CASE REPORT-RECONSTRUCTION OF ORBITAL FLOOR WITH TITANIUM MESH IN A ZYGOMATICOMAXILLARY COMPLEX FRACTURE

Zygomaticomaxillary fractures are complex fractures that can involve the ?oor of the orbit. These fractures often lead to complications like diplopia, disability in rotation of the eye superiorly due to herniation of muscle and orbital fat into the maxillary sinus. These fractures if left untreated can result in malunion, visual disturbances and are not aesthetically pleasing due to effect on the symmetry of face. Various treatment modalities are available for the treatment of zygomaticomaxillary fracture and reconstruction of the ?oor of the orbit. Complications include retrobulbar hemorrhage, orbital ?ssure syndrome, and reduction in orbital volume, with minor effects like ectropion or entropion. A case report of a 21-year-old male patient with a Orbit zygomaticomaxillary complex fracture is described.

Zygomaticomaxillary complex fractures with infraorbital nerve damage / 华西口腔医学杂志

Zygomaticomaxillary complex (ZMC) fracture is a common type of maxillofacial fracture. In addition to facial depression and diplopia, paresthesia of the lower eyelid, malar regions, nose skin, upper lip skin, and mucous membranes occurs because of infraorbital nerve injury. This article reviewed the anatomy, diagnosis, assessment, treatment, and prognosis of ZMC fracture-related infraorbital nerve injury.

Advantages of intraoral and transconjunctival approaches for posterior displacement of a fractured zygomaticomaxillary complex / 대한악안면성형재건외과학회지

BACKGROUND: Fracture of the zygomaticomaxillary complex (ZMC) is one of the most common facial injuries. A previous study has performed 3D analyses of the parallel and rotational displacements that occur in a fractured ZMC. However, few studies have investigated adequate fixation methods according to these displacements. Here, we assessed whether specific approaches and fixation methods for displacement of ZMC fractures produce esthetic results. METHODS: Hospital records and pre- and post-surgical computed tomographic scans of patients treated for ZMC fractures at the Department of Oral and Maxillofacial Surgery, College of Dentistry, Wonkwang University, between January 2010 and December 2015, were selected. Data were analyzed according to the direction of displacement and post-reduction prognosis using a 3D software. RESULTS: With ZMC fractures, displacement in the posterior direction occurred most frequently, while displacement in the superior-inferior direction was rare. A reduction using a transconjunctival approach and an intraoral approach was statistically better than that using an intraoral approach, Gillies approach, and lateral canthotomy approach for a posterior displacement (P<0.05). CONCLUSIONS: When posterior displacement of a fractured ZMC occurs, use of an intraoral approach and transconjunctival approach simultaneously is recommended for reducing and fixing the displaced fragment accurately.

Infraorbital nerve transpositioning into orbital floor: a modified technique to minimize nerve injury following zygomaticomaxillary complex fractures

OBJECTIVES: Transpositioning of the inferior alveolar nerve to prevent injury in lower jaw has been advocated for orthognathic, pre-prosthetic and for implant placement procedures. However, the concept of infra-orbital nerve repositioning in cases of mid-face fractures remains unexplored. The infraorbital nerve may be involved in trauma to the zygomatic complex which often results in sensory disturbance of the area innervated by it. Ten patients with infraorbital nerve entrapment were treated in similar way at our maxillofacial surgery centre. MATERIALS AND METHODS: In this article we are reporting three cases of zygomatico-maxillary complex fracture in which intra-operative repositioning of infra-orbital nerve into the orbital floor was done. This was done to release the nerve from fractured segments and to reduce the postoperative neural complications, to gain better access to fracture site and ease in plate fixation. This procedure also decompresses the nerve which releases it off the soft tissue entrapment caused due to trauma and the organized clot at the fractured site. RESULTS: There was no evidence of sensory disturbance during their three month follow-up in any of the patient. CONCLUSION: Infraorbital nerve transposition is very effective in preventing paresthesia in patients which fracture line involving the infraorbital nerve.

Clinical Experiences of Facial Asymmetries in Zygomaticomaxillary Complex Bone Fracture Patients

PURPOSE: Zygomaticomaxillary complex(ZMC) fracture is one of the most common facial injuries after facial trauma. As ZMC composes major facial buttress, it is a key element of the facial contour. So, when we treat these fractures, the operator should have a concern with the symmetry to restore normal appearance and function. But sometimes, unfavorable results may occur. The aim of this study is to analyze the unsatisfied midfacial contour after ZMC fractures reduction retrospectively and to point out the notandum. METHODS: 369 patients, treated for fractures of the ZMC were included in the study. After the operation, such as open reduction and internal fixation(ORIF with titanium or absorbable materials), open reduction, and closed reduction, midfacial contour was evaluated with plain films and 3-dimensional computed tomography. And unfavorable asymmetric midfacial contours were correcterd by secondary correction and re-evaluated. Gross photographs were obtained at outpatient clinic. RESULTS: Total of 38 patients had got a facial asymmetry and among of them 24 patients were treated secondary revisional ORIF operations for correction of unfavorable result of after primary reduction. Two of them had received tertiary operations, three patients had got osteotomy more than after one year and six patients had got minor procedures. The etiology of asymmetry were lateral displaced simple fracture of arch(n=2), lateral displaced comminuted fracture of arch(n=6), comminuted arch fracture combined posterior root fracture(n=9), and communited arch and body fracture(n=12), severely contused soft tissue(n=9). After the manipulations outcomes were acceptable. CONCLUSION: To prevent the asymmetry in ZMC fracture reduction, complete analysis of fracture, choice of appropriate operation technique, consider soft tissue, and secure of zygoma position are important. Especially, we should be more careful about communited fracture of zygomatic body and lateral displacement, root fracture of zygomatic arch. Because they are commom causes that make facial asymmetry. To get optimal result, ensure the definite bony reduction.

External Traction Technique for the Adjuvant Treatment of Zygomaticomaxillary Complex Fracture

The fixation of zygomaticomaxillary complex fracture is accomplished by the various internal placement of interosseous wiring, miniplates, microplate and even absorbable miniplate across properly reduced fracture lines to resist torsional rotation and masticatory force. However, in cases of comminuted compound fracture which makes zygomaticomaxilary complex fixed unstably, asymmetric malar height due to incomplete intraoperative reduction and predictable re-depression of zygoma postoperatively, we can hardly solve the malar asymmetry only by internal fixation device. So we employ the new external traction device which is made of hard board paper, cast, Steinmman pin, and rubber band. It is easy to make and apply it to the patient and morever, it is a dynamic traction method because it can control of traction force by rubber band and control of traction vector variously depending on degree of placement of fracture segment and fracture location, respectively. And it has less limitation to patient's hospital activity. Whereas it makes tiny traction pain during the traction device applied and the patient can feel uncomfortable head tightness. In summary, The authors' external rubber tration device can be used as a simple and convenient method in combination with internal fixation method in the postoperative management of malar symmetry.