Tratamento de fratura órbito-zigomática decorrente de acidente com projétil de bala de borracha / Treatment of orbito-zygomatic fracture due to accident with rubber bullet project / Tratamiento de fractura orbito-cigomática por accidente com proyecto bala de goma

Objetivo: Relatar um caso clínico de um paciente com fratura zigomático orbitária vítima de tiro de bala de borracha e mostrar a importância de um planejamento adequado. Relato de caso: Paciente do sexo masculino, 19 anos de idade, deu entrada no Hospital de Urgências de Teresina, relatando ter sofrido uma agressão por bala de borracha durante uma manifestação. Foi observado no exame clínico: aumento de volume, equimose palpebral superior e dificuldade de abertura bucal. Na imagem foi observado, projétil de borracha na região zigomática esquerda, fraturas de zigoma com comunicação na região de pilar zigomático, fratura com deslocamento na região de margem Infraorbital e fratura na sutura fronto-zigomática. Foi proposto para o caso clínico, cirurgia sob anestesia geral com acesso intrabucal para fixação do pilar zigomático com placa do sistema 2.0mm, acesso superciliar para fixação da sutura fronto-zigomática com placa 1.5mm, e reconstrução do assoalho orbitário com malha de titânio. Conclusão: No pós-operatório o paciente não apresenta relato de enoftalmia, distopia ou diplopia, ausência de dor e déficits visuais.

Objective: To report a clinical case of a patient with zygomatic-orbital fracture, victim of rubber bullet shooting and show the importance of an adequate planning. Case Report: A 19-year-old male patient was admitted to the Teresina Emergency Hospital, reporting having suffered an aggression by rubber bullet during a demonstration. On clinical examination was observed: increased volume, upper eyelid ecchymosis and difficulty opening the mouth. In the image it was observed, rubber bullet in the left zygomatic region, zygoma fractures with communicationin the region of the zygomatic pillar, fracture with displacement in the region of infraorbital margin and fracture in the fronto-zygomatic suture. It was proposed for the clinical case, surgery under general anesthesia with intraoral access for fixation of the zygomatic pillar with a 2.0 mm plate, superciliary access for fixation of the fronto-zygomatic suture with a 1.5 mm plate, and reconstruction of the orbital floor with titanium mesh. Conclusion: Postoperatively, the patient did not report enophthalmia, dystopia or diplopia, absence of pain and visual deficits.

Objetivo: Informar de un caso clínico de un paciente confractura zigomática-orbital víctima de un disparo de bala de goma y mostrar la importancia de una planificación adecuada. Reporte de caso: Paciente masculino, de 19 años, fue admitido enel Hospital de Urgencias de Teresina, informando haber sufrido una agresión por bala de goma durante una manifestación. Se observó en elexamen clínico: aumento de volumen, equimosis del párpado superior y dificultad para abrir la boca. En la imagen se observó, bala de goma en la región cigomática izquierda, fractura del cigoma con comunicación en la región del pilar cigomático, fractura con desplazamiento en la región del margen infraorbitario y fractura en la sutura fronto-cigomática. Se propuso para el caso clínico, cirugía bajo anestesia general conacceso intraoral para fijacióndel pilar cigomáticocon sistema de placas de 2,0 mm, acceso superciliar para fijación de la sutura fronto-cigomática de placas de 1,5 mm, y reconstrucción del suelo orbitario con malla de titanio. Conclusión: En el post operatorio, la paciente no presentó informes de enoftalmia, distopía o diplopía, ausencia de dolor y déficit visual.

Alcohol consumption and maxillofacial fractures in times of Covid-19: a cross-sectional study in a cuban university hospital / Consumo de alcohol y fracturas maxilofaciales en tiempos de Covid-19: un estudio transversal en un hospital universitario cubano

Introduction: The consumption of alcoholic beverages reduces the body's ability to deal with dangerous situations and exposes people to trauma. Objective: To determine the association between the consumption of alcoholic beverages and the characteristics of maxillofacial fractures treated at a Cuban university hospital in the context of COVID-19. Material and Methods: An observational, analytical, and cross-sectional study was carried out in the Maxillofacial Surgery unit at the "Carlos Manuel de Céspedes" General University Hospital during the year 2020. Prevalence ratios, 95% confidence intervals and p-values were obtained using generalized linear models. Results: In 58.23% of the cases, fractures were related to the consumption of alcoholic beverages. The fundamental etiology was interpersonal violence (47.75%), regardless of the consumption of alcoholic beverages. There was a prevalence of patients with nasal fractures (n=98; 55.06%), among which, 35.71% had consumed alcoholic beverages at the time of the trauma. Being male (p=0.005), the lack of university studies (p=0.007), the need for surgical treatment (p<0.001), the fractures of the zygomaticomaxillary complex (p=0.023), and the traumas that occurred during the weekends (p<0.001) or during the month of June (p=0.029) were factors associated with a higher frequency of fractures related to the consumption of alcoholic beverages. There was a lower frequency of fractures associated with alcohol consumption during the months of January (p=0.006) and March (p=0.001). Conclusion: Six out of ten cases were under the influence of alcoholic beverages. There was a greater number of young and male patients, mainly due to interpersonal violence.

Introducción: La ingestión de bebidas alcohólicas disminuye la capacidad del organismo para enfrentar situaciones de peligro y lo predispone a sufrir traumatismos diversos. Objetivo: Determinar la asociación entre el consumo de bebidas alcohólicas y las características de las fracturas maxilofaciales atendidas en un hospital universitario cubano en el contexto de la COVID-19. Material y Métodos: Estudio observacional, analítico y transversal realizado en el servicio de Cirugía Maxilofacial del Hospital General Universitario "Carlos Manuel de Céspedes" durante el 2020. Se obtuvieron razones de prevalencia, intervalos de confianza a 95% y valores p mediante modelos lineales generalizados. Resultados: En el 58.23% de los casos las fracturas se relacionaron con la ingestión de bebidas alcohólicas. La etiología fundamental fue la violencia interpersonal (47.75%), independientemente del consumo o no de bebidas alcohólicas. Predominaron los pacientes con fracturas nasales (n=98; 55.06%), en los que el 35.71% había consumido bebidas alcohólicas en el momento del trauma. El sexo masculino (p=0.005), la carencia de estudios universitarios (p=0.007), la necesidad de tratamiento quirúrgico (p<0.001), las fracturas del complejo cigomático-maxilar (p=0.023), los traumas sucedidos durante los fines de semanas (p<0.001) o durante el mes de junio (p=0.029) fueron factores asociados a una mayor frecuencia de fracturas relacionadas con el consumo de bebidas alcohólicas. Hubo menor frecuencia de fracturas asociadas a este consumo durante los meses de enero (p=0.006) y marzo (p= 0.001). Conclusión: Seis de cada diez casos estuvieron bajo los efectos de la ingestión de bebidas alcohólicas. Existió una mayor afectación de pacientes jóvenes, masculinos, a causa principalmente de la violencia interpersonal.

Efficacy of navigation-assisted cosmetic incision for reduction and internal fixation in treating unilateral type B zygomatic fracture / 中华创伤杂志

Objective:To analyze the clinical effect of navigation-assisted cosmetic incision for reduction and internal fixation in treating unilateral B-type zygomatic fracture.Methods:A retrospective cohort study was performed on clinical data of 35 patients with unilateral type B zygomatic fracture treated from January 2018 to December 2019 in First Affiliated Hospital of Fujian Medical University. There were 20 males and 15 females at age range of 5-62 years [(38.7±11.3)years]. Navigation-assisted cosmetic incision for reduction and internal fixation was performed for 17 patients (navigation group), and empirical incision to reduction and internal fixation was performed for 18 patients (convention group). The length of bony zygomatic process (zygomatic process) and width of zygomatic temporal point (frontal width) of the bilateral zygomatic bone were measured on the horizontal axis of CT at 1 week after operation. The absolute values of the difference of bony zygomatic process degree and frontal bony width between affected side and the healthy side were compared between the two groups. The patients′ satisfaction and occurrence of complications such as lower eyelid ectropion, incision infection and facial nerve injury were compared between the two groups at half a year after operation.Results:All patients were followed up for 6-24 months [(9.3±1.2)months]. The absolute difference of bony zygomatic process was 0.60(0.25, 0.85) mm in navigation group, and was 0.75 (0.20, 1.98)mm in convention group ( P>0.05). The absolute difference of frontal bony width was (0.37±0.11)mm in navigation group, and was (2.47±0.63)mm in convention group ( P<0.01). Satisfaction rates by both objective evaluation and subjective evaluation in navigation group were better than that in convention group at half a year after operation (both P<0.05). Navigation group showed lower eyelid ectropion in 1 patient and incision infection in 1 patient. Convention group showed facial nerve injury in 1 patient and incision infection in 2 patients. There was no significant difference in the incidence of complications between navigation group [12%(2/17)] and conventional group [17%(3/18)] ( P>0.05). Conclusion:For unilateral type B zygomatic fracture, navigation-assisted cosmetic incision for reduction and internal fixation can more accurately restore the frontal width, and improve satisfaction rate as compared with empirical reduction and internal fixation.

Retrospective study of sports-related maxillofacial fractures in a Brazilian trauma care center

Aim: Maxillofacial fractures occur frequently in the general population, and sports-related fractures represent some of these cases. However, few studies have been carried out in Brazilian populations aimed at sports-related maxillofacial fractures. This study assessed the demographic and fracture characteristics of patients with sports-related maxillofacial fractures who were seen at a Brazilian trauma care center. Methods: Medical records of patients with a history of sports-related maxillofacial fractures treated between January 2018 and December 2019 were retrospectively evaluated. Personal data, fracture characteristics, sport type, treatment performed and need for hospitalization were collected. The data were subjected to statistical analyses with likelihood ratio test using the Statistical Package for Social Sciences (SPSS) 25.0 (p ≤ 0.050). Results: Forty cases (4.96% of the total) of facial fractures were included. The mean age was 24.9 (± 9.8) years, with a predominance of males (92.5%). The use of protective equipment was rare. The most frequently involved sport modality was soccer (47.5%), followed by cycling (27.5%). The most frequent fracture location was nose (45%), followed by mandible (25%) and zygomatic complex (17.5%). Soccer was responsible for most nose fractures (61.1%), while cycling caused the majority of mandibular fractures (60%). Conservative treatment predominated (60%). There was only a significant difference between fracture location and the need for hospitalization (p = 0.021). Conclusion: Patients with sportsrelated maxillofacial fractures were typically young adult males, the injury was more often located in the nose and mandible and related to soccer or cycling. The use of protective equipment must be reinforced

Diagnostic properties of sensitivity changes in patients with maxillofacial fractures: a systematic review

Aim: Verify the accuracy of objective assessments compared to subjective tests in detecting changes in somatosensory perception in individuals affected by maxillofacial trauma. Methods: The review (PROSPERO n ° CRD42019125546) used the databases: MEDLINE, Cochrane, EMBASE, LILACS and other bibliographic resources. Prospective and retrospective studies that used objective and subjective methods of assessing facial sensitivity in maxillofacial fractures were included. There was no restriction on language or publication date. Risk of bias was assessed using the QUADAS-2. Data extraction and analysis were performed using a form developed for the study. Results: 21 studies were included. The clinical objective examination mainly includes assessments of: tactile sensitivity (95.24%) and nociceptive sensitivity (57.14%). The subjective assessment was based on the patient's report, spontaneously (61.90%), guided by structured questionnaires (33.33%) and/or using scales (9.52%) to measure the degree of impairment. In risk of bias assessment, were observed no adequate interpretation and classification of changes in subjective sensitivity, subject to inappropriate analysis of the data. In addition, the studies bring several instruments without standardization for assessing sensory modalities. Conclusion: The objective assessment is a complement to the subjective assessment, using the touch assessment as the main parameter in the profile of the facial peripheral integrity, associated or not with nociceptive assessment. Lack of consensus on the indication of specific instruments for testing is a limiting factor. Thus, based on the studies, is proposed a minimum battery of sensitivity assessment to obtain an overview of the patient's peripheral nervous situation

Fratura do complexo zigomático orbitário: relato de caso / Fracture of the Zygomatic Orbital Complex: Case report

Fraturas faciais podem ocorrer de forma isolada ou concomitante a outras lesões. O complexo zigomático orbitário (CZO) ocupa uma posição proeminente da face, deixando-o bastante susceptível a traumas de alto e baixo impacto, que podem causar afundamento facial. O trauma de face frequentemente resulta em danos ao tecido ósseo, tecido mole e elementos dentários, causando prejuízo na função e estética do paciente. Os acidentes automobilísticos são uma das causas mais significativas de traumas faciais. As fraturas do terço médio da face incluem as que afetam a maxila, o zigoma e complexo NOE. O presente estudo tem por objetivo relatar o caso clínico de um paciente de 47 anos, sexo masculino, vítima de acidente automobilístico (carro x carro). Diagnosticado com fratura do CZO direito, classe IV. Foi realizada redução incruenta da fratura de arco zigomático; redução e fixação interna rígida de fratura de parede lateral de órbita e pilar zigomático com instalação de camadas de surgicel na região para melhora do contorno, resultando em regressão do afundamento malar e consequente reestabelecimento estético funcional. Estudos como este podem ser fonte de referência em busca constante pelo aprimoramento profissional, objetivando completo domínio teórico-prático das formas de condutas e tratamentos específicos à situação em questão... (AU)

Facial fractures may occur in isolation or concomitantly with other injuries. The zygomatic orbital complex (ZOC) occupies a prominent position of the face, leaving it quite susceptible to high and low impact trauma, which can cause facial sinking. Face trauma often results in damage to bone tissue, soft tissue and dental elements, causing injury to the patient's function and aesthetics. Auto accidents are one of the most significant causes of facial trauma. Fractures of the middle third of the face include those affecting the maxilla, the zygoma, and the NOE complex. The present study aims to report the clinical case of a 47-year-old male patient, victim of an automobile accident (car x car). Diagnosed with right CZO fracture, class IV. A non-invasive reduction of the zygomatic arch fracture was performed; reduction and rigid internal fixation of lateral wall orbital fracture and zygomatic pillar with installation of surgicel layers in the region to improve the contour, resulting in regression of the malar sinking and consequent functional aesthetic reestablishment. Studies like this can be a source of reference in constant search for professional improvement, aiming at a complete theoretical-practical domain of the forms of conduct and treatments specific to the situation in question... (AU)

Fixação single-point com placa reabsorvível em fratura pediátrica: relato de caso / Single-point fixation with resorbable plate in pediatric fracture: case report

Introdução: As fraturas faciais pediátricas são geralmente decorrentes de traumas de alta energia e o seu tratamento está relacionado à fase do crescimento facial e do padrão do trauma ocorrido. A literatura atual descreve, com sucesso, a fixação de fraturas de zigoma com pouco deslocamento, utilizando apenas um ponto, seja ele na sutura frontozigomática ou no pilar zigomaticomaxilar, podendo ser associado ao uso de placas do sistema de fixação absorvível, principalmente, em pacientes em fase de crescimento. Este trabalho tem por objetivo relatar um caso de fratura de zigoma em paciente pediátrico tratado com placa e parafusos absorvíveis, utilizando o princípio de fixação em um único ponto. Relato de caso: Paciente de 06 anos de idade foi atendido em serviço de Cirurgia Bucomaxilofacial, cursando com ferimento cortocontuso em margem supraorbitária direita associada à presença de degrau palpável em região de sutura frontozigomática direita, o qual foi confirmado pela tomografia computadorizada, demonstrando leve deslocamento medial. O paciente foi submetido à redução aberta e fixação da fratura com material reabsorvível. Considerações finais: A utilização de fixação com placas reabsorvíveis em um único ponto tem sido um excelente aliado, porém não é indicado para fraturas com deslocamento significativo, instáveis e panfaciais... (AU)

Introduction: Pediatric facial fractures are usually consequence of high energy trauma and its treatment is related to the facial growth phase and the trauma itself. The current literature describes, successfully, the fixation of zygoma fracture with little displacement using the single point fixation, being on the frontozygomatic suture or on the zygomatic-maxillary buttress, which can be associated to the use of resorbable fixation system plates, especially in patients growing phase. The aim of this work is report a case of zygomatic fracture in a pediatric patient treated with plate and resorbable screws, using the principle of single-point fixation. Case Report: A 06-year-old patient, attended in the Oral and Maxillofacial Surgery Service, suffering from a cut-contusion wound on the right supraorbital margin associated with the presence of a palpable step in the region of the right frontozygomatic suture, which was confirmed by computed tomography, demonstrating slight medial displacement. The patient was underwent to open reduction and internal fixation of the fracture with resorbable material. Final considerations: The use of fixation with resorbable plates in a single-point has been an excellent approach, however it is not indicated for fractures with significant displacement, unstable and panfacial... (AU)

Expert consensus on navigation-guided unilateral delayed zygomatic fractures reconstruction techniques / 中华口腔医学杂志

The zygoma is located in the medial and lateral parts of the face, supporting the midfacial contour. The forward projection of the zygoma and the zygomatic arch expose them to frequent injury. Fractures of the zygoma can lead to displacement of the zygoma and the zygomatic arch, causing facial collapse deformity. For delayed zygomatic fractures, the loss of normal anatomical landmarks, caused by the malunion of the fracture lines and remodeling of the bony contour, makes it difficult to determine the correct positions of the zygomatic bones. In such cases, using traditional surgical methods, ideal and steady outcomes with satisfactory midface symmetry have been difficult to obtain. Nowadays, the application of digital surgical software and surgical navigation help surgeons to perform accurate preoperative simulations to obtain ideal 3-dimensional (3D) virtual surgical plans, and achieve accurate reduction by intraoperative navigation systems, which increase the accuracy and predictability of fracture reduction outcomes. Experts from the Oral and Maxillofacial Surgery Committee of the Chinese Stomatological Association have fully discussed and formulated an expert consensus on navigation-guided unilateral delayed zygomatic fracture reconstruction techniques, to standardize the clinical operation procedures and promote the application.

Expert consensus on navigation-guided unilateral delayed zygomatic fractures reconstruction techniques / 中华口腔医学杂志

The zygoma is located in the medial and lateral parts of the face, supporting the midfacial contour. The forward projection of the zygoma and the zygomatic arch expose them to frequent injury. Fractures of the zygoma can lead to displacement of the zygoma and the zygomatic arch, causing facial collapse deformity. For delayed zygomatic fractures, the loss of normal anatomical landmarks, caused by the malunion of the fracture lines and remodeling of the bony contour, makes it difficult to determine the correct positions of the zygomatic bones. In such cases, using traditional surgical methods, ideal and steady outcomes with satisfactory midface symmetry have been difficult to obtain. Nowadays, the application of digital surgical software and surgical navigation help surgeons to perform accurate preoperative simulations to obtain ideal 3-dimensional (3D) virtual surgical plans, and achieve accurate reduction by intraoperative navigation systems, which increase the accuracy and predictability of fracture reduction outcomes. Experts from the Oral and Maxillofacial Surgery Committee of the Chinese Stomatological Association have fully discussed and formulated an expert consensus on navigation-guided unilateral delayed zygomatic fracture reconstruction techniques, to standardize the clinical operation procedures and promote the application.

Oroantral fistula after a zygomaticomaxillary complex fracture

Zygomaticomaxillary complex (ZMC) fractures account for a substantial proportion of trauma cases. The most frequent complications of maxillofacial fracture treatment are infections and soft tissue flap dehiscence. Postoperative infections nearly always resolve in response to oral antibiotics and local wound care. However, a significant infection can cause a permanent fistula. A 52-year-old man visited our clinic to treat an oroantral fistula (OAF), which was a late complication of a ZMC fracture. Postoperatively, the oral suture site dehisced, exposing the absorbable plate. However, he did not seek treatment. After 5 years, an OAF formed with a 2.0× 2.0 cm bony defect on the left maxilla. We completely excised the OAF, harvested a piece of corticocancellous bone from the iliac crest, inserted the harvested bone into the defect, and covered the soft tissue defect with a buccal mucosal transposition flap. Although it is necessary to excise OAFs, the failure rate is higher for large OAFs (> 5 mm in diameter) because of the extensive defect in the underlying bone that supports the overlying flap. Inappropriate management of postoperative wounds after a ZMC fracture can lead to disastrous outcomes, as in this case. Therefore, proper postoperative treatment and follow-up are essential.

Zygomaticomaxillary buttress and its dilemma

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.

Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction

BACKGROUND: Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of the extended transconjunctival approach (ETA) combined with T-bar screw reduction in minimizing scarring and complications for the treatment of ZMC fractures. METHODS: A total of 26 patients underwent ZMC reduction through the ETA and intraoral approach. A skin incision measuring roughly 5 to 8 mm in length was placed following the lateral canthal skin crease. After releasing the inferior crus of the lateral canthal tendon for canthotomy, the medial periosteum of the lateral orbital rim was preserved for canthal reattachment. A limited subperiosteal dissection and partial relaxing incision of the orbicularis oculi were performed to expose the fracture line of the inferior orbital rim and zygomaticofrontal suture. Reduction was performed using a T-bar screw through the transconjunctivalincision and an elevator through the intraoral incision. RESULTS: The aesthetic and functional results were excellent. Successful reduction was achieved and the skin incision was less than 8 mm in 20 cases (76.9%). Only six patients had an additional skin incision (less than 5 mm) to achieve reduction. No cases of ectropion, entropion, or excessive scarring were noted. CONCLUSIONS: The ETA using a T-bar screw is a useful method for maximizing aesthetic results in ZMC fractures, with the advantages of minimal scarring, faster recovery, and maintenance of pretarsal fullness.

The Measurement of the Sensory Recovery Period in Zygoma and Blow-Out Fractures with Neurometer Current Perception Threshold

BACKGROUND: Facial hypoesthesia is one of the most troublesome complaints in the management of facial bone fractures. However, there is a lack of literature on facial sensory recovery after facial trauma. The purpose of this study was to evaluate the facial sensory recovery period for facial bone fractures using Neurometer. METHODS: Sixty-three patients who underwent open reduction of zygomatic and blowout fractures between December 2013 and July 2015 were included in the study. The facial sensory status of the patients was repeatedly examined preoperatively and postoperatively by Neurometer current perception threshold (CPT) until the results were normalized. RESULTS: Among the 63 subjects, 30 patients had normal Neurometer results preoperatively and postoperatively. According to fracture types, 17 patients with blowout fracture had a median recovery period of 0.25 months. Twelve patients with zygomatic fracture had a median recovery period of 1.00 month. Four patients with both fracture types had a median recovery period of 0.625 months. The median recovery period of all 33 patients was 0.25 months. There was no statistically significant difference in the sensory recovery period between types and subgroups of zygomatic and blowout fractures. In addition, there was no statistically significant difference in the sensory recovery period according to Neurometer results and the patients' own subjective reports. CONCLUSIONS: Neurometer CPT is effective for evaluating and comparing preoperative and postoperative facial sensory status and evaluating the sensory recovery period in facial bone fracture patients.

The Efficacy of Bioabsorbable Mesh in Craniofacial Trauma Surgery

BACKGROUND: The ultimate goal of craniofacial reconstructive surgery is to achieve the most complete restoration of facial functions. A bioabsorbable fixation system which does not need secondary operation for implant removal has been developed in the last decade. The purpose of this study is to share the experience of authors and to demonstrate the efficacy of bioabsorbable mesh in a variety of craniofacial trauma operations. METHODS: Between October 2008 and February 2015, bioabsorbable meshes were used to reconstruct various types of craniofacial bone fractures in 611 patients. Any displaced bone fragments were detached from the fracture site and fixed to the mesh. The resulting bone-mesh complex was designed and molded into an appropriate shape by the immersion in warm saline. The mesh was molded once again under simultaneous warm saline irrigation and suction. RESULTS: In all patients, contour deformities were restored completely, and bone segments were fixed properly. The authors found that the bioabsorbable mesh provided rigid fixation without any evidence of integrity loss on postoperative computed tomography scans. CONCLUSION: Because bioabsorbable meshes are more flexible than bioabsorbable plates, they can be molded and could easily reconstruct the facial bone in three dimensions. Additionally, it is easy to attach bone fragments to the mesh. Bioabsorbable mesh and screws is effective and can be easily applied for fixation in various craniofacial trauma reconstructive scenarios.

Reduction of Zygomatic Arch Isolated Fracture Using Ultra Sound and Needle Marking

BACKGROUND: Zygomatic arch is a bony arch constituting the lateral midface, which consists of 25% of all midface fractures. There are a number of ways to evaluate the extent of zygomatic arch fracture. Some authors have reported successful treatment outcomes using ultrasound (U/S). To add to the previous methods, we have considered ways to accurately display the location of the fracture line while using U/S with 23 gauge needle marking. We introduce our method, which provided satisfactory results for reduction using a portable U/S, and it can evaluate the fracture line simultaneously when reduction of an isolated zygomatic arch fracture is necessary, and needle marking, which can easily point out the fracture line on U/S. METHODS: We studied 21 patients with an isolated zygomatic arch fracture who underwent closed reduction using U/S and needle marking between 2013 and 2015. RESULTS: We achieved satisfactory results in all our cases with respect to reduction by using the Dingman elevator after performing a temporal approach incision, while confirming relative positioning between needle marking and zygomatic fracture at the same time, after insertion of a 23 gauge needle in the skin above the zygomatic arch fracture line parallel to it. CONCLUSION: We treated 21 patients with an isolated zygomatic arch fracture using U/S and the needle marking method, which provided satisfactory results because the extent of reduction of the fracture could be evaluated in real-time during the operation and exposure to radiation was reduced.

Surgical Methods of Zygomaticomaxillary Complex Fracture

BACKGROUND: Zygoma is a major buttress of the midfacial skeleton, which is frequently injured because of its prominent location. Zygoma fractures are classified according to Knight and North based on the direction of anatomic displacement and the pattern created by the fracture. In zygomaticomaxillary complex (ZMC) fracture many incisions (lateral eyebrow, lateral upper blepharoplasty, transconjunctival, subciliary, subtarsal, intraoral, direct percutaneous approach) are useful. We reviewed various approaches for the treatment of ZMC fractures and discussed about incisions and fixation methods. METHODS: A retrospective review was conducted of patients with ZMC fracture at a single institution from January 2005 to December 2014. Patients with single zygomatic arch fracture were excluded. RESULTS: The identified 694 patients who were admitted for zygomatic fractures from which 192 patients with simple arch fractures were excluded. The remaining 502 patients consisted of 439 males and 63 females, and total 532 zygomatic bone was operated. Orbital fracture was the most common associated fracture. According to the Knight and North classification the most frequent fracture was Group IV. Most fractures were fixated at two points (73%). CONCLUSION: We reviewed our cases over 10 years according to fracture type and fixation methods. In conclusion, minimal incision, familiar approach and fixation methods of the surgeon are recommended.

Kirschner Wire Fixation for the Treatment of Comminuted Zygomatic Fractures

BACKGROUND: The Kirschner wire (K-wire) technique allows stable fixation of bone fragments without periosteal dissection, which often lead to bone segment scattering and loss. The authors used the K-wire fixation to simplify the treatment of laborious comminuted zygomatic bone fracture and report outcomes following the operation. METHODS: A single-institution retrospective review was performed for all patients with comminuted zygomatic bone fractures between January 2010 and December 2013. In each patient, the zygoma was reduced and fixed with K-wire, which was drilled from the cheek bone and into the contralateral nasal cavity. For severely displaced fractures, the zygomaticofrontal suture was first fixated with a microplate and the K-wire was used to increase the stability of fixation. Each wire was removed approximately 4 weeks after surgery. Surgical outcomes were evaluated for malar eminence, cheek symmetry, Kwire site scar, and complications (based on a 4-point scale from 0 to 3, where 0 point is 'poor' and 3 points is 'excellent'). RESULTS: The review identified 25 patients meeting inclusion criteria (21 men and 4 women). The mean age was 52 years (range, 15-73 years). The mean follow up duration was 6.2 months. The mean operation time was 21 minutes for K-wire alone (n=7) and 52 minutes for K-wire and plate fixation (n=18). Patients who had received K-wire only fixation had severe underlying diseases or accompanying injuries. The mean postoperative evaluation scores were 2.8 for malar contour and 2.7 for K-wire site scars. The mean patient satisfaction was 2.7. There was one case of inflammation due to the K-wire. CONCLUSION: The use of K-wire technique was associated with high patient satisfaction in our review. K-wire fixation technique is useful in patient who require reduction of zygomatic bone fractures in a short operating time.

Evaluation of soft tissue asymmetry using cone-beam computed tomography after open reduction and internal fixation of zygomaticomaxillary complex fracture

OBJECTIVES: In this study, we assessed soft tissue asymmetry that occurred after open reduction of unilateral zygomaticomaxillary complex (ZMC) fractures. We proposed a simple method to assess soft tissue asymmetry after reduction surgery by evaluating the symmetry between the affected and the unaffected sides. The factors affecting soft tissue contour after surgery were also analyzed. MATERIALS AND METHODS: Subjects included patients admitted to Wonkwang University Dental Hospital from 2008 to 2013. Cone-beam computed tomography (CBCT) images of asymmetric patients who underwent open reduction at least 3 months prior were compared with healthy patients. RESULTS: The degree of asymmetry was measured in both the open reduction and control groups. Landmarks that showed a statistically significant difference between the two groups were zygion (1.73+/-0.24 mm), bucclae (1.08+/-0.26 mm), point of cheek (2.05+/-0.33 mm) and frontozygomatic point (1.30+/-0.31 mm). CONCLUSION: When compared with the normal group, asymmetry can occur in the affected side, which usually shows depression of overlying soft tissue and is statistically significantly different. Evaluation of soft tissue asymmetry with CBCT images after open reduction of ZMC fracture is useful.

Effectiveness of Dual-Maneuver Using K-Wire and Dingman Elevator for the Reduction of Unstable Zygomatic Arch Fracture

BACKGROUND: The zygoma is the most prominent portion of the face. Almost all simple zygomatic arch fractures are treated in a closed fashion with a Dingman elevator. However, the open approach should be considered for unstable zygomatic arch fractures. The coronal approach for a zygomatic arch fracture has complications. In this study, we introduce our method to reduce a special type of unstable zygomatic fracture. METHODS: We retrospectively reviewed zygomatic arch view and facial bone computed tomography scans of 424 patients who visited the Wonju Severance Christian Hospital from 2007 to 2010 with zygomaticomaxillary fractures, among whom 15 patients met the inclusion criteria. RESULTS: We used a Dingman elevator and K-wire simultaneously to manage this type of zygomatic arch fracture. Simple medial rotation force usually collapses the posterior fractured segment, and the fracture becomes unstable. Thus, the posterior fracture segment must be concurrently elevated with a Dingman elevator through Keen's approach with rotation force applied through the K-wire. All fractures were reduced without any instability using this method. CONCLUSION: We were able to reduce unstable and difficult zygomatic arch fractures without an open incision or any external fixation device.

Effectiveness of Dual-Maneuver Using K-Wire and Dingman Elevator for the Reduction of Unstable Zygomatic Arch Fracture

BACKGROUND: The zygoma is the most prominent portion of the face. Almost all simple zygomatic arch fractures are treated in a closed fashion with a Dingman elevator. However, the open approach should be considered for unstable zygomatic arch fractures. The coronal approach for a zygomatic arch fracture has complications. In this study, we introduce our method to reduce a special type of unstable zygomatic fracture. METHODS: We retrospectively reviewed zygomatic arch view and facial bone computed tomography scans of 424 patients who visited the Wonju Severance Christian Hospital from 2007 to 2010 with zygomaticomaxillary fractures, among whom 15 patients met the inclusion criteria. RESULTS: We used a Dingman elevator and K-wire simultaneously to manage this type of zygomatic arch fracture. Simple medial rotation force usually collapses the posterior fractured segment, and the fracture becomes unstable. Thus, the posterior fracture segment must be concurrently elevated with a Dingman elevator through Keen's approach with rotation force applied through the K-wire. All fractures were reduced without any instability using this method. CONCLUSION: We were able to reduce unstable and difficult zygomatic arch fractures without an open incision or any external fixation device.