Clinical Manifestations, Management, and Ophthalmologic Complications of Orbital Roof Fractures and Zygoma Fractures

PURPOSE: To investigate the clinical manifestations, management, and ophthalmologic complications of orbital roof fractures and zygoma fractures. METHODS: A retrospective survey of 119 patients who visited Korea University Medical Center from June 2009 to June 2010 was performed. The sex, age, causes, fracture characteristics, neurologic injury, ocular injury, and combined facial bone fractures of patients who were diagnosed with orbital roof fracture and zygoma fracture were statistically analyzed. RESULTS: The mean age of patients with orbital roof fracture was 33.0 years old. The most common cause of orbital roof fracture was traffic accident (36.1%) with 6 patients receiveing surgical treatement (9.8%). Among the ophthalmologic diagnoses of the patients with orbital roof fracture, traumatic iridocyclitis was the most common (7 eyes) followed by eyeball rupture (2 eyes). The mean age of patients with zygoma fracture was 36.6 years old. The most common cause of zygoma fracture was traffic accident (32.8%), with 51 patients receiving surgical treatement (87.9%). Among the ophthalmologic diagnoses of the patients with zygoma fracture, traumatic iridocyclitis was the most common (6 eyes), followed by commotio retina (4 eyes). CONCLUSIONS: The present study regarding clinical characteristics and treatment of orbital roof fracture and zygoma fracture is helpful for ophthalmologists regarding the treatment of accompanying ophthalmologic complications.

A Survey of Patient Satisfaction after Treating Zygomatic Complex Fractures Using a Coronal Approach

PURPOSE: It is difficult to objectively evaluate the outcomes of plastic surgical procedures. The combination of aesthetic and medical factors makes outcome quantification difficult. In this study, fracture reduction accuracy was objectively evaluated in patients with zygomatic complex fractures. Patients satisfaction with the accuracy was also examined. In addition, the patients' overall satisfaction and discomfort due to complications were analyzed. METHODS: Eighty-five patients who had surgeries via bicoronal incision for zygomatic complex fracture from March 2006 to December 2009 were included in this study. Two plastic surgeons evaluated the accuracy of the fracture reduction with postoperative computed tomography. A survey questionnaire was administered to evaluate the patients' overall satisfaction and the impact of symptoms associated with the procedure on the patients' daily lives. RESULTS: The overall patient satisfaction rate was 82.1 +/- 10.9% (range, 45~100%). The level of deformation was 6.7 +/- 10.9%, the levels of discomfort in daily life due to pain, paresthesia, scar, and facial palsy were 8.5 +/- 13.2%, 5.8 +/- 8.9%, 4.4 +/- 9.9%, and 1.9 +/- 9.2%, respectively. According to the visual analogue scale, paresthesia was found to be the most frequent symptom (43.5%), and pain was the most troublesome symptom. CONCLUSION: The use of bicoronal incision for treating zygomatic complex fractures can cause various complications due to wide incision and dissection. However, this technique can provide optimized reduction and rigid fixation. Most of these postoperative complications can cause significant discomfort in the patient. It is thought that the use of correct surgical technique and the accurate knowledge of craniofacial anatomy will result in a reduction of complications and significantly increase patient satisfaction.

Quantitative Analysis of the Orbital Volume Change in Isolated Zygoma Fracture

PURPOSE: The zygoma(Zygomaticomaxillary) complexes make up a large portion of the orbital floor and lateral orbital walls. Zygoma fracture frequently causes the posteromedial displacement of bone fragments, and the collapse or overlapping of internal orbital walls. This process consequently can lead to the orbital volume change. The reduction of zygoma in an anterolateral direction may influence on the potential bone defect area of the internal orbital walls. Thus we performed the quantitative analysis of orbital volume change in zygoma fracture before and after operation. METHODS: We conducted a retrospective study of preoperative and postoperative three-dimensional computed tomography scans in 39 patients with zygoma fractures who had not carried out orbital wall reconstruction. Orbital volume measurement was obtained through Aquarius Ver. 4.3.6 program and we compared the orbital volume change of injured orbit with that of the normal contralateral orbit. RESULTS: The average orbital volume of normal orbit was 19.68cm3. Before the operation, the average orbital volume of injured orbit was 18.42cm3. The difference of the orbital volume between the injured orbit and the normal orbit was 1.18cm3(6.01%) on average. After operation, the average orbital volume of injured orbit was 20.81cm3. The difference of the orbital volume between the injured orbit and the normal orbit was 1.17cm3(5.92%) on average. CONCLUSION: There are considerable volume changes in zygoma fracture which did not accompany internal orbital wall fracture before and after operation. Our study reflects the change of bony frame, also that of all parts of the orbital wall, in addition to the bony defect area of orbital floor, in an isolated zygoma fracture so that it evaluates orbital volume change more accurately. Thus, the measurement of orbital volume in isolated zygoma fractures helps predict the degree of enophthalmos and decide a surgical plan.

Simultaneous Reduction of Contralateral Malar Complex in Cases of Unilateral Zygoma Bone Fracture

PURPOSE: Reduction by simply assembling bones is recognized as treatment for a zygoma fracture. However, in patients who originally had a protruding zygoma, the fractured parts look like malarplasty after the edema subsides, giving a soft impression which patients notice. Thus, we created symmetry through simultaneous contralateral malar reduction in a unilateral zygoma fracture. METHODS: In this study, the patients who had surgery between July, 2008 and December, 2009 with admission were object. In 76 patients with a zygoma fracture, the patients with bilateral zygoma fractures were excluded. Among 48 patients who had a reduction only after a unilateral zygoma fracture, the patients hoping for a reduction of their rough protruding zygoma were analyzed with front cephalometry. The study progressed on 22 patients who had simultaneous contralateral malar reduction in a unilateral zygoma fracture with consent. After fixing the fracture, we did a straight zygoma osteotomy through a 1.5cm intraoral incision. After that, we created symmetry with a special ruler and fixed the broken zygomatic arch with a screw and plate. We evaluated the facial index and satisfaction with a statistical analysis before and after the surgery. RESULTS: In 22 patients, there was no reoperation except for 1 patient who had a zygoma fracture. None of the patients were treated for infection or hematoma. Two patients complained of paresthesia after the malar reduction operation, but this subsided in 4 months. Most of them were satisfied with the malar reduction, especially the women, and we obtained a better mid facial contour with decreased facial width(p<0.05). CONCLUSION: Existing zygoma fracture surgery focuses on anatomical reduction. However, we need to have a cosmetic viewpoint in fractures as interests of face contour arise. Thus, contralateral malar reduction got a 4.7 (range 0~5) from patients who had malar reduction surgery in our hospital. Although adjusting to all zygoma fractures has limitations, it can be a new method in zygoma fractures when there are limited indications of protruding zygoma and careful attention is given to patients' high demands.

Open Reduction and Non-fixation Method for the Zygoma Body Fracture

PURPOSE: Zygoma is a major portion of the midfacial skeleton, forms the malar prominence and the three adjacent bony articulations. Zygoma fracture is a very common in facial trauma. Open reduction and rigid fixation of displaced zygoma fractures are necessary to avoid immediate and delayed facial asymmetry and depression. However, it is possible to happen the complications related to the plates and screws. So, we planned to treat the 24 patients of Group II, III, IV zygoma fractures with precise reduction and non-fixation method via intraoral approach. METHODS: From August, 2006, to August, 2009, we treated 24 cases of zygoma fracture with reduction and non-fixation methods. Before the surgery, we choose the patients who could be treated with this method among the Group II, III, IV patients. RESULTS: No patients in this study had postoperative complications such as displacement of bony fragments, facial depression and asymmetry, malocclusion, hypoesthesia. Satisfactory aesthetic and functional results can be obtained. CONCLUSION: In the treatment of the zygoma fracture, it is possible to treat with precise reduction and non-fixation method. The greatest advantage is to decrease the operative time, no need to wide dissection, no complications related to the plates and screws. For the using of this method, it is necessary to choose the adequate patients through the preoperative planning.

Open Reduction and Non-fixation Method for the Zygoma Body Fracture

PURPOSE: Zygoma is a major portion of the midfacial skeleton, forms the malar prominence and the three adjacent bony articulations. Zygoma fracture is a very common in facial trauma. Open reduction and rigid fixation of displaced zygoma fractures are necessary to avoid immediate and delayed facial asymmetry and depression. However, it is possible to happen the complications related to the plates and screws. So, we planned to treat the 24 patients of Group II, III, IV zygoma fractures with precise reduction and non-fixation method via intraoral approach. METHODS: From August, 2006, to August, 2009, we treated 24 cases of zygoma fracture with reduction and non-fixation methods. Before the surgery, we choose the patients who could be treated with this method among the Group II, III, IV patients. RESULTS: No patients in this study had postoperative complications such as displacement of bony fragments, facial depression and asymmetry, malocclusion, hypoesthesia. Satisfactory aesthetic and functional results can be obtained. CONCLUSION: In the treatment of the zygoma fracture, it is possible to treat with precise reduction and non-fixation method. The greatest advantage is to decrease the operative time, no need to wide dissection, no complications related to the plates and screws. For the using of this method, it is necessary to choose the adequate patients through the preoperative planning.

The Signficance of Intraoperative Radiograph in Treatment of Zygoma Fracture

PURPOSE: The surgical treatment of zygoma fracture use generally three point fixation of the zygomaticofrontal suture, inferior orbital rim and zygomaticomaxillary buttress. But, this procedure has the disadvantage that we cannot know symmetry of the zygoma and visualize the reduction of the zygomatic arch. So, we take a intraoperative simple radiograph(zygomatic arch view) in reduction of zygoma fracture. METHODS: From 2004 to 2006, We compared 21 patients with taking a intraoperative simple radiograph and 28 patients with not taking a radiograph. To assess the difference between the two groups, the authors compared the patients' subjective symptoms and measured the axial angle of the zygoma and zygomatic arch and the degree of the zygomatic arch inclination on zygomatic arch view. And we compared intraoperative simple radiograph with postoperative facial bone CT scan. RESULTS: There was significant difference in appearance of subjective symptoms and the degree of zygomatic arch inclination representing the local contour of fractured zygomatic arch. And intraoperative simple radiograph is accorded with the postoperative facial bone CT scan. CONCLUSION: We think that taking a intraoperative simple radiograph in the treatment of zygoma fracture is satis-factory methods in cosmetics and accuracy of reduction.

Simple External & Internal Fixation for the Zygoma Tripod Fracture

Precise reduction and rigid fixation is essential in preventing facial asymmetry in zygoma fracture patients. Numerous methods are used for treating zygoma fractures categorized largely as open reduction and simple external reduction. The conventional three point open reduction method has drawbacks such as long operating time, visible scar, cheek drooping and soft tissue violence. Simple external reduction has drawbacks such as inadequate mechanical fixation, long lasting external fixation, long term deviation of malar eminence and poor visualization. To avoid drawbacks of the conventional method, we combined one point plate fixation method and one point external fixation with double K wire technique. Total 25 patients were treated with this technique. Follow up time was 3 months to 3 year. All cases showed very good cosmetic symmetry without any complications. Advantages of this technique include, simple procedure, smaller incisional scar, early removal of pin, early return to mastication, prevention of malar eminence deviation, and less soft tissue violence. This internal and external fixation technique is a simple and effective method in treatment of uncomminuted zygoma fracture.

The Operation of Facial Bone Fractures

Plastic surgeons who perform reconstructive surgery of facial injuries have a dual responsibility: repair of the aesthetic defect and restoration of the function. The third goal is to minimize the period of disability. although emergent situations are limited in facial injuries, I would like to emphasize the advantages of prompt definitive reconstruction of the injuries and the contribution of early operative intervention to the superior aesthetic and functional outcomes. Socioeconomic and psychological factors make it imperative that an aggressive, expedient, and wellplanned surgical program be outlined, operated, and maintained to rehabilitate the patient to return to his or her active and productive life as soon as possible while minimizing aesthetic and functional disabilities. Teaching points: the techniques of extended open reduction and immediate repair or replacement of bone and microvascular tissue transfer of bone or soft tissue have made extensive and challenging injuries manageable. The principle of immediate skeletal stabilization in anatomic position has been enhanced by the use of rigid fixation and the application of craniofacial techniques that is safer and less traumatic for facial bone exposure. In this article, I will present mandibular fracture, orbital wall fracture and maxillar fracture, which are commonly encountered facial bone injuries. We can improve both the functional and aesthetic outcomes of facial fracture treatment when we manage the patients with the current concept of craniofacial techniques based on precise anatomic knowledge.

Simple Fixation Technique Using Double Kirschner's Wires for the Uncomminuted Zygoma Fracture

Zygoma fracture is very common in facial trauma because zygoma composes a prominent part of the midface. For the zygoma fracture, its precise reduction and fixation is very important to prevent residual facial asymmetry. There are various modalities of treatment of fractured zygoma and now open reduction with multiple rigid fixation technique is widely accepted. The method of internal fixation enables accurate reduction and stable fixation. However, closed reduction can be used in simple and uncomminuted cases. Although the closed reduction has some advantages of simplicity, it has lost popularity because of the inadequate mechanical fixation and poor visualization. We designed an improved technique of the closed reduction and fixation using double Kirschner's wires. 19 patients were treated with this technique and all cases showed successful results without any complications. The potential advantages of this technique include simple procedure, short operation time, less incisional scar and soft tissue violation and fairly low price without use of foreign materials like miniplates. We conclude that double Kirschner's wire suspension technique is a simple and effective method in the treatment of uncomminuted zygoma fracture.

A Study on the Clinical and Statistical Analysis of the Zygoma Fracture

The zygomatic bone is a major portion of the midfacial skeleton, forms the malar eminence and the four adjacent bony articulation, when the zygomatic bone was fractured, the patient was suffered from not only esthetic facial contour problem but also functional disturbance such as eyeball movement and masticatory action. This retrospective study comprised 269 patients who had 280 zygoma fractures by various accidents and treated in Pusan Paik hopital between October 1994 and October 1999. The medical records of these 269 patients with zygoma fracture were reviewed and analysed. The studied items are the time of the accidents, the age and sex distribution, the causes of the injuries, anatomical types of the fractures, associated maxillofacial and non- maxillofacial trauma, the treatment methods and fixation materials and the days of hospitalization and complications. The results were obtained. The most patients with zygomatic bone fracture were injured between 22:00 and 04:00. The incidence of zygomatic bone fracture was shown to be decreased annually. The monthly incidence was the highest in January, May and October. The highest incidence in age distribution was the second and third decade(45%) and male to female ratio was 4.7:1. And the most common cause of the zygomatic bone fracture was motor vehicle accident(51%) followed by fall down, assault, industrial accident and sports accident. The most common anatomical site of the zygomatic bone fracutre was group III type fracture(33%) by Knight and North Classification. Associated maxillofacial bone fracture was mainly maxilla, followed by nasal bone, mandible, and frontal bone. The most prevalent time interval between onset and surgical intervention was within the 10 days and the prevalent interval time between the surgical intervention and discharge was within the 14 days. Postoperative compliction was malocclusion(2 cases).

A clinical study of complications following zygoma fracture

Endoscopic application in treatment of fracture of the zygomatic arch

Although the zygomatic arch can be employed as a key landmark to the accurate alignment of a displaced zygoma fracture, it has been traditionally avoided because of the need for a bicoronal incision. Exposure of the zygomatic arch by means of the conventional bicoronal incision has several possible disadvantages, including an increased risk of blood loss, alopecia, loss of sensation posterior to the incision, and traction palsy of the facial nerve. Endoscopic-assisted exposure of a zygomatic arch can largely obviate the disadvantages of a bicoronal incision and yield this site accessible to reduction and internal fixation in the routine treatment of displaced zygoma fractures. 9 cases of endoscope-assisted open reduction of zygomatic arch fracture and 3 cases of internal fixation of a moderately displaced zygoma fracture are presented. To accomplish this technique, a rigid 4 mm, 30 degree down-angled endoscope, trocar and cannula, endoscopic forehead lift instrument were used. The postoperative courses were satisfactory with few complications. The use of endoscope in the treatment of zygoma reduction provided an expanded field of vision, direct manipulation of lesions, minimal postoperative scar. In particular, exposure and fixation of the zygomatic arch were performed without the need for a bicoronal incision.

Endoscopic application in treatment of fracture of the zygomatic arch

Although the zygomatic arch can be employed as a key landmark to the accurate alignment of a displaced zygoma fracture, it has been traditionally avoided because of the need for a bicoronal incision. Exposure of the zygomatic arch by means of the conventional bicoronal incision has several possible disadvantages, including an increased risk of blood loss, alopecia, loss of sensation posterior to the incision, and traction palsy of the facial nerve. Endoscopic-assisted exposure of a zygomatic arch can largely obviate the disadvantages of a bicoronal incision and yield this site accessible to reduction and internal fixation in the routine treatment of displaced zygoma fractures. 9 cases of endoscope-assisted open reduction of zygomatic arch fracture and 3 cases of internal fixation of a moderately displaced zygoma fracture are presented. To accomplish this technique, a rigid 4 mm, 30 degree down-angled endoscope, trocar and cannula, endoscopic forehead lift instrument were used. The postoperative courses were satisfactory with few complications. The use of endoscope in the treatment of zygoma reduction provided an expanded field of vision, direct manipulation of lesions, minimal postoperative scar. In particular, exposure and fixation of the zygomatic arch were performed without the need for a bicoronal incision.