Optimization of management for zygomatic complex fractures: a study at tertiary care teaching hospital in Pakistan

The aim of this study was to determine the incidence, cause and characteristics of the zygomaticomaxillary complex fractures, modalities of treatment used and analysis of post operative complaints at tertiary care teaching hospital in Multan Pakistan and compare the findings with similar studies. Study was conducted on 97 patients treated for zygomatic complex fractures during the period of January 2006 to June 2008 in the oral and maxillofacial surgery unit and trauma centre of a tertiary care, Nishter [teaching] hospital in Multan Pakistan.Out of 277 maxillofacial injuries received at this teaching hospital, 97 individuals were treated for zygomatic fractures. Patients according to treatment modalities were classified into two basic groups; Group-I: open reduction and rigid fixation with mini or micro plates, Group-II: open reduction and fixation with soft stainless steel wire sutures. Data, regarding age, sex, location, etiology of zygomatic complex fracture, modality of treatment used and post operative complaints of patients, were collected, tabulated, analyzed and compared with similar other studies. Total of 97 patients were treated for Zygomaticomaxillary fractures, male to female ratio was 13:1, majority [53.6%] of patients belonged to age group of 16-30 years, isolated zygomatic complex fractures were 35.1% followed by associated fractures with mandible [33%] and with maxilla [25.8%], majority of patients [74.2%] were treated in G-I and [25.8%] were treated in G-II. Uneventful recovery was there in 93 individuals [95.9%], four patients [4.2%] had post operative complications in the form of enophthalmos, limited opening of mouth, facial asymmetry and infection at surgery site. These complications were subsequently treated successfully as a secondary procedure for all the patients. This study has shown that road traffic accidents are responsible for most zygomatic complex fractures in our environment. Zygomatic fractures are commonly associated with other facial fractures mainly mandible, open precise reduction and reliable internal miniplate fixation optimized the esthetic and functional results in treating such fractures

Optimization in treatment modality for mandibular fracture

This study aims to provide analysis of mandibular fracture treated in a tertiary care hospital during the period from 1 st January 2006 to 30 th June 2008, it also share the author's experience of using different modalities to treat mandibular fractures and their outcome for comparison with other similar studies in literature. One hundred and ninety nine patients with mandibular fractures were included in this study. The age, sex, etiology, fracture characteristics, associated facial injuries, various methods of management and postoperative complications were evaluated. According to treatment modality used, patients were classified into four groups; G-I, closed reduction [CR] and Maxillomandibular fixation [MMF], G-II, open reduction and internal fixation [ORIF] with miniplate, G-III, open reduction and internal fixation with wire, G-IV, closed reduction and acrylic splint fixation with circum-mandibular wiring. Road traffic accident was the commonest cause of mandibular fracture, with male to female ratio 8:1, age of the patients range from 3-68 yrs; mean age was 27 yrs with Std +/- 13.8. Majority of the patients belonged to age group 16 to 30 years, isolated mandible fractures were 72.9%, common site of fracture was parasymphysis [33.2%]. Mainly open reduction and internal fixation techniques employed for [110] cases [G-II] showed good results with fewer complications. The study re-emphasized that ORIF with miniplate osteosynthesis is a reliable method for mandibular fracture management with multiple advantages and fewer complications