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Affiliation(s)
- Raluca Iulia Juncar
- Department of Oral and Maxillofacial Surgery, University of Oradea, Str. Piața 1 Decembrie, no.10, 410073, Oradea, Romania
| | - Paul Andrei Tent
- Department of Oral and Maxillofacial Surgery, University of Oradea, Str. Piața 1 Decembrie, no.10, 410073, Oradea, Romania.
| | - Mihai Juncar
- Department of Oral and Maxillofacial Surgery, University of Oradea, Str. Piața 1 Decembrie, no.10, 410073, Oradea, Romania
| | - Ioan Anton Arghir
- Pulmonology Department, Faculty of Medicine, Ovidius University of Constanta, Consteanta, Romania
| | - Oana Cristina Arghir
- Pulmonology Department, Faculty of Medicine, Ovidius University of Constanta, Consteanta, Romania
| | - Mircea Rivis
- Discipline of Oral Surgery, 2nd Department of Dental Medicine, "Victor Babeş" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041, Timisoara, Romania
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Ţent PA, Juncar RI, Juncar M. Epidemiological Analysis of Zygomatic Bone Fractures in North-Western Romanian Population: A 10-Year Retrospective Study. In Vivo 2020; 34:2049-2055. [PMID: 32606181 DOI: 10.21873/invivo.12006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Midface fractures represent a challenge for medical practitioners due to the severe esthetic and functional consequences. This study aimed to determine the causes and to provide a demographic analysis of zygomatic bone fractures in our geographical area, with a view to implementing the necessary prevention methods, training the medical staff for a certain type of patients and decreasing the required costs. PATIENTS AND METHODS A retrospective statistical epidemiological analysis of 242 patients with zygomatic bone fractures over a 10-year period was performed. RESULTS The most affected age group was 20-29 years (27.27%). The most affected were men (n=211, 87.19%) from urban areas (n=140, 57.85%), and without education (n=122, 50.41%). The most frequent cause was interpersonal violence (54.04%), followed by falls (17.36%) and road traffic accidents (16.53%). CONCLUSIONS Interpersonal violence as a cause of zygomatic bone fractures is currently reaching epidemic proportions. Taking legal measures to prevent aggression is a public health emergency that would considerably decrease the incidence of these fractures in our population.
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Affiliation(s)
- Paul Andrei Ţent
- Department of Oral and Maxillofacial Surgery, University of Oradea, Oradea, Romania
| | - Raluca-Iulia Juncar
- Department of Oral and Maxillofacial Surgery, University of Oradea, Oradea, Romania
| | - Mihai Juncar
- Department of Oral and Maxillofacial Surgery, University of Oradea, Oradea, Romania
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Nissen NJ, Okhah ZI, Basta MN, Hsieh S, Crozier JW, Jehle CC, Rao V, Woo AS. Underdiagnosis of Nasoorbitoethmoid Fractures in Patients with Zygoma Injury. Plast Reconstr Surg 2020; 145:1001-1008. [PMID: 32221221 DOI: 10.1097/prs.0000000000006626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nasoorbitoethmoid fractures commonly accompany midface fractures and may be underdiagnosed, resulting in incomplete reconstruction or inadequate treatment following facial trauma. To better understand the nasoorbitoethmoid fracture diagnosis and treatment tendencies, the authors analyzed concomitant nasoorbitoethmoid injuries in the setting of zygoma fractures. METHODS The facial trauma database at a level I trauma center was evaluated. All patients with diagnosed zygoma fractures from June of 2011 to March of 2016 were assessed for a concomitant nasoorbitoethmoid injury. Documentation of these fractures in radiology, plastic surgery, and operative notes was recorded, as was the rate of nasoorbitoethmoid fracture surgical repair. RESULTS The authors identified 339 eligible patients and completed retrospective analysis of computed tomographic images for their 356 zygoma fractures. The incidence of concomitant nasoorbitoethmoid fractures was 30.6 percent (109 of 356). Documentation rates of nasoorbitoethmoid fractures were 0 percent, 3.7 percent, and 8.3 percent in radiology, plastic surgery, and operative notes, respectively. The rate of surgical correction of nasoorbitoethmoid injuries was 22.9 percent (25 of 109). Of those fractures identified, 44.9 percent (49 of 109) were minimally displaced or nondisplaced. Subset analysis of only significantly displaced fractures yielded an incidence of 16.8 percent (60 of 356). Of significantly displaced fractures, documentation rates were 0 percent, 6.7 percent, and 16.8 percent in radiology, plastic surgery, and operative notes, respectively. The surgical repair rate of significantly displaced fractures was 31.7 percent (19 of 60). CONCLUSIONS These findings suggest a high concomitance rate of nasoorbitoethmoid fractures with zygoma fractures and identify a tendency to underdocument and undertreat this injury pattern. Clinicians managing patients with midface trauma should have a high suspicion for nasoorbitoethmoid trauma. Plastic surgeons and radiologists should be better trained in identifying the nasoorbitoethmoid fracture pattern.
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Affiliation(s)
- Nicholas J Nissen
- From the Warren Alpert Medical School of Brown University and the Department of Plastic and Reconstructive Surgery, Rhode Island Hospital
| | - Zachary I Okhah
- From the Warren Alpert Medical School of Brown University and the Department of Plastic and Reconstructive Surgery, Rhode Island Hospital
| | - Marten N Basta
- From the Warren Alpert Medical School of Brown University and the Department of Plastic and Reconstructive Surgery, Rhode Island Hospital
| | - Sun Hsieh
- From the Warren Alpert Medical School of Brown University and the Department of Plastic and Reconstructive Surgery, Rhode Island Hospital
| | - Joseph W Crozier
- From the Warren Alpert Medical School of Brown University and the Department of Plastic and Reconstructive Surgery, Rhode Island Hospital
| | - Charles C Jehle
- From the Warren Alpert Medical School of Brown University and the Department of Plastic and Reconstructive Surgery, Rhode Island Hospital
| | - Vinay Rao
- From the Warren Alpert Medical School of Brown University and the Department of Plastic and Reconstructive Surgery, Rhode Island Hospital
| | - Albert S Woo
- From the Warren Alpert Medical School of Brown University and the Department of Plastic and Reconstructive Surgery, Rhode Island Hospital
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Discussion: Underdiagnosis of Nasoorbitoethmoid Fractures in Patients with Zygoma Injury. Plast Reconstr Surg 2020; 145:1009-1010. [PMID: 32221222 DOI: 10.1097/prs.0000000000006733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ha YI, Kim SH, Park ES, Kim YB. Approach for naso-orbito-ethmoidal fracture. Arch Craniofac Surg 2019; 20:219-222. [PMID: 31462011 PMCID: PMC6715548 DOI: 10.7181/acfs.2019.00255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/29/2019] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study is to discuss several approaches to addressing naso-orbito-ethmoidal (NOE) fracture. Orbital fracture, especially infraorbital fracture, can be treated through the transconjunctival approach easily. However, in more severe cases, for example, fracture extending to the medial orbital wall or zygomatico-frontal suture line, only transconjunctival incision is insufficient to secure good surgical field. And, it also has risk of tearing the conjunctiva, which could injure the lacrimal duct. Also, in most complex types of facial fracture such as NOE fracture or panfacial fracture, destruction of the structure often occurs, for example, trap-door deformity; a fracture of orbital floor where the inferiorly displaced blowout facture recoils to its original position, or vertical folding deformity; fractured fragments are displaced under the other fragments, causing multiple-packed layers of bone.
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Affiliation(s)
- Young In Ha
- Department of Plastic and Reconstructive Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Sang Hun Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eun Soo Park
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Yong Bae Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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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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Schreurs R, Dubois L, Becking AG, Maal TJ. The orbit first! A novel surgical treatment protocol for secondary orbitozygomatic reconstruction. J Craniomaxillofac Surg 2017; 45:1043-1050. [DOI: 10.1016/j.jcms.2017.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/30/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022] Open
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Kühnel TS, Reichert TE. Trauma of the midface. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc06. [PMID: 26770280 PMCID: PMC4702055 DOI: 10.3205/cto000121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.
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Affiliation(s)
- Thomas S Kühnel
- Department of Otolaryngology, Head & Neck Surgery, University of Regensburg, Germany
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Morrison CS, Taylor HO, Collins S, Oyelese A, Sullivan SR. Use of intraoperative computed tomography in complex craniofacial trauma: an example of on-table change in management. Craniomaxillofac Trauma Reconstr 2014; 7:298-301. [PMID: 25383151 DOI: 10.1055/s-0034-1378179] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 12/27/2013] [Indexed: 10/25/2022] Open
Abstract
The primary goals in repairing complex craniofacial fractures are restoration of occlusion and mastication, and anatomic reconstruction of a symmetric facial skeleton. Failure to accomplish these goals may result in the need for secondary operations. Recognition of malreduction may not be appreciated until review of a postoperative computed tomographic (CT) scan. Intraoperative CT scanning enables immediate on-table assessment of reduction and fixation, allowing alteration of the surgical plan as needed. We report using intraoperative CT scanning while repairing a panfacial injury in which malreduction was appreciated intraoperatively and corrected. Intraoperative CT can be used to improve outcomes and quality of complex facial fracture repair.
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Affiliation(s)
- Clinton S Morrison
- Department of Plastic Surgery, Rhode Island Hospital and Hasbro Children's Hospital, Providence, Rhode Island ; Departments of Surgery, the Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Helena O Taylor
- Department of Plastic Surgery, Rhode Island Hospital and Hasbro Children's Hospital, Providence, Rhode Island ; Departments of Surgery and Pediatrics, the Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Scott Collins
- Department of Radiology, Rhode Island Hospital and Hasbro Children's Hospital, Providence, Rhode Island
| | - Adetokunbo Oyelese
- Department of Neurosurgery, the Warren Alpert Medical School of Brown University, Providence, Rhode Island ; Department of Neurosurgery, Rhode Island Hospital and Hasbro Children's Hospital, Providence, Rhode Island
| | - Stephen R Sullivan
- Department of Plastic Surgery, Rhode Island Hospital and Hasbro Children's Hospital, Providence, Rhode Island ; Departments of Surgery and Pediatrics, the Warren Alpert Medical School of Brown University, Providence, Rhode Island
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