Fratura de complexo zigomático ­ relato de caso / Zygomatic process fractures ­ case report

Dentre as fraturas maxilofaciais, o complexo zigomático é o mais acometido, seguido das fraturas nasais e das fraturas Mandibulares O objetivo deste trabalho é apresentar um relato de caso de fratura de complexo zigomático tratada pelo serviço de Cirurgia e Traumatologia Bucomaxilofacial, como também descrever as formas de diagnóstico e tratamento clínico e cirúrgico.

Among the maxillofacial fractures, the zygomatic complex is most affected followed by nasal fractures and mandibular fractures. The objective of this work is to present a case report of a zygomatic complex fracture treated by the bucomaxillofacial Surgery and Traumatology service, as well as to describe the forms of diagnosis, clinical and surgical treatment.

Secuelas en pacientes con fracturas cigomáticas tratados con osteosíntesis semirrígida / Sequelae in patients with zygomatic fractures treated with semirigid osteosynthesis

Se realizó un estudio descriptivo, transversal y aleatorizado de 102 pacientes con fracturas del complejo cigomático, tratados con osteosíntesis semirrígida en el Servicio de Cirugía Maxilofacial del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero de 2005 hasta diciembre de 2011, con vistas a caracterizarles según variables demográficas y terapéuticas en las fases preoperatoria, intraoperatoria y posoperatoria. En la casuística predominaron los accidentes del tránsito como mecanismos causales de las lesiones (55,8 por ciento), la depresión de la eminencia cigomática y la presencia de escalones óseos palpables en el marco orbitario inferior y/o lateral como síntomas principales (92,1 por ciento, respectivamente), y la exposición escleral como complicación posoperatoria (55,2 por ciento), entre otros; asimismo, el valor del tiempo preoperatorio incrementó el riesgo de secuelas y la vía de acceso subciliar se asoció con un mayor riesgo de exposición escleral para el acceso al marco inferior y/o suelo orbitario. Por otra parte, tanto el enoftalmos como el hipoftalmos son de difícil solución y tienen una tendencia significativa de convertirse en secuelas posoperatorias

A descriptive, cross-sectional and randomized study of 102 patients with fractures of the zygomatic complex, treated with semirigid osteosynthesis in the Maxillofacial Surgery Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba, from January, 2005 to December, 2011, aimed at characterizing them according to demographic and therapeutic variables in the presurgical, intrasurgical and postsurgical phases. In the case material there was a prevalence of traffic accidents as causal mechanisms of the lesions (55.8 percent), depression of the zygomatic eminence and presence of palpable bony steps in the lower and/or lateral orbitary edge as main symptoms (92.1 percent, respectively), and the scleral exhibition as postsurgical complication (55.2 percent), among others; also, the value of the presurgical time increased the risk of sequelae and the subciliary approach was associated with a higher risk of scleral exhibition for approaching to the lower edge and/or orbitary floor. On the other hand, either enophthalmos or hypophthalmos are of difficult solution and have a significant tendency of becoming postsurgical sequelae

Complications of supratemporalis approach with scalp coronal incision for orbital-zygomatic fracture / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aimed to examine the complications of supratemporalis approach with scalp coronal incision for the treatment of orbital-zygomatic fractures.</p><p><b>METHODS</b>A total of 206 patients with orbital-zygomatic fractures were treated with scalp coronal incision through the supratemporalis approach. The effects and complications of the treatment were analyzed.</p><p><b>RESULTS</b>The degree of fracture of the 206 patients was successfully reduced. The facial morphologies and functions were improved. No facial nerve injury was observed in all of the cases. However, the following complications were noted: fossa introcession in 1 case, forehead scalp pain or paresthesia in 11 cases, incision infection in 1 case, subcutaneous hematoma in 1 case, incision scar in 5 cases, and alopecia in 3 cases.</p><p><b>CONCLUSIONS</b>The supratemporalis approach prevents facial nerve injury and does not increase the frequency of other complications. Therefore, this approach can be applied as a routine and safe procedure in clinical settings. 
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Transconjuctival Incision with Lateral Paracanthal Extension for Corrective Osteotomy of Malunioned Zygoma

BACKGROUND: Conventional correction of malunioned zygoma requires complete regional exposure through a bicoronal flap combined with a lower eyelid incision and an upper buccal sulcus incision. However, there are many potential complications following bicoronal incisions, such as infection, hematoma, alopecia, scarring and nerve injury. We have adopted a zygomaticofrontal suture osteotomy technique using transconjunctival incision with lateral paracanthal extension. We performed a retrospective review of clinical cases underwent correction of malunioned zygoma with the approach to evaluate outcomes following this method. METHODS: Between June 2009 and September 2015, corrective osteotomies were performed in 14 patients with malunioned zygoma by a single surgeon. All 14 patients received both upper gingivobuccal and transconjunctival incisions with lateral paracanthal extension. The mean interval from injury to operation was 16 months (range, 12 months to 4 years), and the mean follow-up was 1 year (range, 4 months to 3 years). RESULTS: Our surgical approach technique allowed excellent access to the infraorbital rim, orbital floor, zygomaticofrontal suture and anterior surface of the maxilla. Of the 14 patients, only 1 patient suffered a complication—oral wound dehiscence. Among the 6 patients who received infraorbital nerve decompression, numbness was gradually relieved in 4 patients. Two patients continued to experience persistent numbness. CONCLUSION: Transconjunctival incision with lateral paracanthal extension combined with upper gingivobuccal sulcus incision offers excellent exposure of the zygoma-orbit complex, and could be a valid alternative to the bicoronal approach for osteotomy of malunioned zygoma.

Radiologic and Histological Study of Healing Process on Malunion Rat Model after Zygomatic Arch Fracture

BACKGROUND AND OBJECTIVES: Zygomatic arch fracture should be treated early, because failure of prompt treatment of these injuries November result in significant morbidity, including malar asymmetry, enopthalmos, and sensory deficits. The purpose of this study was to evaluate the radiologic and histological changes of healing process on zygomatic arch fracture with malunion in animal model. MATERIALS AND METHOD: Ten rats with malunion after zygomatic arch fracture were used in this study. Using micro computerized tomography, we evaluated the defect of fracture site with serial weeks (1, 2, 4, and 8). We also analyzed the histological findings at same period. RESULTS: The 2-D images were able to assess a difference in recovery process of a bone fracture, but it was too small to be recognized. However, we could find to the definite changes of healing process by using the 3-D reconstructed image according to time sequence. Additionally, fracture sites were healed by primary bone healing process in the zygomatic arch fracture malunion state. CONCLUSION: The 3-D image is more useful to evaluate for fracture healing state. Moreover, the proper evaluation and adequate management is necessary even after eight weeks, because healing of fracture was not completed.

Radiologic and Histological Study of Healing Process on Malunion Rat Model after Zygomatic Arch Fracture

BACKGROUND AND OBJECTIVES: Zygomatic arch fracture should be treated early, because failure of prompt treatment of these injuries November result in significant morbidity, including malar asymmetry, enopthalmos, and sensory deficits. The purpose of this study was to evaluate the radiologic and histological changes of healing process on zygomatic arch fracture with malunion in animal model. MATERIALS AND METHOD: Ten rats with malunion after zygomatic arch fracture were used in this study. Using micro computerized tomography, we evaluated the defect of fracture site with serial weeks (1, 2, 4, and 8). We also analyzed the histological findings at same period. RESULTS: The 2-D images were able to assess a difference in recovery process of a bone fracture, but it was too small to be recognized. However, we could find to the definite changes of healing process by using the 3-D reconstructed image according to time sequence. Additionally, fracture sites were healed by primary bone healing process in the zygomatic arch fracture malunion state. CONCLUSION: The 3-D image is more useful to evaluate for fracture healing state. Moreover, the proper evaluation and adequate management is necessary even after eight weeks, because healing of fracture was not completed.

Reduction of Zygomatic Fractures Using the Carroll-Girard T-bar Screw

Zygomatic fractures are the second most common facial bone fractures encountered and treated by plastic surgeons. Stable fixation of fractured fragments after adequate exposure is critical for ensuring three-dimensional anatomic reduction. Between January 2008 and December 2010, 17 patients with zygomatic fractures were admitted to our hospital; there were 15 male and 2 female patients. The average age of the patients was 41 years (range, 19 to 75 years). We exposed the inferior orbital rim and zygomatic complex through a lateral brow, intraoral, and subciliary incisions, which allowed for visualization of the bone, and then the fractured parts were corrected using the Carroll-Girard T-bar screw. Postoperative complications such as malar asymmetry, diplopia, enophthalmos, and postoperative infection were not observed. Lower eyelid retraction and temporary ectropion occurred in 1 of the 17 patients. Functional and cosmetic results were excellent in nearly all of the cases. In this report, we describe using the Carroll-Girard T-bar screw for the reduction of zygomatic fractures. Because this instrument is easy to use and can rotate to any direction and vector, it can be used to correct displaced zygomatic bone more accurately and safely than other devices, without leaving facial scars.

Results of the cause occasion and form of zygomatic fractures / Монголын Анагаах Ухаан

Introduction: We decided to study the prevalence of zygomatic fracture among the population which presented one variation of facial fractures has been occurred more often from traffic accidents, sports trauma and other injures with high-impact. There were the quantity of patients with zygomatic fractures has been treated at in-patients and out-patients.In 1998,Gerhard S., Joseph A. (USA) reviewed 259 patients with zygomatic fractures and found that ZMC (zygomaticomaxillary complex) fractures occurred in 78.8% of patients, arch fractures occurred in 10.8% and 10.4 % of patients, respectively. Of note, displaced or comminuted fractures were found in 59.3% of patients with isolated zygomatic arch fractures.Goal: The main purposes of this study are to determine cause of zygomatic fractures, the occasion and form of fractural lines.Specific objectives:1. To reveal the occurance of zygomatic fracture2. To identify etiology of zygomatic fracture3. To classify the configuration of zygomatic fractureMaterials and Methods: The study of the science discussion be provide necessity which faced on medical science. Therefore: In-patients with zygomatic fracture treated in State of central hospital. The data of this study composed 13314 in-patients records who treated 480 patients at maxillofacial department of State hospital between 1996-2011. Objectives representative expecting is 8-10%.Result: There were 3.61% 480 patients with zygomatic fractures of total patients 13314 treated in Maxilla facial-oral surgery clinic from 1996-2011. The zygomatic fractures have been occurred mostly in the everyday life injures and traffic accidents 61.25% have resulted from beginning fight. There were arch fractures 17,53%, zygomatic fractures 18.31%. There were the main fractures 64.16% in the zygomatic have occurred in the maxillary sinusitis.

Simple Identification of Symmetric Reduction in Unilateral Depressed Zygomatic Fracture

PURPOSE: The zygoma is a key element which composes the facial contour. Zygomatic fracture induces facial asymmetry. We use radiologic evaluation or inspections mainly for identification of symmetry after reduction depressed zygomatic fracture. But the disadvantages of such methods are time-consuming and complicated process. So we tried to develop a new testing method with a ruler and a level. METHODS: In unilateral depressed zygomatic fracture patient, parallel to the patient's head to make sure lay horizontaly. Put the leg of a ruler on the malar eminence so that it is at the same distance from the facial midline. Then take the level of malar eminence as put the level above the ruler. This process was performed before and after the reduction. RESULTS: We were able to fix with plate and screw after checking the results of reduction fast and easily. Good results were obtained at post-operative radiologic evaluation. CONCLUSION: We can easily get the ruler and level around life. This method is not only simple but also short-time process compared with other method-radiologic evaluation or inspection. And the operator can explain the results to the patients easily and objectively. Authors obtained the good results with this new method, and would introduce it for another method of identifying the result of reduction in depressed zygomatic fractures.

Transient Hypoglossal Nerve Palsy after Open Reduction of Zygomatic Complex Fracture

PURPOSE: Isolated hypoglossal nerve palsy is a rare manifestation of various underlying disease. This article presents a rare complication of general anesthesia associated with an surgical procedure on a case of zygomatic fracture. METHODS: An 18-year-old female patient was referred to our department by painful swelling on her left zygomatic area after the traffic accident. Left zygomatic complex fracture was identified on the simple x-ray and facial bone CT scan, and the fracture was treated with open reduction and internal fixation under general anesthesia. On the first postoperative day, she complained of difficulty in swallowing solid food, dysarthria and deviated tongue to her right side. There was no abnormal findings on the neurological examination, brain MRI and routine chemistry. She was diagnosed with transient hypoglossal nerve palsy and dexamethasone with multi-vitamins was administrated intravenously for 5 days. RESULTS: The symptoms were completely resolved by the ninth postoperative day and the patient was discharged without any other complications. CONCLUSION: The hypoglossal(cranial nerve XII)nerve supplies motor innervation to all of the ipsilateral extrinsic and intrinsic tongue muscles. The hypoglossal nerve damage may caused by the compression between the airway and the hyoid bone during the endotracheal intubation, and direct trauma due to excessive pressure or neck extension. We described a rare case of unintended injury to hypoglossal nerve and care must be taken not to cause the hypoglossal nerve damage especially in facial plastic surgery with excessive neck extension under general anesthesia.

Classification and Clinical Analysis of Zygomatic Fractures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study investigated the surgical methods and their results according to the subtypes of zygomatic fractures. SUBJECTS AND METHOD: Medical records of 99 zygomatic fractures treated between March 1997 and December 2006 were reviewed regarding fracture type, surgical method and time of operation from the initial trauma. RESULTS: Overall, operations were performed in 70 out of 99 cases. For zygomatic arch fractures, facial asymmetry and trismus in all 14 of 20 cases after surgery by Gillies incision were improved, and one revision procedure was performed. For tetrapod and multifragment fractures, one revision procedure was performed because of displacement of repaired bone fragment following surgery in 60 cases. Considering location and replacement of fractures, surgery was performed through one of incisions below: Gillies, lateral canthal, gingivobuccal, and subcilliary incision. All preoperative symptoms were improved. CONCLUSION: For zygomatic arch fractures, Gillies approach would be an optimal method, while for displaced tetrapod and multifragment fractures, two or more point fixation points would achieve satisfactory results.

Application of three-dimensional CT orbital diameter measurement in orbital zygomatic fracture treatment / 重庆医科大学学报

Objective:To explore the effective treatment way of orbital zygomatic fracture with diplopia,reduce orbital capacity and regenerate referenced criterion of orbital capacity.Methods:To compare three-dimensional CT orbital diameters between before and after operation,and then reduce orbital capacity with special material.Results:Three-dimensional CT orbital diameter measurement can realize fracture shift and orbital capacity change accurately.Three-dimensional CT orbital diameter measurement before and after operation provides an important basis for orbital reconstruction.Conclusions:three-dimensional CT orbital diameter measurement is very simple,accurate and important for orbital zygomatic fracture treatment and orbital reconstruction.

Zygomatic fracture at Siriraj Hospital.

A prospective study was made of patients with zygomatic bone fracture at Siriraj Hospital from January 1st, 1995 to December 31st, 2000 to evaluate their etiology, type of fracture, complications of fracture, operative techniques used and the results of treatment. Out of 2127 cases that presented to the Facial Fracture Clinic, Division of Trauma Surgery, Department of Surgery during this period, there were 431 cases of fractured zygoma. Most of the cases, which were more common in males, were caused by traffic accidents. The peak age-incidence was 21-30 years old and the most common type of fracture was trimalar. Common complications of fracture were sensory impairment, limitation of opening the mouth and diplopia. In order to reduce the fractures, a Gillies' approach was used in 210 cases, an infraorbital approach in 203 cases, Dingman's approach in 87 cases and a Gingivo buccal approach in 20 cases and applied internal fixation in 216 cases. The floor of the orbit was repaired in 36 cases. The post-operative wound infection rate was 1.1%. The authors conclude that zygomatic fracture is a common facial fracture caused by traffic accidents. Open reduction with or without internal fixation by a variety of approaches provides good functional and cosmetic results with very few complications.

Endoscopic Reconstruction of Zygomatic Bone Fracture without Periorbital Incision

Endoscopic techniques have revolutionized current surgical techniques and have now been introduced to plastic surgery including zygomatic fracture repair. The main advantages of endoscopic zygomatic fracture repair are the minimization of scars, avoidance of undesirable risks and sequelae of the traditional open method. In previous endoscopic techniques for repair of zygomatic fracture, some used various additional percutaneous incisions besides temporal scalp and intraoral incisions for approach of the infraorbital rim and the zygomaticofrontal region, and others who did not use those additional incisions skipped the infraorbital rim fixation. The authors performed 16 cases of the reconstructions of the zygomatic bone fractures with endoscopic approach between September 1999 and April 2002, and all the fracture sites showing fracture displacement were approached using temporal and intraoral incisions only. The fracture sites over the zygomaticofrontal area and arch were stabilized with plates and screws through temporal scalp incisions under endoscopic control. Also the fracture of the zygomaticomaxillary buttress and the infraorbital rim were restored through upper buccal sulcus incision. All the patients showed rapid recovery without visible scar, and obtained acceptable zygoma symmetry, which was confirmed on the postoperative CT scans. With the use of the endoscope, we could minimize morbidity, and obtained favorable functional and aesthetic results.

Primarily study on the application of the fixation of screw Kischner in the treatment of the zygomatic fracture

The facial trauma is increased in few years and the zygomatic fracture took a high incidence. There are many surgical methods for treatment this kind of fractures the fixation of screw kischner is a effective and economical method. It brings good results and shortens the duration of treatment. We can apply this method at every provincial hospital