ABSTRACT
Objective@# To investigate the clinical features, diagnosis and treatment of osteomyelitis of the jaw caused by an actinomycotic infection and to provide a reference for clinical diagnosis and treatment.@*Methods@#A case of osteomyelitis in the bilateral maxilla and the left zygomatic bone and arch caused by a mixed bacterial infection dominated by Actinomycetes was reviewed and analyzed in combination with the literature. @*Results @#The patient had left upper posterior tooth pain with repeated left facial swelling for 7 months. The patient's left face was swollen before surgery, the left maxillary alveolar bone was necrotic, and the upper palate showed fistula discharge. A maxillofacial magnetic resonance imaging scan excluded tumors and other space-occupying lesions. According to CBCT images, the initial diagnoses were left infraorbital space infection and osteomyelitis of the bilateral maxillary, the left zygomatic bone, the left zygomatic arch and the lateral orbital wall. Necrosis of the left maxilla and the zygomatic bone was excised, the focus was cleared and the focal tooth was extracted under general anesthesia. Histopathological results confirmed osteomyelitis and actinomycotic infection. Anti-inflammatory therapy with penicillin sodium was given before surgery, and piperacillin sodium and tazobactam sodium, dexamethasone sodium phosphate, tranexamic acid and mecobalamine were given after surgery. The patients' 6-month follow-up results showed that the maxillofacial shape was basically symmetrical; no ulceration, pus or abnormal secretion was found in the skin or intraoral mucosa; and the surgical area showed good recovery. A review of the relevant literature showed that Actinomyces is an opportunistic pathogen, and factors such as trauma and dental infection have been implicated in the pathogenesis of osteomyelitis. In addition to surgery, antibiotics are used to treat the disease and multidisciplinary symptomatic treatment combined with supportive treatment is required to achieve a better prognostic effect. @*Conclusion @# Actinomycotic osteomyelitis occurring in the maxilla and the zygomatic bone is an extremely rare disease that can be diagnosed by clinical manifestations, bacteriological examination and biopsy. Appropriate and effective penicillin drugs should be given at the initial stage of treatment, more sensitive antibiotics should be selected according to the results of the drug sensitivity test, and the lesions should be surgically removed when the patient's condition improves. Active symptomatic and supportive treatment should be performed during the treatment period.
ABSTRACT
RESUMO: As fraturas do complexo zigomático-orbitário são bastante frequentes devido a sua localização e projeção na face, podendo gerar grandes transtornos funcionais e estéticos ao paciente. O osso zigomático é essencial na configuração da face, sendo a principal estrutura formadora do terço médio dela. Os traumas que mais frequentemente provocam fraturas do complexo zigomático-orbitário são agressões físicas, acidentes de trânsito e esportivos. O tipo de fratura, tempo decorrido, a severidade e o envolvimento de outras estruturas faciais influenciam a modalidade de tratamento a ser empregado. O presente trabalho apresenta um caso clínico de fratura do complexo zigomático-orbitário esquerdo, diagnosticada tardiamente, e tratada por meio de osteotomia, redução e fixação em três pontos com placas e parafusos do sistema 1.5, e reconstrução do assoalho orbitário com tela de titânio. (AU)
ABSTRACT: Fractures of the zygomatic-orbital complex are quite frequent due to their location and projection on the face, which can cause major functional and aesthetic disorders to the patient. The zygomatic bone is essential in the configuration of the face, being the main forming structure of the middle third of it. The traumas that most often cause fractures of the zygomatic-orbital complex are physical aggression, traffic accidents, and sports. The type of fracture, elapsed time, severity, and the involvement of other facial structures influence the type of treatment to be employed. The present work presents a clinical case of fracture of the left zygomatic-orbital complex, diagnosed late, and treated by osteotomy, reduction, and fixation in three points with 1.5 system plates and screws, and reconstruction of the orbital floor with titanium mesh. (AU)
Subject(s)
Humans , Male , Adult , Orbit/injuries , Zygoma/injuries , Accidents, Traffic , Fractures, Bone , Facial Bones/injuries , Facial Injuries/surgeryABSTRACT
El hueso cigomático, ubicado en la parte superior y lateral de la cara, es un hueso par e irregular con forma cuadrilátera o romboidal. Se describen 2 caras, 4 aristas y 4 ángulos, forma cavidades, permite la inserción muscular y aponeurótica, es parte de la arquitectura facial, distribuye las fuerzas masticatorias y permite el paso del nervio cigomático. Su margen postero-superior presenta una prominencia ósea conocida como tubérculo marginal, en el que se observa la inserción de la fascia temporal. El objetivo de este trabajo fue describir las características particulares de esta prominencia. La muestra correspondió a 30 cráneos de adultos chilenos de ambos sexos. A través de una serie de puntos óseos, se describió la presencia, ubicación, tamaño, forma, cortical y trabeculado del tejido óseo del tubérculo marginal. Para realizar las mediciones se utilizaron cámara digital, compas de precisión y cáliper digital. El análisis radiográfico requirió tomografía computarizada de alta resolución. Los resultados mostraron que el tubérculo marginal del hueso cigomático es una prominencia constante, ubicada en el tercio medio del proceso frontal del hueso y que la mayoría de los individuos mostraron una forma semilunar. Su altura fluctúa entre 3 y 4 mm, siendo más pronunciada en hombres que en mujeres. El grosor de la corteza ósea es directamente proporcional a la prominencia del tubérculo, mientras que el trabeculado esponjoso está inversamente relacionado con este último. El análisis de estos resultados parece indicar que las fuerzas biomecánicas ejercidas por la musculatura masticatoria y transmitidas por la fascia temporal, determinan la morfología externa e interna de esta prominencia y del propio hueso cigomático. Concluimos, declarando la necesidad de revisar el conocimiento anatómico a la luz de las nuevas técnicas de imagen e integración disciplinar.
The zygomatic bone, located in the upper and lateral area of the face, is an even and irregular quadrilateral or rhomboid shaped bone. It presents 2 faces, 4 margins and 4 angles. It forms cavities, allows muscular and aponeurotic insertion, is part of the facial architecture, distributes masticatory forces and allows the passage of the zygomatic nerve. Its postero-superior margin presents a bony prominence known as a marginal tubercle, in which the insertion of the temporal fascia is observed. The objective of this work was to describe the particular characteristics of this prominence. The sample corresponded to 30 skulls of Chilean adults of both sexes. Through a series of bone points, the presence, location, size, shape, cortical and trabeculate of the bone tissue of the marginal tubercle was described. A digital camera, precision compass and digital caliper were used to perform the measurements. The radiographic analysis required high-resolution computed tomography. The results showed that the marginal tubercle of the zygomatic bone is a constant prominence, located in the middle third of the frontal process of the bone and that most individuals showed a semilunar shape. Its height fluctuated between 3 and 4 mm, being more pronounced in men than in women. The thickness of the bone cortex was directly proportional to the prominence of the tuber, while the spongy trabeculate was inversely related to the latter. The analysis of these results seems to indicate that the biomechanical forces exerted by the masticatory musculature and transmitted by the temporal fascia, determine the external and internal morphology of this prominence, and of the zygomatic bone itself. In conclusion, it is recommended to review anatomical knowledge in the light of new imaging techniques and disciplinary integration.
Subject(s)
Humans , Male , Female , Zygoma/anatomy & histology , Facial Bones/anatomy & histologyABSTRACT
Background: The anatomical boundaries of the orbit are defined and the contribution of various bones in makingup the orbital margins is determined .Associated with this, orbital dimensions like length, breadth and theorbital index are determined along with the associated dimorphic and bilateral variations. The findings of theseterritorial specimens are analyzed and compared with similar findings from other vernacular territories. Thebilateral craniofacial structures are studied and they are dimensionally classified and characterized.Comprehensive documentation thus promulgated functions to prove vital in the conquest of dexterity in the fieldof surgery and forensic anthropometry alike. The evaluated parameters also serve as an empirical guide indiscerning tenuous sites that are susceptible to impaction and in defining the safe limits of orbital explorationResults: The study has returned an average value of 81.47 as the orbital index of the scrutinized dry skullspecimens thus placing them under the category of microseme. The average values of orbital length and breadthwere found to be 31.26mm and 38.37mm respectively. The superior margin formed exclusively by the frontalbone measured 32.7mm on average with the supraorbital notch/foramen being displaced 5.92mm from themedial limit of the superior margin. For 25.88mm, which was the average length of medial margin, maxilla stoodthe dominant contributor (13.81mm) with the frontal bone chipping in to contribute to the rest. The inferiormargin paints a contrary picture of maxilla being the secondary contributor (16.13mm) whilst here it is thezygoma which makes a greater contribution (17.29mm).Conclusion: This study hereby establishes Microseme to be the predominant orbital index of the scrutinized skullspecimens in addition to quantifying the contributions of various bones towards making up the margins.Comparative analysis with confluent such studies from other provinces of the Indian subcontinent has confirmedthe latitude variation associated with orbital index. The results thus established will be unerringly essential inthe field of surgery and forensic anthropometry
ABSTRACT
Zygomatic fractures are the second most common fractures of the facial skeleton, after nasal bone fractures. Due to its uniqueness, the malar bone plays a very important role in maintaining appropriate facial contours. Zygomatic fractures can cause ocular and mandibular functional impairment, along with cosmetic defects. With the help of advanced imaging techniques and various treatment options, the management of zygomatic fractures has become more sophisticated and less invasive. This article discusses zygomatic fractures in detail: their clinical and radiographic features, and the various treatment options available.
Subject(s)
Nasal Bone , Skeleton , Zygoma , Zygomatic FracturesABSTRACT
Objective To explore a new approach that is better than coronal scalp incision and facial percutaneous small incision in surgical treatment of zygomatic bone and zygomatic arch fracture.Methods The modified auriculotemporal incision was applied in 43 patients with zygomatic bone and zygomatic arch fracture that needed open reposition,and the exposure degree,bleeding,postoperative elasticity and texture of skin,facial nerve function and satisfactory degree were evaluated after operation.Results In present study,the upper part of zygomatic arch and lateral orbital margin could be greatly explored for operation of zygomatic bone and zygomatic arch fracture in all 43 patients by application of this approach.Less bleeding was observed during operation.All patients had primary healing and none of them presented with temporal numbness and facial palsy.After 6 months follow-up,41 cases (95.3％) and 43 cases (100％) showed fine elasticity of operative skin and satisfactory degree,respectively.Conclusions The modified auriculotemporal incision is better than conventional approach in surgical treatment of zygomatic bone and zygomaticarch fracture.
ABSTRACT
Ewing’s sarcoma is an uncommon malignancy usually arising from the skeletal system particularly pelvic bones and long bones of lower extremities and mostly affecting children and young adults. Its occurrence in the maxillofacial region with soft tissue involvement is struck with rarity. It carries a poor prognosis due to its uncontrolled potential for metastatic spread; therefore an early and integrated treatment approach must be adopted to improve patient’s long term survival.
Subject(s)
Adult , Drug Therapy , Female , Humans , Sarcoma, Ewing/classification , Sarcoma, Ewing/diagnosis , Sarcoma, Ewing/drug therapy , Sarcoma, Ewing/diagnostic imaging , Tomography, X-Ray Computed , Zygoma/pathologyABSTRACT
Avulsion injuries of facial bones are rare, as well as accounts regarding the management of these lesions. This study describes a facial trauma that resulted from a bull gore, which caused the avulsion of the zygomatic bone, which was left hanging by only a small pedicle. The case study involved a 36 year old male leukoderma patient who sought the Maxillo-Facial Surgery and Trauma Department at the Emergency Unit in Pelotas-RS (Brazil). Clinical examination showed extensive laceration of the face in the middle third area on the left side, with the avulsion of the zygomatic body, causing the displacement of the eyeball towards the maxillary sinus. Treatment included bone and eyeball repositioning, zygoma fixation and suture, yielding good aesthetic and functional results. The peculiarity of the etiology and the particular features of the trauma are highlighted... (AU)
Lesões avulsivas dos ossos faciais são raras, assim como descrições quanto ao manejo dessas injúrias. Este estudo descreve um traumatismo facial decorrente de uma chifrada de um boi, que ocasionou a avulsão do osso zigomático, restando preso apenas por um pequeno pedículo. Trata-se de um paciente gênero masculino, 36 anos, leucoderma, que procurou o serviço de Cirurgia e Traumatologia Buco-Maxilo-Facial do Hospital de Pronto-Socorro da cidade de Pelotas-RS (Brasil). Ao exame clínico observava-se extensa laceração na face, em área de terço médio, lado esquerdo, com avulsão do corpo do zigoma, determinando o deslocamento do globo ocular em direção ao seio maxilar. O tratamento constou de reposicionamento ósseo e do globo ocular, fixação do zigoma e sutura, obtendo-se um bom resultado estético e funcional. Destaca-se a peculiaridade da etiologia e características únicas deste trauma... (AU)
Subject(s)
Humans , Male , Adult , Zygoma , Zygomatic Fractures , Facial Bones , Facial Bones/injuries , Maxillary SinusABSTRACT
The surgical treatment of craniofacial disorders, using metallic internal osteofixation system has inspired an evolution with advanced operative technique and fixation devices over past two decades. As any other surgical procedures, this procedure also associates problems such as infection, palpability, loosening, and restrict craniofacial skeleton growth, which lead to undue secondary operations for removal. These problems are improved by using bioabsorbable osteofixation system. We compared the patient's subjective symptoms using bioaborbable system versus metallic osteofixation system in zygomatic bone fracture. we should take the individual steps (postoperative 2 weeks, and 1 year) in treating fractured zygoma. From August, 2001 to August, 2003, we used bioabsorbable osteofixation system in 28 patients in zygomatic fracture (Biosorb(TM) FX(R)) and compared 23 patients who were treated with metallic osteofixation system. There was no significant difference in the both groups in subjective symptoms and postoperative result.
Subject(s)
Humans , Fractures, Bone , Skeleton , Zygoma , Zygomatic FracturesABSTRACT
This is a retrospective study on the nature and severity of zygomatic bone fractures. This study was based on a series of 358 patients with zygomatic bone fractures who treated as in-patient at Soonchunhyang Chonan Hospital during the period of Jan. 1993 through Dec. 1996. The results obtained are as follows : 1. The ratio of men to women was 4.41:1. The age frequency was highest in the second, third decade. The yearly distribution was the highest in 1993. The monthly distribution was highest in Feb. and Jun. 2. The most frequent cause was the traffic accident.(66.2%) 3. The most frequent type of fractures was the class I(undisplaced fx.).(25%) 4. The most frequent associated oral and maxillofacial injuries was soft tissue.(46.9%) 5. The most frequent associated systemic injuries was upper, lower extremity.(38%) 6. In A.I.S of oral and maxillofacial area, the mean score of A.I.S was 2.5~3. In I.S.S, the highest mean score was in the ped TA.(19) 7. In respect of treatment, the most common method was open reduction with rigid fixation on fronto-zygomatic suture area.(47.8%) 8. The incidence of complication was 12% and the most common complication was malunion.(6.1%)
Subject(s)
Female , Humans , Male , Fractures, Bone , Incidence , Maxillofacial Injuries , Retrospective Studies , SuturesABSTRACT
Subject(s)
Adult , Female , Humans , Male , Depression , Diagnosis , Esthetics , Overbite , RehabilitationABSTRACT
In order to clarify the anthropological characteristics of the zygomatic bones that influence to the facial morphology, authors measured the metric dimensions of the zygomatic bones and observed the non -metric traits of Korean 192 skulls (122 males, 43 females, and unknown 27 cases). The results were as follows. In the anterior aspects of the skull, the bizygomatic breadth was 134.8 +/-6.0 mm in the male and 126.6 +/-5.5 mm in the female and the bijugale breadth was 117.3 +/-5.1 mm and 110.1 +/-4.0 mm in the male and female, respectively. The mid -orbital breadth was 53.5 +/-5.7 mm in the male and 52.2 +/-4.7 mm in the female and the bimaxillary breadth was 98.9 +/-5.0 mm in the male and 94.8 +/-4.4 mm in the female. In the lateral aspects of the skulls, the distance from the porion to the ectoconchion (oder - tiefe) was 71.1 +/-2.7 mm in the female and 69.0 +/-3.0 mm in the female and the distance between the porion and the jugale (ohrjochbeinlange) was 54.2 +/-2.7 mm in the male and 53.1 +/-2.7 mm in the female. The maximum zygomatic length was 54.5 +/-3.7 mm in the male and 50.5 +/-2.9 mm in the female and the zygomatic height was 49.6 +/-3.0 mm in the male and 45.8 +/-2.4 mm in the female. The incidences of the absence of the zygomaticofacial foramina and the zygomaticotemporal foramina were 12.0% and 7.3%, respectively. The average number of the zygomaticofacial and the zygomaticotemporal foramina was 1.7 and 0.8, respectively. The positions of these foramina located on the bodies of the zygomatic bones in many cases, and the other cases were that these foramina located on the frontal processes of the zygomatic bones or on the borderlines of the body and frontal process.
Subject(s)
Female , Humans , Male , Incidence , SkullABSTRACT
This retrospective study comprised of 141 patients with zygoma fracture caused by various types of accidents and treated in the department of Plastic and Reconstructive Surgery, Pusan National University Hospital during past 10 years from April, 1986 to March, 1996. The medical records of these 141 patients were reviewed and analysed retrospectively in order to obtain the annual variation of clinical pattern of zygomatic bone fracture and to help understand change of therapeutic tendency during 10 years in our hospital. The statistical items were the age, sex, distribution of cause, fracture sites, diagnostic method, the accompanied facial bone injury, intervals between onset of accident and time of operation, and the approach methods with fixation materials. The following results were obtained. 1. Mean age of patients was 33.6 years, and age range was 3 to 75 years. Most injuries occurred in young male with the highest incidence in the third decade of life. Male predominated more than female in the ratio of 4:1. Annual variation was not observed. 2. Traffic accident(47.5%) was the most common cause of injuries and incidence has been increased since 1993. Relative incidence of assault has been increased since 1994. Otherwise, incidence of industrial accident has been decreased since 1993. 3. The most common anatomical site of the zygomatic bone fracture was group III type fracture(44%) in Knight and North Classification. According to Larsen and Thomsen classification, type B(predicted unstable fracture : 68.1%) was the most common. Annual variation was not observed. 4. Associated facial bone fractures were mainly maxillary fracture followed by nasal, panfacial and blow-out(in odder of frequency). And head injury was the most common non-maxiilofacial bone injury accompanying zygomatic bone fracture. Annual variation was not observed. 5. The most prevalent time interval between onset and surgical intervention was within seven days and the most prevalent time interval between surgical intervention and discharge was within 2-3 weeks. 6. Open reduction was used for 75.1% of total cases. The most common reduction approach incision of the zygomatic bone fracture was bicoronal approach in conjunction with subciliary incision that had been mainly used since 1991 and the most common fixation material used was microplate and screw that had been used since 1989.