A zygoma fracture is often the result of facial trauma such as violence, falls or automobile accidents. Using free navigation reference points and prefabricated bone. The acute management of facial fractures springerlink. Delineation of zygomatic arch fractures is best performed by a. Pdf zygomaticomaxillary complex fracture researchgate. The classification of the present study distinguis. Treatment and complications of orbitozygomatic fractures scielo. Aug 01, 1992 surgical anatomy the term tripod fracture attributed to a specific type of zygomatic fracture is a misnomer because, along with its frontal, maxillary, and temporal articulations, the orbital extension of the zygoma has a broad abutment against the greater wing of the sphenoid, thus rendering it a tetrapod. The data recorded included patient sex, age, etiology, diagnosis, pattern of zygoma fracture, dislocation of fractures. Through the incision just below the lower eyelid s. Zygomatic arch fracture open reduction with stablization using micro plates wiring.
Predicting zygoma fractures from baseball impact brc online. The displacement of the fractured zygomatic arch may also limit the mouth opening due to mechanical impairment of the coronoid process of the mandible ellis. Classification and treatment of zygomatic fractures. Intraoral reduction of the fracture is seen being performed under genera. Open correction of zygomatic fractures plastic surgery key. Intraoral reduction of a fracture of the zygomatic arch with a finger. Predicting zygoma fractures from baseball impact authors mr. This pdf is available for free download from a site hosted by medknow publications.
Injury to this facial bone was most likely recognized for many years before the appearance of records on the subject. Using free navigation reference points and prefabricated bone plates for zygoma fracture model surgeries tienhsiang wang1,2,4 hsu ma1,4 chingshiow tseng2 yihong chou3,4 kunlin cai2 received. Download fulltext pdf download fulltext pdf read fulltext. Surgical approaches and fixation patterns in zygomatic complex fractures. This study was designed to investigate epidemiological data age, gender, fracture sites malar bone, zygoma arch, fracture etiology and surgical approach. Operative techniques in plastic surgery 3volume set pdf. V shaped fracture of the right zygomatic arch before and after developments in this field, and advocate their use to improve reduction with a finger. This video clipping shows fracture of right zygoma following road traffic accident. Contraction of the muscle causes vertical grooves in the glabellar skin and imparts an angry expression. We report a case of a patient with a 9day history of trismus measured at 9 mm figure 1. Protection of reduction to prevent postoperative displacement of the reduced zygomatic arch, protection to the side of the face should be provided.
The fracture complex results from a direct blow to the malar eminence and results in three distinct fracture components that disrupt the anchoring of the zygoma. Ppt zygomatic complex fractures powerpoint presentation. Abstract the purpose of this study is to develop injury risk functions that predict zygoma. Orif was defined as reduction and rigid miniplate fixation of at least one of the zygoma. Reduction of fractures of the zygomatic arch using a finger. Etiology and pattern of zygomatic complex fractures.
Clinically, the depressed arch fracture has impinged on the coronoid process producing the limitation in mouth opening. The treatment of zygomatic fractures varies among surgeons, and the cosmetic. A free powerpoint ppt presentation displayed as a flash slide show on id. The study was conducted at department of plastic sur ger y. Surgical management of zygomatic complex fractures in a major. Jun 29, 2020 type a1 zygomatic arch fracture nondisplaced fractures of the zygomatic arch are often observable, whereas displaced fractures of the zygomatic arch require reduction, which is possible via a gillies approach via a temporal incision, a transcutaneous carollgirard screw directly over the depressed fracture site, or a keen approach via a. Orif was defined as reduction and rigid miniplate fixation of at least one of the zygoma buttresses. Jan 05, 2018 rowe and killey classification type 1. Definitions zygoma is a very crucial component which maintains facial contour.
It ranges from henderson i, which is an undisplaced fracture at any site, to henderson vii, which is a comminuted fracture. Pdf the clinical presentation and management of zygomatic. Materials and methods this pdf is available for free download from a site hosted by medknow publications. Radiologic assessment of maxillofacial, mandibular, and.
Surgical management of zygomatic complex fractures in a. In the area where it inserts to the body of the zygoma it is commonly 4 mm or more in thickness. Symptoms include flattening of the face, trismus reduced opening of the jaw and lateral subconjunctival hemorrhage. Avoid and manage common complications associated with zygomatic fracture repair. A pure blowin fracture is one limited to the orbital walls while the orbital rim remains intact figs. Rome, italy in the treatment of zygomatic complex fracture patients. Fractures of the zygomatic arch za or any of its bony. The zygomatic arch, which lies lateral to the zygoma, includes the temporal process of the zygoma and the zygomatic process of the temporal bone. After maxillofacial injuries, the possibility of fractures of the zygoma and zygomatic arch should always be considered and adequately investigated. Economic analysis of open approach versus conventional. Single transconjunctival incision and twopoint fixation. Since the zygoma is a solid bone, a direct blow to the cheek usually results in fractures of its relatively weaker articulation points. Nov 24, 2019 unless the fracture is a pure fracture of the zygomatic arch, all zygomatic complex fractures also result in orbital fractures, commonly of the of and lateral orbital wall.
Eight zygomatic fractures were created in four skull models, and preoperative. This article presents an evidencebased, systemic approach to the assessment and trea. The trismus occurred immediately after an alleged assault with punch injuries to the face. This is the largest reported survey on the repair of zygoma fractures. One point fixation of zygomatic tripod fractures in the. The malar complex refers to the zygoma and maxillary bones and therefore forms part of the orbital floor and lateral orbital wall. They are seen as isolated or in association with other facial fractures due to the complex midface anatomy 46. The standard treatment for zygomaticomaxillary complex zmc fracture has been open.
Dec 03, 2018 the zygomatic bone occupies a prominent and important position in the facial skeleton. Using free navigation reference points and prefabricated. The data recorded included patient sex, age, etiology, diagnosis, pattern of zygoma fracture, dislocation of fractures, associated facial and general trauma, methods of treatment. Fractures of the zygomatic complex occur worldwide and are a component part of. Zygomatic complex fractures represent the second most common facial fracture after nasal fractures. The collapse of these regions is dependent on the direction of the impact, but in general, the most structurally impaired of these regions will collapse first. Management of zygomatic arch fractures by intraoral open. Referral and immediate treatment once diagnosed as a depressed zygoma fracture, john was referred to the maxillofacial. Closed treatment for zygoma, isolated zygomatic arch. Fractures of the zygoma are some of the most commonly treated facial fractures, yet reconstruction of the threedimensional structure of the zygomaticomaxillary complex can be challenging, and malunions are common. Eighty percent of the zygoma fractures were correctly identified, with respect to the side of the fracture, by the blinded examiner on the basis of the neurosensory measurements alone p free navigation reference points and prefabricated bone plates for zygoma fracture model surgeries tienhsiang wang1,2,4 hsu ma1,4 chingshiow tseng2 yihong chou3,4 kunlin cai2 received. Zygomatic bone alone is rarely involved in fractures. Evolution of technique is also evident by predominance of orif with emphasis of multiple points of exposure, reduction, and fixation with rigid hardware.
This document was downloaded for personal use only. Materials and methods from january 1st 2001 to december 31th 2009, 642 patients with zygomatic complex fractures were. To transfer the spatial information from the object to the navigation system. Zygomatic complex fractures musculoskeletal system. In these patients fracture lines in zygoma could be seen only in. The blowin fracture is an inwardly displaced fracture of the orbital wall andor rim resulting in a reduced orbital volume. In all probability many instruments and methods were devised. Other fracture patterns, include isolated zygomatic arch fractures, or zmc fractures with associated panfacial fractures, such as le fort ii and iii. The diagnosis of such fractures can be made by one or. The zygoma forms a significant portion of the floor and lateral wall of the orbit and forms a portion of the zygomatic arch, otherwise known as the malar eminence, which plays a key role in the determination of facial morphology. A zygoma fracture zygomatic fracture is a form of facial fracture caused by a fracture of the zygomatic bone. Occipitomental xray illustrating two fractures in the left zygomati.
Treatment and complications of orbitozygomatic fractures. Patients were selected if they sustained an isolated zygoma fracture, based on the preoperative computed tomography scan, and were treated within 10 days of injury using either orif or the gillies method. The preference for open reduction and internal fixation of zygomatic fractures at three points has continued to grow in response to observations. Infraorbital nerve injury associated with zygoma fractures. Pdf on aug 21, 2014, srinivas m susarla and others published zygomaticomaxillary complex fracture find, read and cite all the research you need on. Note the flattening of the malar process on the left hand side of the face. Type 2 zygomatic arch type 3 tripod fracture intact fz suture type 4 tripod fracture distracted fz suture type 5 associated orbital floor fracture type 6 orbital rim fracture type 7 comminuted and other fracture fig. Furthermore, the zygoma is connected to the maxilla and sphenoid bone as part of the inferior orbital floor, and forms the lateral orbital margin with the frontal bone. Then, the surgeon freed the zygoma and monitored the reduction using a probing procedure, and the prefabricated bone plates were applied and fixed. The submentovertex view more clearly detects fracture of the zygomatic arch.
Orbito zygomatic fractures represent a type of maxillofacial injury that happens very often due to the. The most frequently associated maxillofacial fracture was mandibular 21. These are generally the result of highenergy trauma and are most commonly seen in association with other fractures 10, 11. A percutaneous hook is placed through the skin around the depressed zygomatic fracture segments and pulled laterally. Pdf management of zygomatic arch fractures by gillies. Trismus secondary to depressed zygomatic arch fracture.
Create a free personal account to download free article pdfs. A total of six zygoma fracture reductions were performed for the skull models. Trauma of the zygomatic complex constitutes 45% of all midface fractures. Comminuted fracture zygoma open reduction and fixation dr. The fractured fragments of a tripod or tetrapod zygomatic complex fracture near these suture lines needs to be restabilized by open reduction followed by fixation. A new classification of zygomatic fracture featuring.
The masseter attaches along the inferior zygomatic arch around the temporal surface of the zygoma and plays a role in the inferior displacement of the zygoma following fracture. Note fracture of zygomaticotemporal articulation arrow. The response rate suggests dominance of omfs in zygoma fracture care, an area pioneered by ps. Pdf reduction of fractures of the zygomatic arch using a.
Fractures of the zygomatic bone can present with complicated aesthetic and neurological pathology. Apr 12, 2012 background the zygoma plays an important role in the facial contour for both cosmetic and functional reasons. Efficacy of altered twopoint fixation in zygomaticomaxillary. The fractured fragments of a tripod or tetrapod zygomatic complex fracture near these suture lines needs. Oct 21, 20 mechanism of zygomatic injury direct blow malar eminence violent face blows contra lateral mid causes a fracture dislocation of the zygoma by reciprocal transfer of forces from the opposite side of the facial skeleton. This is a case of a road traffic accident just 24 hours back. He was punched in the face and then fell towards the ground hitting his face against a low stone wall. Zygomatic complex zmc fractures result when disarticulation of the zygomatic bone at the zygomaticofrontal suture along the lateral orbital.
Open reduction and internal fixation orif of fractured arch is indicated in specific clinical presentations. The surgical treatment of fracture dislocations of the zygoma and zygomatic arch has a long and interesting development. Xrays of the facial bones showed a depressed fracture of the zygomatic arch with a medial rotation of the zygomatic complex figure 2. The intact zygomatic complex is crucial in maintaining facial contours and also significantly contributes to orbital integrity. Comminuted fracture zygoma open reduction and fixation. Other anatomic landmarks of relevance include lockwoods suspensory ligament, whitnalls tubercle, and the lateral canthal tendon. Management of maxillofacial fracture open access macedonian. Zygomatic complex fractures free download as powerpoint presentation. Pdf surgical approaches and fixation patterns in zygomatic.
Fractures that involve the zygoma often occur at these four figure 1 suture sites, leading to a tetrapod fracture pattern, known as a zygomatic complex fracture zmc. Jan 02, 2015 the zygoma forms part of the floor and lateral wall of the orbit and the zygomatic arch is an important feature in the structure and appearance of the face. Sep 28, 2019 fraktur zygomatic pdf definitions zygoma is a very crucial component which maintains facial contour. Fractures involving zygoma is very common, in fact it is the second most common facial bone to the fractured following facial trauma next only to nasal bones. Any zygomatic fracture must include a discontinuity. Comparison of various surgical approaches and their complications can only be done objectively using outcome measurements which in turn require protocol management and longterm follow up. As the orbit is involved, a complete orbital exam is required to confirm that the patients globe and vision have not been compromised. This classification suggested by knight etal in 1961 helped to determine prognosis and optimal treatment modality for these individuals. These fractures are caused chiefly by automobile accidents, fist blows, and accidental falls. The medial head of the cs has motor innervation from the zygomatic branch of the facial nerve, whereas the lateral portion is supplied by the temporal branch of the nerve.
Surgical treatment of zygomatic bone fracture using two points. A zygoma fracture is often the result of facial trauma such as violence, falls or automobile accidents symptoms include flattening of the face, trismus reduced opening of the jaw and lateral subconjunctival hemorrhage see also. Fractures of this complex are one of the more common types of maxillofacial injuries to treat. This study suggests altered twopoint fixation of zmc fracture without accessing the zf suture. Duma publication biomedical sciences instrumentation symposium.
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