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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: 2] [Impact Index Per Article: 2.0] [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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Pandya AR, Panneerselvam E, Vignesh A, Krishnakumar VBR. Evaluation of sub-brow approach to the frontozygomatic suture for Open Reduction and Internal Fixation (ORIF) of Zygomatico maxillary complex (ZMC) fractures: A prospective cohort study. Natl J Maxillofac Surg 2023; 14:55-62. [PMID: 37273427 PMCID: PMC10235740 DOI: 10.4103/njms.njms_106_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/30/2022] [Accepted: 10/19/2022] [Indexed: 06/06/2023] Open
Abstract
Introduction Contemporary incisions used to access the frontozygomatic (FZ) sutures are the lateral brow and upper blepharoplasty incisions which are associated with specific limitations and complications. The authors describe the use of sub-brow incision as an alternate approach for exposure of the FZ region. Methods This is a prospective cohort study involving patients requiring surgical management of zygomatico maxillary complex (ZMC) fractures with fixation at FZ suture alone or along with fixation at infra-orbital rim and/or zygomaticomaxillary buttress. A sub-brow incision was used to expose the fracture and fixation was done with a 4-hole miniplate. The parameters evaluated were specific to the FZ region (sub-brow incision), namely surgical access, bleeding, fracture exposure time, post-operative scar, and pain. Each patient was reviewed on 1st, 5th, 7th, 10th, 30th, and 90th day. Results The study sample included eight male patients. The mean age was 30 years. The sub-brow incision demonstrated favorable postoperative outcomes; adequate exposure was achieved in all 8 patients. The scar formation was found to be higher on the 7th day and the least scar formation was seen by the third month. The mean pain score was found to be high on first post-operative day and the least pain was seen by the 10th day. The mean score of surgical field bleeding was found to be 1.75 which signified mild bleeding according to Fromme's scale. The mean time taken for adequate exposure of the fracture was 6.62 min. All the assessment parameters were statistically significant (P value <0.01). Conclusion Sub-brow incision is an effective approach for ORIF of zygomatic fractures at FZ suture. The technique is quick, simple, and associated with minimal complications.
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Affiliation(s)
- Avadh R. Pandya
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, Tamil Nadu, India
| | - Elavenil Panneerselvam
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, Tamil Nadu, India
| | - Arun Vignesh
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, Tamil Nadu, India
| | - V B Raja Krishnakumar
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram Campus, Ramapuram, Chennai, Tamil Nadu, India
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Elkahwagi M, Eldegwi A. Minimally Invasive Single-Point Stabilization of Zygomaticomaxillary Complex Fractures. J Maxillofac Oral Surg 2022; 21:1355-1362. [PMID: 36896059 PMCID: PMC9989094 DOI: 10.1007/s12663-021-01520-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/22/2021] [Indexed: 11/29/2022] Open
Abstract
Objective This study aimed to present a minimally invasive surgical management of zygomaticomaxillary complex (ZMC) fractures with reduction and single-point stabilization over the frontozygomatic buttress. Methods This prospective cohort study was conducted on cases of ZMC fractures. The inclusion criteria were displaced tetrapod zygomatic factures, asymmetry of the facial bones, and unilateral lesion. The exclusion criteria were extensive skin or soft tissue loss, comminuted inferior orbital rim, limited ocular mobility, and enophthalmos. Surgical management included reduction and single-point stabilization over the zygomaticofrontal suture with miniplates and screws. The outcome measure was correction of the clinical deformity with less scarring and low postoperative morbidity. The late outcome was maintenance of a stable fixed reduced zygoma over the follow-up period. Results Forty-five patients were included in the study with a mean age of 30 ± 5.56 years. The study included 40 men and 5 women. Motor vehicle accident was the most common cause of fracture (62.2%). They were managed via lateral eyebrow approach with single-point stabilization over the frontozygomatic suture after reduction. Preoperative and postoperative and radiologic images were available. All cases had optimum correction of the clinical deformity. Postoperative stability was excellent in the follow-up period, which had a mean of 18.5 ± 7.81 months. Conclusion There is an increased interest in minimally invasive procedures, and concerns about scarring have increased. Therefore, single-point stabilization over the frontozygomatic suture provides good support to the reduced ZMC with low morbidity.
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Affiliation(s)
| | - Ahmed Eldegwi
- HNS and Maxillofacial Surgery, Mansoura University, Mansoura, Egypt
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Lee KS, Do GC, Shin JB, Kim MH, Kim JS, Kim NG. One-point versus two-point fixation in the management of zygoma complex fractures. Arch Craniofac Surg 2022; 23:171-177. [PMID: 36068692 PMCID: PMC9449097 DOI: 10.7181/acfs.2022.00164] [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: 04/07/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background The treatment of zygoma complex fractures is of crucial importance in the field of plastic surgery. However, surgical methods to correct zygoma complex fractures, including the number of fixation sites, differ among operators. Although several studies have compared two-point and three-point fixation, no comparative research has yet been conducted on one-point versus two-point fixation using computed tomography scans of surgical results. Therefore, the present study aimed to address this gap in the literature by comparing surgical results between one-point and two-point fixation procedures. Methods In this study, we randomly selected patients to undergo surgery using one of two surgical methods. We analyzed patients with unilateral zygoma complex fractures unaccompanied by other fractures according to whether they underwent one-point fixation of the zygomaticomaxillary buttress or two-point fixation of the zygomaticomaxillary buttress and the zygomaticofrontal suture. We then made measurements at three points—the zygomaticofrontal suture, inferior orbital wall, and malar height—using 3-month postoperative computed tomography images and performed statistical analyses to compare the results of the two methods. Results All three measurements (zygomaticofrontal suture, inferior orbital wall, and malar height) showed significant differences (p<0.05) between one-point and two-point fixation. Highly significant differences were found for the zygomaticofrontal suture and malar height parameters. The difference in the inferior wall measurements was less meaningful, even though it also reached statistical significance. Conclusion Using three parameters in a statistical analysis of imaging findings, this study demonstrated significant differences in treatment outcomes according to the number of fixations. The results indicate that bone alignment and continuity can be achieved to a greater extent by two-point fixation instead of one-point fixation.
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Affiliation(s)
- Kyung Suk Lee
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Gi Cheol Do
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jae Bong Shin
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Min Hyung Kim
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jun Sik Kim
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Nam Gyun Kim
- Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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Rohit, Vishal, Prajapati VK, Shahi AK, Prakash O, Ekram S. Etiology, Modalities of Zygomaticomaxillary Complex Fracture, open reduction and fixation. J Clin Exp Dent 2021; 13:e215-e220. [PMID: 33680322 PMCID: PMC7920566 DOI: 10.4317/jced.57445] [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: 06/08/2020] [Accepted: 09/23/2020] [Indexed: 12/01/2022] Open
Abstract
Background Zygomatic complex fracture is second most common mid face fracture and frequent amongst the maxillofacial trauma. Fracture pattern ranges from simple to comminuted and from minimally displaced to severely displaced depending on various factors.
Material and Methods 98 patients with zygomaticomaxillary complex fracture reporting during December 2017 to January 2020 were included in the study. On the basis of radiographic evaluation and computerized tomography scan (CT scan) with 3D reconstruction severity of fracture was assessed and different treatment options were selected.
Results Road traffic accident accounted as the leading cause of fracture (57.1%) followed by self-fall (16.3%), interpersonal violence (12.3%). Reduction and semi rigid fixation was done in (83.7%), in which 1-point fixation in (22.9%), 2-point fixation in (42.4%) and 3-point fixation in (18.4%). Rest 16.3 % of the cases were managed conservatively since they had minimal displacement.
Conclusions Road traffic incident was the main etiology in our study and younger age group patients were more involved. Occipitomental radiograph and computerized tomography scan (CT scan) were used to confirm the diagnosis and to determine the severity of displacement of zygomatic fracture on the basis of which treatment options were decided. Key words:Incidence, etiology and management zygomaticomaxillary complex fracture
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Affiliation(s)
- Rohit
- Tutor. Department of Oral and Maxillofacial Surgery. Dental Institute. Rajendra Institute of Medical Sciences
| | - Vishal
- Tutor. Department of Oral and Maxillofacial Surgery. Dental Institute. Rajendra Institute of Medical Sciences
| | - Virendra-Kumar Prajapati
- Professor. Head of Department. Department of Oral and Maxillofacial Surgery. Dental Institute. Rajendra Institute of Medical Sciences
| | - Ajoy-Kumar Shahi
- Associate Professor. Department of Oral and Maxillofacial Surgery. Dental Institute. Rajendra Institute of Medical Sciences
| | - Om Prakash
- Assistant Professor. Department of Oral and Maxillofacial Surgery. Dental Institute. Rajendra Institute of Medical Sciences
| | - Subia Ekram
- Tutor. Department of Oral and Maxillofacial Surgery. Dental Institute. Rajendra Institute of Medical Sciences
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Kim JH, Kim YS, Oh DY, Jun YJ, Rhie JW, Moon SH. Efficacy of Altered Two-Point Fixation in Zygomaticomaxillary Complex Fracture. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8537345. [PMID: 32258152 PMCID: PMC7103990 DOI: 10.1155/2020/8537345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/10/2020] [Accepted: 01/27/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To reconstruct a zygomaticomaxillary complex (ZMC) fracture, zygomaticofrontal (ZF) suture is the most reliable site to assess anatomical alignment and to secure rigidity. It has been chosen primary site to be fixed, but approach through the lateral eyebrow incision may leave a visible scar. This study suggests altered two-point fixation of ZMC fracture without accessing the ZF suture. METHODS In the retrospective study, a total of 40 patients with ZMC fracture were divided into two groups (group 1, two-point fixation and group 2, three-point fixation). Patient demographics and follow-up were evaluated, and degree of reduction including cortical gaps of ZF and inferior orbital (IO) area, protruding difference of zygoma, and malar difference using asymmetry index were measured through preoperative and postoperative CT. RESULTS Preoperatively, the means of ZF displacement, IO displacement, protruding difference of zygoma, and facial asymmetry index between the groups were not statistically different. The result was the same after the operation. However, all variables were significantly different before and after surgery within each group. Moreover, mean operation time was significantly different between groups (P value = 0.026). CONCLUSION Altered two-point fixation in ZMC fracture excluding incision approaching the ZF provides surgical efficacy and similar surgical outcomes to three-point fixation but offers reduced operation time and fewer complications.
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Affiliation(s)
- Jun Hyeok Kim
- Department of Plastic & Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ye Sol Kim
- Department of Plastic & Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Deuk Young Oh
- Department of Plastic & Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Joon Jun
- Department of Plastic & Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Won Rhie
- Department of Plastic & Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Suk-Ho Moon
- Department of Plastic & Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Kim SY, Nam SM, Park ES, Kim YB. Evaluation of one-point fixation for zygomaticomaxillary complex fractures using a three-dimensional photogrammetric analysis. J Otolaryngol Head Neck Surg 2019; 48:36. [PMID: 31362786 PMCID: PMC6668153 DOI: 10.1186/s40463-019-0359-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of treatment for zygomaticomaxillary (ZM) complex (ZMC) fractures is to achieve stability and restore aesthetic appearance through three-dimensional reduction and rigid fixation. The purpose of this study was to evaluate the stability and aesthetic appearance outcomes of one-point fixation using a three-dimensional photogrammetric analysis. METHODS From March 2014 to December 2014, 34 patients with ZMC fractures were treated by one-point fixation in the ZM buttress using unsintered hydroxyapatite (u-HA)/poly-L-lactide (PLLA) plates. Differences in soft tissue inter-malar height between the fractured side and unfractured sides were evaluated using photogrammetric analysis with a three-dimensional camera (Morphius®) at the preoperative and 1 week, 1 and 3 months after surgery. The differences in bony inter-malar height between the fractured and unfractured sides were evaluated using computer tomography at the pre-operative and 6 months after surgery. The paired t-test was used to compare differences in malar height. RESULTS Six months after surgery, 34 patients achieved satisfactory bony stability and symmetric malar appearances. Comparisons of differences in soft-tissue inter-malar height revealed statistically significant differences between the pre-operative period and 1 week and 1 month after surgery (p < .01). There was no statistically significant difference between 1 and 3 months after surgery. Comparison of differences in bony inter-malar height revealed a statistically significant difference between before and 6 months after surgery (p < .01). CONCLUSIONS When we conducted a three-dimensional photogrammetric analysis, although it has restricted surgical indications, one-point fixation of the ZM buttress using an u-HA / PLLA plate yielded reliable, satisfactory, and safe clinical results in patients with ZMC fractures. CLINICAL QUESTION / LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Se Young Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea
| | - Seung Min Nam
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea.
| | - Eun Soo Park
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea
| | - Yong Bae Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea
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Jazayeri HE, Khavanin N, Yu JW, Lopez J, Shamliyan T, Peacock ZS, Dorafshar AH. Fixation Points in the Treatment of Traumatic Zygomaticomaxillary Complex Fractures: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2019; 77:2064-2073. [PMID: 31132344 DOI: 10.1016/j.joms.2019.04.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE Controversy remains regarding the optimal degree of anatomic exposure, reduction, and fixation required during open reduction and internal fixation of zygomaticomaxillary complex (ZMC) fractures. We critically examined the reported data to compare the patient outcomes after various degrees of ZMC reduction and internal fixation. MATERIALS AND METHODS A systematic review and meta-analysis were designed to test the null hypothesis of no difference in outcomes between different degrees of fixation of ZMC fractures. The PubMed, EMBASE, Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov trial registries were queried. The quality of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation method. RESULTS Of 1213 screened studies, 13 met the inclusion criteria. Fracture instability at 3 months was greater with 2-point fixation (61.1%) than with 3-point fixation (10.6%; relative risk, 2.5, 95% confidence interval [CI], 1.4 to 3.3). Less vertical orbital dystopia was seen with 3-point fixation than with 2-point fixation (mean difference, 0.9 mm; 95% CI, 0.6 to 1.3 mm). The incidence of infection and malar asymmetry did not differ between the groups. The quality of evidence was very low to low. CONCLUSIONS The reported data were limited by low quality, retrospective studies. However, the meta-analysis of randomized control trial data suggested a superiority of 3 points of exposure and fixation regarding fracture stability. When 2 points appear to provide stable fixation, the potential benefits of a third point should be weighed against the cost, operative time, and exposure/periosteal stripping on a case-by-case basis.
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Affiliation(s)
- Hossein E Jazayeri
- DMD Candidate, Department of Oral and Maxillofacial Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Nima Khavanin
- Resident, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Jason W Yu
- Fellow, Hansjorg Wyss Department of Plastic and Reconstructive Surgery, New York University, New York, NY
| | - Joseph Lopez
- Resident, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | | | - Zachary S Peacock
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA
| | - Amir H Dorafshar
- Professor and Chief, Division of Plastic Surgery, Rush University Medical Center, Chicago, IL.
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Evaluation of Postoperative Stability After Open Reduction and Internal Fixation of Zygomaticomaxillary Complex Fractures Using Cone Beam Computed Tomography Analysis. J Craniofac Surg 2018; 29:980-984. [DOI: 10.1097/scs.0000000000004355] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ji SY, Kim SS, Kim MH, Yang WS. Surgical Methods of Zygomaticomaxillary Complex Fracture. Arch Craniofac Surg 2016; 17:206-210. [PMID: 28913285 PMCID: PMC5556838 DOI: 10.7181/acfs.2016.17.4.206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 12/02/2022] Open
Abstract
Background Zygoma is a major buttress of the midfacial skeleton, which is frequently injured because of its prominent location. Zygoma fractures are classified according to Knight and North based on the direction of anatomic displacement and the pattern created by the fracture. In zygomaticomaxillary complex (ZMC) fracture many incisions (lateral eyebrow, lateral upper blepharoplasty, transconjunctival, subciliary, subtarsal, intraoral, direct percutaneous approach) are useful. We reviewed various approaches for the treatment of ZMC fractures and discussed about incisions and fixation methods. Methods A retrospective review was conducted of patients with ZMC fracture at a single institution from January 2005 to December 2014. Patients with single zygomatic arch fracture were excluded. Results The identified 694 patients who were admitted for zygomatic fractures from which 192 patients with simple arch fractures were excluded. The remaining 502 patients consisted of 439 males and 63 females, and total 532 zygomatic bone was operated. Orbital fracture was the most common associated fracture. According to the Knight and North classification the most frequent fracture was Group IV. Most fractures were fixated at two points (73%). Conclusion We reviewed our cases over 10 years according to fracture type and fixation methods. In conclusion, minimal incision, familiar approach and fixation methods of the surgeon are recommended.
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Affiliation(s)
- So Young Ji
- Department of Plastic and Reconstructive Surgery, Dong Kang General Hospital, Ulsan, Korea
| | - Seung Soo Kim
- Department of Plastic and Reconstructive Surgery, Dong Kang General Hospital, Ulsan, Korea
| | - Moo Hyun Kim
- Department of Plastic and Reconstructive Surgery, Dong Kang General Hospital, Ulsan, Korea
| | - Wan Suk Yang
- Department of Plastic and Reconstructive Surgery, Dong Kang General Hospital, Ulsan, Korea
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Dakir A, Muthumani T, Prabu NP, Mohan R, Maity A. One point fixation of zygomatic tripod fractures in the zygomatic buttress through Keen's intraoral approach: A review of 30 cases. J Pharm Bioallied Sci 2015; 7:S238-41. [PMID: 26015722 PMCID: PMC4439682 DOI: 10.4103/0975-7406.155934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 10/31/2014] [Accepted: 11/09/2014] [Indexed: 11/04/2022] Open
Abstract
For decades, facial beauty and esthetics have been one of the most important quests of the human race. The lateral prominence and convexity of the zygomatic bone makes it the most important bone for providing the aesthetic facial look and sets up the facial width but at the same time this prominence and convexity makes this bone more vulnerable to injury. Zygomatic complex fractures or tripod fractures are the second most common fractures after nasal fractures among facial injuries. Several studies have been undertaken regarding the reduction and fixation of zygomatic fractures with mini plates and screws. In 2002 Fujioka et al in vivo studies successfully proved that one point fixation at the zygomaticomaxillary complex gives three point alignment and sufficient rigidity when the fractures are not comminuted. In this article, 30 cases have been reviewed with one point fixation of zygomatic complex tripod fractures at the zygomatic buttress through Keen's intraoral approach along with advantages and disadvantages.
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Affiliation(s)
- Abu Dakir
- Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India
| | - T Muthumani
- Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India
| | - N P Prabu
- Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Rakesh Mohan
- Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Abhishek Maity
- Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India
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Ramneesh G, Gulzar G, Sanjeev U, Rajinder M, Ranabir P, Nikhil G. A retrospective audit of hundred patients of orbitozygomatic fractures with brain injury. J Clin Diagn Res 2014; 8:NC04-6. [PMID: 25177598 DOI: 10.7860/jcdr/2014/9465.4547] [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: 03/29/2014] [Accepted: 06/06/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Orbitozygomatic fracture that most commonly accompanies craniofacial injury is a challenge for medical science to reduce complications and to attain aesthetically satisfying results. OBJECTIVE To summarize our experiences with the optimum management of orbito-zygomatic fractures. MATERIALS AND METHODS This retrospective study was aimed at investigating indications and surgical approaches for orbitozygomatic fractures with clinical follow-up, particularly with regard to postoperative complications. Since 2010, 100 cases with faciomaxillary injury were assessed for Orbitozygomatic fractures with the help of physical examination, non-invasive investigations including computed tomography of the orbit. Patients were retrospectively analysed for data, such as mechanism of injury, classification of fracture, and complications. RESULTS Amongst 100 consecutive patients with orbito-zygomatic fractures an overwhelming majority were males (n=83). In the age distribution a great majority (45%) were in 30-45 years age group, followed by 15-30 years (22%) and 45-60 years (18%). So in the productive age group i.e. 15-60 years age group were affected mostly (85%) in our series. Among different injury mechanism, Road traffic accident affected most (69%) that landed up in orbito-zygomatic fractures followed by altercations (22%). We preferred Open reduction and internal fixation (ORIF) for 68% of the patients with orbito- zygomatic fractures, followed by closed reduction (12%). CONCLUSION Ophthalmology consultation is recommended for all patients presenting with orbitozygomatic fractures, and is essential for patients with orbital blowout fractures, based on the high incidence of clinical ocular findings and injuries in this subgroup of patients.
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Affiliation(s)
- Garg Ramneesh
- Assistant Professor, Department of Plastic Surgery, Dayanand Medical College & Hospital , Ludhiana, Punjab, India
| | - Gupta Gulzar
- Assistant Professor, Department of Neuro Surgery, Dayanand Medical College & Hospital , Ludhiana, Punjab, India
| | - Uppal Sanjeev
- Professor, Department of Plastic Surgery, Dayanand Medical College & Hospital , Ludhiana, Punjab, India
| | - Mittal Rajinder
- Professor, Department of Plastic Surgery, Dayanand Medical College & Hospital , Ludhiana, Punjab, India
| | - Pal Ranabir
- Additional Professor, Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences , Jodhpur, Rajasthan, India
| | - Garg Nikhil
- Resident, Department of General Surgery, Dayanand Medical College & Hospital , Ludhiana, Punjab, India
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Comparison of 1-Point Fixation With 2-Point Fixation in Treating Tripod Fractures of the Zygoma. J Oral Maxillofac Surg 2011; 69:2848-52. [DOI: 10.1016/j.joms.2011.02.073] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 01/14/2011] [Accepted: 02/12/2011] [Indexed: 11/23/2022]
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