[Application of 3D printing in the treatment of unilateral comminuted zygomatic bone fracture]

To explore the validity of 3D printing technique in the treatment of unilateral comminuted zygomatic bone fracture.

METHODS

Twenty-one patients with unilateral comminuted zygomatic bone fracture were included in the present study, which were treated from hospital January 2014 to April 2017. All patients underwent CT scan and the data were imported in Mimics 10.01 software. The zygomatic bone of healthy side was mirrored to the fracture side to rebuild a "perfect" reduction model. Bone fixation plates were pre-modeled on the model printed by a 3D printing machine and used for bone reduction and fixation during operation. Three dimensional measurements were performed to evaluate the validity of 3D printing based on pre- and post-operative three dimensional CT model. SPSS25.0 software package was used to perform paired t test on the measured data.

RESULTS

No significant difference were observed between postoperative CT model and preoperative "perfect" reduction model. All patients were satisfied with their facial appearance.

CONCLUSIONS

3D printing technique is helpful to improve the accuracy of reduction of unilateral comminuted zygomatic bone fracture via preoperative pre-modeling.

Maxillofacial injury

This chapter has emphasized the relative infrequency of severe skeletal maxillofacial injuries in children. When they do occur, it is extremely important that they be approached by a team of physicians, each of whom is competent to manage the injury and complications related to his specialty. Particular attention must be given to the issues of general facial bone growth as well as future dental development. All operative procedures must be designed to avoid further injury to unerupted teeth, and the traditional methods of immobilization must be modified in order to avoid the avulsion of deciduous teeth.

Management of facial fractures

This article presents up-to-date information for the emergency medicine community on several patterns of facial fractures and their associated injuries. The article contains information about the anatomic structure and pathologic injuries that occur in the setting of facial trauma and guides the emergency medicine community in the thorough physical and diagnostic evaluation, emergent treatment, and proper surgical or outpatient treatment.

Treatment cost of patients with maxillofacial fractures at the University Hospital in Mostar 2002-2006

The aim of this study was to establish the costs structure of medical treatment for the patients with maxillofacial fractures, to perform a treatment cost evaluation, describe the factors which considerably influence the costs and discover the ways of achieving financial savings in treated patients. The study group consisted of patients with maxillofacial fractures who were admitted and treated at the Department of Maxillofacial Surgery of the University Hospital Mostar in the period from January 2002 until December 2006. Data for the study were collected from the patients' databases, case histories and data obtained on the basis of individual payments for the treatment that was collected by Finance Department of the University Hospital of Mostar Most patients in this study were men (83%), of average age 34 +/- 19 years. Zygomatic bone fracture was the commonest injury. Open surgical procedure was performed in 84.7% of treated cases. The costs for the open procedure were considerably higher than conservative treatment. Medication cost made up a total of 37.9% and cost of hospital accommodation 27.3% out of total hospital charge. Cost reduction in treated patients with maxillofacial fractures should be achieved through protocols of urgent treatment of maxillofacial trauma patients immediately after sustaining an injury and with earlier discharge of the patients when postoperative complications are not expected.

[Forensic medical criteria for the assessment of severity of harm to the health in subjects with zygomatic bone fractures]

Expert reports concerning subjects with zygomatic bone fractures were analysed and comprehensively evaluated using investigatory, clinical and anamnestic data. A total of 704 forensic medical reports were available for the purpose including 225 (32%) isolated and 479 (68%) combined fractures. It was shown that most complications of zygomatic fractures develop late in the post-traumatic period which requires repeated examination of the patients within at least one month after the injury. It is emphasized that such examination must involve neuropathologist, ophthalmologist, and maxillofacial surgeon to adequately evaluate harm to the health in patients with isolated zygomatic fractures. The main causes of discrepancy between results of estimation of harm to the health during primary and subsequent forensic medical examination of subjects with zygomatic fractures are considered.

Zygomatic fractures managed by closed reduction: an analysis with postoperative computed tomography follow-up evaluating the degree of reduction and remaining dislocation

PURPOSE

To evaluate possible associations between the degree of reduction, remaining dislocation (mm), fracture type, and the sequelae from which the patient may suffer postoperatively in patients with zygomaticomaxillary fracture managed by closed reduction.

MATERIAL AND METHODS

A 3-year retrospective audit was undertaken to identify all patients who had sustained a fractured zygoma and were operated on by closed reduction at the Ear, Nose, and Throat Department, Karolinska University Hospital, Huddinge, Sweden. Patients were followed up by mail questionnaire and postoperative computed tomography (CT).

RESULTS

The odds of having symptoms (odds ratio [OR] 4.26, confidence interval [CI] 1.09-18.44) was significantly higher in the group with a reduction less than 100% (n = 34) compared with the group with 100% reduction (n = 17) (P = .035). The odds of having symptoms (OR 9.91, CI 0.89->500) was higher in the group with remaining dislocation 6 to 10 mm compared with the group with no remaining dislocation (P = .069). The type of fracture (A, B, or C) also influenced the patients' postoperative symptoms. The odds of having symptoms was 48.40 (CI 4.60->500) times higher having fracture C compared with fracture A (P < .001).

CONCLUSIONS

The degree of reduction and remaining dislocation of zygomaticomaxillary fractures is important to achieve a good postoperative result, that is, reducing the patient's postoperative symptoms. Furthermore, the type of fracture also influences the patient's long-term sequelae.

Clinical Analysis of Isolated Zygomatic Arch Fractures

PURPOSE

The purpose of this study is to analyze the characteristics of isolated zygomatic arch fractures and to evaluate the functional and radiological outcomes of the treatment.

PATIENTS AND METHODS

Forty patients with isolated zygomatic arch fractures were analyzed clinically.

RESULTS

The patients were 25 males and 15 females with an average age of 42 years. The cause of injury was traffic accident in 26, followed by fall in 8, sports in 3, and assault in 3. The left side was involved in 25 cases. Fractures were classified into 5 types according to the degree of displacement and loss of bone contact. Reduction was performed in 31 patients, 26 treated by the Gillies temporal approach. Conservative treatment was chosen in 9 patients. The reduction status was excellent in 12 cases, good in 17 cases, and fair in 2 cases. There was no difference in the reduction status in terms of the fracture types or the interval between reduction and injury. Interincisal distance (IID) at maximal mouth opening recovered from 33.4 to 43.8 mm by excellent reduction, from 26.2 to 42.2 mm by good reduction, from 27.5 to 40 mm by fair reduction, and from 41 to 46.6 mm by conservative treatment.

CONCLUSIONS

Good functional and radiological outcomes were obtained in isolated zygomatic arch fractures. Reduction status was not influenced by either the fracture type or the interval between reduction and injury, and recovery of IID was similarly achieved by excellent, good, and fair reduction.

A New Proposal of Classification of Zygomatic Arch Fractures

PURPOSE

Among facial fractures, zygomatic arch fractures occur rather frequently. Facial fractures have recently been classified in fine detail according to computed tomographic findings. Nevertheless, there exists no classification of the zygomatic arch fracture, which has a physiognomically important place, to provide guidance for treatment. We aimed to make a detailed classification of zygomatic fractures in various shapes, which does not exist in the literature, and to form an algorithm for treatment.

PATIENTS AND METHODS

A total of 451 patients with zygomatic arch fractures treated in our clinic from 1987 through 2004 were assessed retrospectively from the treatment viewpoint together with radiological and clinical findings.

RESULTS

At the end of this assessment, arch fractures were divided into 2 groups: 1) isolated fractures in which the zygomatic arch alone broke, and 2) combined fractures in which the zygomatic arch broke together with the other facial bones. Isolated fractures were also divided into 2 subgroups as A) 2 fractures in the arch, and B) more than 2. Isolated arch fractures with more than 2 fracture lines were also classified as V-shaped fractures where fragments are partially reduced and those where fragments are displaced. As for combined fractures, they were subgrouped as A) single fracture in the arch, and B) plural. Plural fractures were further classified within their own group, also according to whether fragments were displaced or not.

CONCLUSION

In the 2 fractures and V-shaped fracture subgroups of isolated fractures, preservation of fragments in reduced position was satisfactory during the closed reduction and afterwards. As for those with more than 2 fractures of isolated arch fractures, they required open reduction and internal rigid fixation. The same treatment was used in combined zygomatic arch fractures where there were more than one displaced fractures. In addition to classification, we formed an algorithm to guide us in treatment based on our series.

Treatment of tripod fracture of zygomatic bone by N-2-butyl cyanoacrylate glue fixation, and its effects on the tissues

The standard treatment of zygomatic bone fractures is fixation by microplates or miniplates and screws today. It is very difficult to place plates and screws into thin bones or small bone fragments especially in the facial bones and bones adjacent to important structures. Cyanoacrylate is used as a hemostatic agent, an embolic agent, in retinal tears, in corneal ulcers, in fixation of mandibular osteotomies and in craniofacial surgery. N-2-Butyl cyanoacrylate is a form of cyanoacrylate which is bioabsorbable and biocompatible. It is easily applied to the tissues. We aimed to determine the effect of N-2-butyl cyanoacrylate in the fixation of displaced zygomatic bone fractures. We examined the histotoxicity and the effects on healing and foreign body reaction of N-2-butyl cyanoacrylate. Eight New Zealand white rabbits underwent zygomatic osteotomies bilaterally. The fractures on left sides of the rabbits were determined as study site and right sides as control site. Knight and North classification of zygomatic bone fractures were used and group 4 fractures were made bilaterally. Open reduction of fractures was performed bilaterally and N-2-butyl cyanoacrylate was applied only on left sides. No fixation was made on right sides representing the control group. Postoperatively in the first, second, third and fourth weeks, two rabbits were sacrificed and the fracture sites were examined macroscopically and histopathologically. In the glued study group, fixation was obtained in all cases whereas in the control group, all the fractures were seen to be displaced. Tissue reaction was similar in the study and the control groups.

Midfacial fractures in children and adolescents: a review of 492 cases

We studied the records of children and adolescents admitted to our hospital with facial fractures between 1993 and 2002. During the 10-year period, 492 patients with 555 midfacial fractures were treated. Their ages ranged from 1 to 18 years, the peak incidence being between 16 and 18. Three-hundred and eighty (77%) were boys. The zygoma was the most commonly fractured bone (n = 286), and the hard palate the least commonly fractured (n = 6). Motor-vehicles were responsible for 272 (55%) of all fractures. Most fractures were treated by closed reduction, and only 139 (25%) were treated by observation. Complications, including unsatisfactory fracture repair and infection, were recorded in 18 (4%) and the overall mortality was 1% (n = 8).

Classification System and Treatment of Zygomatic Arch Fractures in the Clinical Setting

A new classification system and algorithm of zygomatic arch fractures is described that provides the surgeon with a useful starting point from which to organize a valid treatment plan and management of zygomatic arch fractures. Hönig Merten (HM) class I is defined as an isolated tripod fracture, HM class II as an isolated stick fracture of the arch, and HM class III is a combined fracture of the malar bone and the zygomatic arch. Although reduction of the class I and II is usually closed, open reduction is mandatory in class III zygomatic arch fractures.

Bone induction capacity of the periosteum and neonatal dura in the setting of the rat zygomatic arch fracture model

OBJECTIVES

Osteogenic properties of the dura and periosteum are thought to contribute to the regenerative capacity of membranous bone tissue. The purpose of this investigation was to elucidate (1) whether dura without underlying neural tissues can induce osteogenesis, (2) to what extent the periosteum participates in membranous bone healing, and (3) the difference between dura-induced and periosteum-induced osteogenesis.

METHODS

A standardized 2-mm defect was created within the middle portion of each zygomatic arch in 30 Wistar albino rats. The rats were divided into 3 groups, 10 animals in each group. In group 1, the periosteum was removed and neonatal dura grafts were transplanted onto the zygomatic arch bone defect circumferentially. In group 2, the overlying periosteum was preserved. In group 3, the periosteum was removed. At 3 and 10 weeks, animals from each group were killed, and specimens were obtained. Data were collected from the 3-dimensional computed tomographic scans and histologic studies to compare the extent of bony repair.

RESULTS

Fracture sites demonstrated osteogenesis associated with chondrogenesis in groups 1 and 2 and only limited osteogenesis with no chondrogenesis in group 3. In some animals in group 3, cortical bone ends underwent resorption. In groups 1 and 2, bone defects were obliterated by the formation of the mature compact bone at 10 weeks postoperatively. The difference between bone regeneration in these groups was not significant (P =.16). In group 3, the defects failed to heal by bony union, and in most of the samples the fibrous union was observed instead. The difference between groups 1 and 3 was significant (P =.03). The difference between groups 2 and 3 was not significant (P =.09).

CONCLUSIONS

The trend toward significance is in agreement with the current clinical practice of preserving periosteum in the manipulations of the membranous bone defects. Newborn dura can exert a potentiating effect on osteogenesis.

Zygomatic complex fractures at the University College Hospital, Ibadan, Nigeria

OBJECTIVE

To determine the pattern of zygomatic complex fractures in a Nigerian population.

DESIGN

A prospective study of cases managed.

SETTING

University College Hospital, Ibadan, Nigeria.

SUBJECTS

Seventy six patients seen and managed between 1995 and 1999.

RESULTS

The most common aetiological factor was road traffic accidents (81.6%). The male/ female ratio was 5.3:1. Most of the fractures occurred in the age group 21-30 years (51.3%). The most common fracture type was type 3 (32.5%) while open reduction and transosseous wiring was the most commonly performed surgical procedure for the management of zygomatic complex fractures in this study (46.25%).

CONCLUSION

There is a need to pay attention to the improvement in automobile safety devices, compliance by motor vehicle occupants and improvement in rules and regulations guiding sporting activities.

Transcutaneous reduction and external fixation for the treatment of noncomminuted zygoma fractures

PURPOSE

This study evaluated the effectiveness of the treatment of noncomminuted monofragment zygoma fractures with closed reduction using transcutaneous threaded pins and an external fixation device instead of open reduction and internal rigid fixation.

PATIENTS AND METHODS

In 46 patients, transcutaneous pin was inserted into the center of the fractured zygoma, and the segment was reduced by moving the pin to counteract the initial vector force of injury. After reduction, the fractured segment was immobilized by the external fixation device for 9 to 14 days.

RESULTS

All patients except one showed accurate fracture reduction without malunion or any complications.

CONCLUSION

This method has advantages over the conventional closed methods in the management of uncomplicated noncomminuted fractures of the zygoma.

Information on infraorbital nerve damage from multitesting of sensory function

Sensory disturbance following orbitozygomatic complex fractures was studied in 65 patients from 4 treatment groups which represented potentially varying degrees of sensory disturbance. The fracture-type-dependent treatments were: no surgical intervention (n = 20), closed reduction with or without wire fixation (n = 17), open reduction with miniplate fixation (n = 15) and/or reconstruction of the orbital floor (n = 13). In order to assess the sensory function of different classes of afferent fibres, several methods of sensory testing were applied. On average 6.3 months after treatment, the patient's report was obtained, and tests regarding touch, two methods of two-point discrimination, and cold were applied on the cheek and upper lip. The degree of sensory disturbance was method-dependent. In patients who underwent closed reduction, pronounced levels of positive correlation occurred between results from different tests or from both test sites. The levels of these correlations were, in general, low for all other treatments. These findings suggest that afferent fibres of both large and small diameter tended to be permanently damaged in the patient group with closed reduction. In contrast, the types of sensory afferent fibres that were involved in the trauma and/or their recovery were highly variable within patients and sites for all other treatment groups.

[Zygomatic fractures]

The zygomatic bone is important for the midfacial contour and for protection of the orbital contents. Zygomatic fractures frequently occur. Because they are hidden behind a simple black eye in many instances, there is a potential risk of missing the diagnosis. Fresh zygomatic fractures are relatively easy to treat, but late secondary corrections are difficult and often have dissatisfying results. The most important clinical signs of a zygomatic fracture are: flattening of the zygomatic contour, edema, haematoma, unilateral nose-bleeding, disturbed sensibility, diplopia, restricted mandibular movements, contour defects. In this paper the clinical signs of a zygomatic fracture are emphasized to enable the general practitioner to examine the patient with a simple black eye appropriately and be able to recognize a zygomatic fracture.

Transcatheter arterial embolization as treatment for life-threatening maxillofacial injury

A rare case of massive maxillofacial hemorrhage, which was controlled by transcatheter arterial embolization, is reported. A 23-year-old man with massive nasal and oral hemorrhage caused by maxillofacial fracture was admitted. Emergency angiography demonstrated extravasation of contrast material from the posterior superior alveolar artery, which was immediately embolized using gelatin sponge particles. This case shows that transcatheter arterial embolization is useful and effective for the treatment of massive hemorrhage resulting from severe maxillofacial injury.

Epistaxis balloon catheter stabilization of zygomatic arch fractures

Isolated zygomatic arch fractures represent about 10% of facial fractures. Most are easily reduced, but about 7% require fixation. Stabilization with plates, transcutaneous wiring, and various packing materials may involve additional morbidity and other drawbacks. A double balloon epistaxis catheter may be inserted beneath the arch fracture site and inflated for 5 to 7 days as a relatively simple, reliable alternative that involves minimal morbidity.

Temporal approach for reduction of zygomatic fractures. Clinical results and advantages of the technique

We have used closed reduction based on Gillies' method using an original Y-shaped zygomatic elevator in 50 cases after radiographic evaluation of the displacement by three directional radiography. No patients had residual restriction of mandibular motion, double vision or facial asymmetry. Radiography showed poor reduction in two cases, and displacement of the initial reduction in three. In all other cases, satisfactory results were achieved.

Aetiology of maxillofacial fracture

The aetiological factors associated with maxillofacial fractures, and the trends in these factors over a 13 year period are reported. The First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokyo Medical and Dental University, managed 695 patients with maxillofacial fractures between 1977 and 1989. The male to female ratio was 3.2:1 and the majority of patients were aged between 10 and 30 years old. Road traffic accidents and accidental falls were the main causes of fractures throughout the 13 year study period. Mandibular fractures occurred in 477 patients (68.6%). A high percentage of patients were treated by closed reduction and maxillo-mandibular fixation, or occlusal splinting.

The Kirschner wire guide

The Kirschner wire guide is a useful means of introducing K-wires into the facial skeleton. It can be easily constructed in the maxillofacial laboratory and its use allows accurate positioning of K-wires, especially in fractures of the zygomatic complex.

Pediatric facial fractures: evolving patterns of treatment

This study reviews the treatment of facial trauma between October 1986 and December 1990 at a major pediatric referral center. The mechanism of injury, location and pattern of facial fractures, pattern of facial injury, soft tissue injuries, and any associated injuries to other organ systems were recorded, and fracture management and perioperative complications reviewed. The study population consisted of 137 patients who sustained 318 facial fractures. Eighty-one patients (171 fractures) were seen in the acute stage, and 56 patients (147 fractures) were seen for reconstruction of a secondary deformity. Injuries in boys were more prevalent than in girls (63% versus 37%), and the 6- to 12-year cohort made up the largest group (42%). Most fractures resulted from traffic-related accidents (50%), falls (23%), or sports-related injuries (15%). Mandibular (34%) and orbital fractures (23%) predominated; fewer midfacial fractures (7%) were sustained than would be expected in a similar adult population. Three quarters of the patients with acute fractures required operative intervention. Closed reduction techniques with maxillomandibular fixation were frequently chosen for mandibular condyle fractures and open reduction techniques (35%) for other regions of the facial skeleton. When open reduction was indicated, plate-and-screw fixation was the preferred method of stabilization (65%). The long-term effects of the injuries and the treatment given on facial growth remain undetermined. Perioperative complication rates directly related to the surgery were low.

Fractures of the facial skeleton in children

Fractures of the facial skeleton are infrequent in children. A series of 147 fractures in 116 children aged from 10 days to 13 years old was retrospectively reviewed. The male to female ratio was 1.4:1 and the highest incidence occurred in the age group 8 to 10 years. The main aetiological factor was road traffic accidents. The mandible was predominantly involved (83.7%). The incidence of fractures of the middle third of the face was very low (4.0%). Closed reduction was undertaken most frequently. Complications were found to be minimal.

[Midfacial and mandibular fractures during the growth period]

This study investigated the occurrence of primary and secondary complications following conservative versus surgical intervention in the treatment of midface and lower jaw fractures. Follow-up studies were undertaken on 81 patients who had been admitted to the above clinic with such fractures during their adolescence. It was found that more complications developed after surgical intervention.

A technique for reducing fractures of the zygomatic complex under local anaesthesia

Fractures of the zygomatic complex are common. A technique is described which enables the majority of these fractures to be reduced under local anaesthetic, intravenous sedation and analgesia on an out-patient basis. The benefits to the patient and to the hospital are highlighted.

Toward CT-based facial fracture treatment

Facial fractures have formerly been classified solely by anatomic location. CT scans now identify the exact fracture pattern in a specific area. Fracture patterns are classified as low, middle, or high energy, defined solely by the pattern of segmentation and displacement in the CT scan. Exposure and fixation relate directly to the fracture pattern for each anatomic area of the face, including frontal bone, frontal sinus, zygoma, nose, nasoethmoidal-orbital region, midface, and mandible. Fractures with little comminution and displacement were accompanied by subtle symptoms and required simple treatment; middle-energy injuries were treated by standard surgical approaches and rigid fixation. Highly comminuted fractures were accompanied by dramatic instability and marked alterations in facial architecture; only multiple surgical approaches to fully visualize the "buttress" system provided alignment and fixation. Classification of facial fractures by (1) anatomic location and (2) pattern of comminution and displacement define refined guidelines for exposure and fixation.

[Analysis of 520 zygomatic fractures. 1]

A descriptive, longitudinal and retrospective study in carried out in a five-year period (1979-1983), during which treatment was provided for 520 patients with a zygomatic fracture diagnosis in the Maxillofacial Surgery services of the Saturnino Lora Surgical and Clinical Hospital. It was shown that Group III and IV zygomatic fractures are the most frequent and unstable, and that the latter ones are linked with the magnitude and direction of the displacement and especially with the duration of the course. The single reduction techniques are the most commonly used (76.5%), mainly Lothrop technique. It was found that those fractures for longer than seven days require combined reduction-contention techniques, except for Groups II and V. The combined management most commonly used was the Lothrop-Dingman. For frontozygomatic disjunction fractures 3 therapeutica variants were employed, according to the associated displacement and the postoperative stability. The contention means and method more commonly applied were the Foley catheter and the Jaraba-Kiviranta technique, respectively.

Reduction of the isolated fracture of the zygomatic arch using a bone hook

A simple technique for the speedy and effective reduction of isolated fracture of the zygomatic arch, using a standard orthopaedic bone hook, is described.

The influence of the mode of treatment of zygomatic bone fractures on the healing process of the infraorbital nerve

Several authors have described the influence of the method of treatment of a fracture of the zygomatic complex on the recovery of the infraorbital nerve. In this study, the results of treatment of 106 patients with an isolated, non-comminuted, unstable fracture of the zygomatic bone are presented. Thirty-eight patients underwent fixation with interosseous wiring and 68 patients were treated with a miniplate osteosynthesis across the frontozygomatic suture. In the group with wire fixation, 50% suffered persistent reduced sensitivity in the infraorbital region at follow-up examination, whereas in the group with a miniplate osteosynthesis only 22.1% had persistent neurological sequelae. On the basis of these findings we recommend a miniplate osteosynthesis in all unstable zygomatic bone fractures with displacement.

Stabilisation of the delayed zygomatic arch fracture

Most fractures of the zygomatic arch do not require active fixation after reduction. After the replacement of the fragments in the week following injury, fragments are held in correct position. Although fragments can be reduced after the first week, stabilisation cannot be provided properly. After several months, replacement of the fracture will be almost impossible. This report presents a technique by using an extraoral acrylic appliance in the delayed zygomatic arch fracture.

Some thoughts on the classification and treatment of Le Fort fractures

A system is proposed which defines the Le Fort fracture pattern more precisely and allows one to compare fractures and describe them adequately. The system involves a description of the highest level of Le Fort fracture on each side, a description of the fragment that carries the maxillary dentition, and a description of accompanying nasoethmoidal or mandibular fractures. The areas that must be considered for open reduction are thus precisely defined and represent the weak structural areas of the maxilla as defined by Le Fort in his experiments. Open reduction should progress from stable bone to stable bone, replacing with bone grafts those areas that are unsatisfactory for interfragment wiring. Aesthetic results obtained are superior and more predictable than after treatment with classical Adam's fixation.

Athletic facial injuries

Most facial injuries that occur during athletic activities are of a minor nature, consisting of lacerations, contusions, and abrasions. These are usually treated by a team physician or an emergency department physician. However, minor injuries must be differentiated from the more significant injuries, especially those involving facial bone fractures. Significant facial trauma must be diagnosed accurately and treated with precision to avoid permanent facial deformity. Soft-tissue trauma as well as fractures are included in this review, and evaluation of the injured athlete is emphasized. A systematic approach is developed for diagnosing and treating common facial injuries in athletes.

Treatment of isolated lateral midface fractures

In the management of recent fractures of the zygomatic bone and arch we prefer transcutaneous repositioning with a sharp hook. If additional fixation is necessary, wire sutures are used. The advantages of osteosynthesis with wire suturing and the treatment of simultaneous fracture of the orbital floor are presented and discussed.

Morbidity associated with the use of antral packs and external pins in the treatment of the unstable fracture of the zygomatic complex

One hundred and forty-seven patients with unstable fractures of the zygoma are discussed. Complications encountered during the treatment of such patients with antral packs and external pins are compared. These results are evaluated.

The trans-nasal Kirschner wire as a method of fixation of the unstable fracture of the zygomatic complex

A technique for the fixation of the unstable zygomatic complex is described and compared with other methods currently available.