Traumatic Hemifacial Avulsion and Degloving Injury With Left Zygomaticomaxillary Complex Fracture: A Case Report.

Managing gross maxillofacial injuries poses significant challenges due to potential complications such as airway obstruction, cervical spine injuries, and damage to cranial structures. The resultant deformities from these injuries can have enduring psychological effects, which, if left unaddressed, can be devastating. This report outlines an approach for a patient with a history of a bull gore injury wherein a 49-year-old male presented to the Department of Oral and Maxillofacial Surgery, reporting an alleged animal attack. The patient had experienced avulsion of the left eye and degloving injuries affecting the lower eyelids, nose, left cheek, and upper and lower lips, along with skin over the chin, coupled with a left zygomaticomaxillary complex fracture. Subsequently, a comprehensive single-stage primary reconstruction and repair procedure was performed. Immediate single-stage reconstruction has shown success in achieving excellent functional and aesthetic outcomes. Preserving original tissue during debridement is crucial in preventing infection and minimizing flap loss.

The Spatial Relationship Between Coronoid Process and Zygomatic Complex After Reduction Malarplasty.

BACKGROUND: Reduction malarplasty presents challenges in terms of postoperative complications, particularly limited mouth opening. Excessive inward displacement of the zygomatic complex can impinge on the coronoid process resulting in restricted mouth opening. This study aimed to assess the spatial relationship between the coronoid process and the zygomatic complex after reduction malarplasty. METHODS: A retrospective study was conducted, including consecutive patients underwent reduction malarplasty. Radiological measurements were performed before surgery and during the final follow-up, including the coronoid-condylar index, distance between the coronoid process and zygomatic complex, and thickness and density of the temporal and masseter muscles. Clinical and radiographic data were recorded and analyzed. RESULTS: A total of 159 female patients were included with an average age of 28.1 years and a mean follow-up of 6.7 months. The mean coronoid-condylar index was 1:1.4, ranging from 1:0.6 to 1:2.6. Following surgery, the distances between the coronoid process and the anterior zygoma decreased by approximately 1 mm. Additionally, the postoperative distance between the highest point of the coronoid process and the zygomatic arch decreased by around 4 mm horizontally and changed approximately 1 mm vertically. No significant changes were observed in the thickness and density of the temporal and masseter muscles after surgery. CONCLUSIONS: Reduction malarplasty led to a slight decrease in the distance between the coronoid process and the zygoma. The operation generally resulted in proximity between the highest point of the coronoid process and the zygomatic arch. However, we believe that common reduction malarplasty rarely leads to osseous impingement. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

C-Arm a Useful Tool for Surgeons in Reduction of Zygomatic Complex Fracture: A Comparative Study: Article Type-Original Research.

Introduction: Reduction of zygomaticomaxillary (ZMC) fracture is often difficult to evaluate intraoperatively because of it peculiar anatomy and limited accessibility. The purpose of this study is to evaluate the efficacy of use of C-arm as a tool for intraoperative monitoring of ZMC fracture reduction. Materials and Methods: Group I (C-Arm) and Group II (control group) comprised of patients with isolated unilateral displaced Zygomatic complex (ZMC) fractures and having orbital volume change. The efficacy of use of C-arm intra-operatively was evaluated to analyse the reduction of fracture. Results: It was observed that mean change in ocular volume was around 1.07cm2 for Group I and 1.51cm2 in Group II. Thus post-operative eye volume was near to normal in Group I than Group II. The change in ocular volume post-operatively was observed to be statistically significant (p-value < 0.05) in both the groups. Post HOC Tukey statistical analysis determined the intergroup relation in change in eye volume between normal, pre- and post-operative and was found to be statistically significant (p-value < 0.05). The intergroup comparison between Group I and Group II was done using ANOVA statistical analysis and was found to be statistically significant (p-value < 0.05). Discussion: Our study revealed that C-arm is definitively an effective tool in the oral and maxillofacial surgery armamentarium, giving better results with minimal surgical exposure and by eliminating operator related error. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03221-y.

Pattern and management of maxillofacial fractures in Jordanian children and adolescents

Background: The aim of this study was to analyze the characteristics, etiology and treatment of maxillofacial fractures among children and adolescents in northern part of Jordan. Material and methods: A retrospective cohort study which included 91 children and adolescents patients who were treated for maxillofacial fractures during a period of three years between January 2019 and December 2021 at a tertiary hospital in Jordan. Results: Over a period of three years, a total of 91 children between the age of 0 and 19 years were treated with 156 total maxillofacial fractures. Of these, 68 (74.73%) were males and 23 (25.27%) were females. One tenth of patients (10 (10.99%) were children of the preschool group and 55 patients (60.44%) were adolescents. Road traffic accident (RTA) was the most common cause of maxillofacial fractures, accounting for 57 (62.64%) of cases. Mandibular fractures were the most common and accounted for 82 (90.2%) of all fractures, followed by the zygomatic bone fractures 40 (44%). The most common treatment was intermaxillary fixation (IMF) with 53 (33.97%) fractures. Conclusions: Maxillofacial fractures are predominant among adolescents in comparison to children. RTA was the most common cause of maxillofacial fractures, mandibular fractures were the most common fractures, and intermaxillary fixation (IMF) was the most common treatment modality. (AU)

A Systematic Review and Meta-Analysis of Complications among Various Reduction Malarplasty.

BACKGROUND: Reduction malarplasty is one of the most common aesthetic procedures to improve a wide bizygomatic width and a prominent zygomatic body. Although there are various kinds of modifications, any method is imperfect, while some complications may occur. The purpose of this review was to compare kinds of complications of reduction malarplasty to provide certain suggestions for clinical application. METHODS: A comprehensive computerized search of scientific literature was performed via the PubMed, Web of Science, and Library of Congress databases, involved in articles from January 1st, 1983 to February 28th, 2022. The outcomes were extracted and analyzed by 3 independent authors, including patient demographics, diagnoses, surgical techniques, postoperative outcomes, and complications. RESULTS: A total of 29 studies covering 6611 patients were included according to the inclusion and exclusion criteria. The L-shaped osteotomy may obtain a better effect when someone has both zygomatic body and arch protrusion. In the view of complications, our conclusion suggested that L-shaped osteotomy without bony resection reduced the zygomatic complex effectively with the lowest incidence of postoperative complications (0.02%). But the amount of bone resection is limited. If increasing bone resection is necessary, L-shaped osteotomy with long arm bony resection and L-shaped osteotomy with short arm bony resection are both preferable choices with lowest incidence of structural and functional complications, respectively. CONCLUSION: L-shaped osteotomy may obtain a better effect when a patient has both zygomatic body and arch protrusion. L-shaped osteotomy without bony resection reduced the zygomatic complex effectively with the lowest incidence of postoperative complications. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Management of zygomatic fractures using different surgical approaches.

Management of zygomatic complex fractures using closed reduction, two point open reduction with internal fixation (ORIF), closed reduction with three point ORIF and two point ORIF is of interest to dentist. 150 patients with zygomatic bone fractures between the ages of 14-60 years were included in the study. At final assessment, the percentage of stable condition was greater in closed reduction + two point ORIF and closed reduction + three point ORIF when compared to two point ORIF alone and three point ORIF alone and closed reduction alone. It was observed that stable condition was lowest in closed reduction alone. It was also observed that stable condition was lower in closed reduction + two point ORIF as compared to closed reduction + three point ORIF. It was also further noticed that stable condition was lower in two point ORIF alone as compared to three point ORIF alone. The treatment approach involving closed reduction and three point ORIF had better outcomes for management of zygomatic complex fractures.

Midface fracture pattern in a tertiary care hospital - A prospective study.

Introduction: The midface with multiple bones and cavities is vulnerable to fractures more commonly. Midface is one of the most frequently injured areas of the body, accounting for 23%-97% of all facial fractures. The classic LeFort type of fractures are uncommon nowadays and a more common picture is more severe forms primarily due to the high-speed vehicles that are a major cause of these fractures. It, therefore, has become imperative to determine the commonly occurring patterns of fractures in this area in the present time for a better insight into diagnosis and treatment plans. The aim of this article was to determine fracture patterns in midface trauma to ease the treatment planning in such a scenario. Materials and Methods: This prospective study included 114 patients who reported to a tertiary hospital during a 4-year period and were diagnosed with suspected midface fractures. The etiology and pattern of fractures of midface were assessed based on history, clinical examination, and imaging data. The diagnosis of a fracture was based on the clinical history, signs and symptoms, manual examination, and correct interpretation of radiographs and computed tomography. Midface fractures were recorded as LeFort I, II, III, dentoalveolar, palatal, zygomatic complex fracture, nasal bones, naso-orbital-ethmoidal complex, and orbital and zygomatic arch fractures. Etiological factors were classified as road traffic accidents (RTAs), fall, assault, and sports injuries. Results: During the 4-year period, a total of 114 patients were included. Patients' ages ranged from 17 to 68 years, with 102 males and 12 females. The most common fracture in this study was found to be zygomatic complex fractures (52%), and RTA was identified as the main cause of fracture in this study (79.2%). Conclusion: The midface fractures are more common in males due to the propensity of males to use two-wheelers more than females. The prominence of the zygoma makes it more vulnerable to fractures than rest of the bones in the midface. Increased speed of vehicles and lack of discipline in following traffic rules have resulted in RTA, being the biggest etiological factor in midface injuries.

Ophthalmic Complications Associated with Zygomatic Complex Fractures: A Randomised Descriptive Clinical Study.

Background and Objectives: Trauma to the maxillofacial region is usually associated with varying degrees of disruption of the soft and hard tissues in the region and injuries to the neighbouring structures such as eyes, brain, nasal apparatus and paranasal sinuses. Injuries to the middle third of the face commonly destroys the integrity of the orbital skeleton, and are frequently complicated by injury to the eye, ranging between 2.7 and 67% as reported in the literature. These injuries may result in loss of vision or compromised ocular function. When these injuries are severe, they may be detected with ease by any medical or maxillofacial surgeon but many injuries appear minimal and may be missed by the non-ophthalmologist. Methods: A total of thirty patients were selected who were diagnosed with a zygomatic complex fracture, irrespective of sex predilection and in the age group of 18-70 years. All patients underwent a thorough ophthalmic examination by an Oral and Maxillofacial Surgeon and an Ophthalmologist preoperatively and on postoperative day 2, and 7 and all findings were documented separately by the surgeon and the ophthalmologist and the findings were later compared. Results: The statistical analysis was performed using SPSS VERSION 21.0, Shapiro-Wilk test which was used to assess the normality. Descriptive analysis was done for age and gender distribution of study subjects, which are expressed as number and frequency. Cochran's q test was used to determine if there are differences in various study factors among OMFS and ophthalmologists at three time intervals which are expressed as number and frequency. Kappa agreement was used to assess the measurement of agreement between OMFS and ophthalmologists for each factor at each time interval and these are expressed as number and frequency, and p ≤ 0.05 is considered as statistically significant. Upon examination by an OMFS periorbital oedema (p = 0.000), periorbital ecchymosis (p = 0.002), chemosis (p = 0.02) and exophthalmos (p = 0.03) were considered clinically significant. Upon examination by an ophthalmologist subconjunctival haemorrhage (p = 0.05), periorbital oedema (p = 0.05), periorbital ecchymosis (p = 0.00), ptosis (p = 0.006), enopthalmos (p = 0.05) and diplopia (p = 0.05) were considered to be clinically significant. Upon correlation of the findings of the surgeon and the ophthalmologist it was seen that certain parameters like corneal injury, Phthisis bulbing, examination of posterior segment can be better done by the ophthalmologist. Interpretation and Conclusion: In conclusion, it was determined that there is a significant correlation between ophthalmic injuries caused by zygomatic complex fractures. There are a wide array of injuries affecting the eye due to trauma to the middle third of the face, and the superficial injury can be well evaluated and documented by a surgeon; however due to the extensive nature of the injuries in trauma and the importance of the eye, an ophthalmic examination cannot be ruled out. The need for evaluation of such injures deem it pertinent for observation by an ophthalmologist.

Ramal bone graft for management of infra-orbital rim fractures with defects - Technical note and a series of 16 cases.

The purpose is to describe a technique of using ramal bone graft for reconstructing defects of the infra-orbital rim (IOR), assess outcomes and complications. This was a retrospective chart review of 16 patients who underwent ramal bone grafting for IOR fractures. Outcomes evaluated were improvement in clinical findings (lid/globe malposition, tethering of facial skin and implant extrusion) and complications. Data analysis included descriptive statistics. The sample included 15 males and 1 female, with a mean age of 31.6 years. Lid malposition, globe malposition and tethering of facial skin was seen in 16, 13 and 6 patients, respectively. One patient demonstrated extrusion of implant. The mean size of bone harvested was 14 × 7 mm. All patients demonstrated improved globe position post-treatment, while 3 had residual lid retraction. Two patients demonstrated wound dehiscence in the donor site. In conclusion ramal bone graft was found to be a viable alternative for IOR reconstruction.

Evaluation of Trigeminocardiac Reflex in Patients Undergoing Elevation of Zygomatic Fractures.

Aim Trigeminocardiac reflex (TCR) manifests as typical hemodynamic perturbations including a sudden lowering of heart rate, mean arterial blood pressure (MABP), cardiac arrhythmias, and asystole. In literature, TCR has been seen during ocular surgeries, Lefort fractures, and craniofacial surgeries. However, the prevalence of the TCR has not been studied in zygomatic complex fractures . The aim of this study was to assess the prevalence of TCR in patients undergoing elevation with/without fixation of zygomatic complex fractures and isolated zygomatic arch fractures under local anesthesia and general anesthesia and to evaluate the prevalence of TCR in different age groups. Materials and methods The study comprised 26 participants diagnosed with zygomatic fractures indicated for surgical intervention. The aim of the study was to find the prevalence of TCR in patients undergoing surgical intervention (elevation of zygomatic complex fractures with/without fixation) under local anesthesia and general anesthesia. The heart rate and blood pressure were measured preoperatively, intraoperatively and postoperatively. Results Variation in heart rate was seen in patients undergoing surgery under local anesthesia and general anesthesia. However, a decrease in the heart rate i.e., bradycardia was noted intra-operatively in 75% of the patients operated under local anesthesia. The prevalence of TCR was noted intra-operatively in 23% of cases operated under general anesthesia. No significant changes were seen in the blood pressure of the patients. Conclusion In our study, we found out that the prevalence of TCR was more in the patients operated under local anesthesia i.e., 75% of patients. Out of the patients operated under general anesthesia i.e., 23% of patients showed TCR. No significant variations in blood pressure were observed in patients operated under local anesthesia or general anesthesia. The prevalence of TCR was found more often in the age group of 31-45 years in our study.

Application of customized integration titanium mesh in the treatment of complicated zygomatic complex fractures: A prospective randomized clinical study.

The present study aimed to quantitatively evaluate the outcomes of the application of customized integration titanium mesh (CITM) in treating unilateral complicated zygomatic complex fractures. A prospective, randomized, controlled clinical study was conducted. Patients were randomly divided into the experimental group who underwent treatment with CITM, and the control group who underwent treatment just with traditional titanium plates. The X2 test and student t-test were used for statistical analyses. Twenty patients who required surgery for unilateral complicated zygomatic complex fracture were included in this study. The results showed that the mean of average distance (AD) between pre- and postoperative CT measurements was 0.487 mm in the experimental group and 1.173 mm in the control group (P < 0.001). Compared with the control group, the experimental group had superior zygomatico-facial symmetry (P＜0.05), a shorter average operation time (150 min versus 229 min; P < 0.001), and a higher rate of anatomic reduction (80.0% versus 30.0%; P＜0.05). In conclusion, CITM deserves to be promoted for the treatment of complicated zygomatic complex fractures. TRIAL REGISTRATION: www.chictr.org.cn (ChiCTR1800016818).

Transconjunctival Approach Using Lateral Skin Extension for Reconstruction of Orbit Zygomatic Complex Fractures: Technique Description and a Case Series Analysis.

STUDY DESIGN: A descriptive-observational study of a series case report of patients diagnosed with orbito-zygomatic complex (OZMC) fracture with lateral wall involvement, was conducted. All patients were assessed in the Oral and Maxillofacial Surgery Service at Hospital El Carmen, Maipu, Santiago, Chile. OBJECTIVE: The purpose of this study was to evaluate a single-institution experience with the transconjunctival approach to the orbit, utilizing a lateral skin extension as unique approach to access to fronto-zygomatic suture, infraorbital rim and/or orbital floor. METHOD: The authors identified 41 patients with OZMC fractures who underwent to surgical treatment over a 45 months period. Among this group, 21 patients needed fixation with osteosynthesis of the frontozygomatic suture, and 16 of whom were treated with the approach being studied. The authors assessed scleral exposure, eyelid position changes, ectropion, and entropion as outcome measures, and reported satisfactory outcomes at a minimum of 9 months follow-up. CONCLUSIONS: This study concludes that in our experience, the transconjunctival approach utilizing a lateral skin extension allows a direct, easy, and quick access to the entire infra orbital rim, orbital floor, fronto-zygomatic suture and lateral wall of the orbit, up to spheno-zygomatic suture, with low associated morbidity and complications.

A Rare Fracture Pattern with Extensive Disruption of the Zygomatico-Orbito-Maxillary Complex.

A case of an unusually oriented fracture pattern and significant disruption of the right Zygomatico-orbito-maxillary complex, with severe comminution and gross displacement of its skeletal components, is described. Wide surgical access to all the fracture sites was provided by a combination of hemicoronal and intraoral surgical approaches. This enabled successful reduction, precise reapproximation, and stable fixation of the multiple displaced fracture fragments. An excellent restoration of the skeletal morphology and orbital volume to their original, preinjury status was achieved, obviating the development of any residual facial deformity, functional deficit or ocular complications.

Comparison of Ultrasonography with Conventional Radiography in Diagnosis of Zygomatic Complex Fractures.

INTRODUCTION: The diagnosis of zygomatic complex fractures is important in planning the treatment since the complex gives form to the projection, width and height of the midface. AIM: This study was carried out to assess the diagnostic sensitivity and utility of high-resolution ultrasonography in comparison with conventional radiography in the diagnosis of the zygomatic complex fractures. MATERIALS AND METHOD: Twenty-five cases of clinically diagnosed zygomatic complex fractures were subjected to conventional radiographs and USG study. RESULTS: The accuracy in terms of specificity and sensitivity of USG was comparable to conventional radiographs in the detection of the fractures of the zygomatic complex. CONCLUSION: This study points to the suitability of USG as an alternative to the use of plain radiographs in the diagnosis of zygomatic complex fractures. USG is safe, inexpensive and an accurate adjunct to conventional radiography in diagnosis of zygomatic complex fractures.

Efficacy of two-point fixation in the management of zygomatic complex fractures - A prospective clinical study.

INTRODUCTION: Anatomic disfigurement caused by zygomatic fracture warrants intervention tore establish facial symmetry. It is most predictably restored to pre morbid condition by ORIF. AIM: To evaluate the efficacy of 2 point fixation in Zygomaticomaxillary complex fractures. MATERIAL AND METHOD: 20 patients with established ZMC fractures were operated using two point fixation method and followed up for upto 3 months. RESULTS: 2 point fixation revealed satisfactory functional and esthetic results. CONCLUSION: 2 point fixation offers efficient outcome as compared to other modalities of management of ZMC.

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.

Maxillofacial Fracture Patterns in Road Traffic Accidents.

OBJECTIVE: The objective of this study is to analyze the maxillofacial fracture pattern from road traffic accidents (RTAs) in cases treated surgically in a tertiary hospital during July 2008-June 2018. MATERIALS AND METHOD: Data available in the department of oral and maxillofacial surgery of the institution of patients with maxillofacial fractures sustained due to RTAs that were treated in the department between the period July 2008 and June 2018 were collected and analyzed. The variables analyzed for the study were etiology, gender, age, and type of fracture. All cases were treated by open reduction and rigid internal fixation. RESULTS: A total of 348 patients with maxillofacial fractures were diagnosed, of which 335 were male and 13 were female. The ages ranged from 7 to 70 years. The maximum cases were in the age group of 16-30 years with 181 fractures followed by 31-45 group with 133 fractures, 45-60 years with 21 fractures, 0-15 years with 8 fractures, and >60 years with five fractures. The maximum incidence of fractures was in the mandible with 168 cases followed by 92 in zygomatic complex, combination of fractures in 53 cases, 13 LeFort I fractures, nine frontal bone fractures, three fractures in other areas, five nasal fractures, and five LeFort II fractures. Males predominated the cases of mandibular fractures involving multiple sites and cases involving multiple bones. CONCLUSION: A maximum number of maxillofacial fractures cases were in the second and third decades of life, and the high-speed vehicles and lack of protective safety accessories such as helmets and seatbelts were responsible for the wide variety of pattern fractures of facial bones.

Orthopaedic Bone Tap: A 'Jugaad' for Zygomatic Bone Reduction.

INTRODUCTION: The use of the Carroll-Girard screw in the management of zygomatic complex fractures has been well documented. The instrument provides an excellent degree of control over the movements of the disrupted zygomatic bone. Often mentioned in textbooks and literature, they are not routinely available for the Indian maxillofacial surgeon. This often prevents the regular use of this approach. MATERIAL AND METHODS: We have used the 2.5-mm orthopaedic bone tap that is very commonly available and routinely used in orthopaedic surgeries for reduction of the malar bone. CONCLUSION: The orthopaedic bone tap is easy to use and functions as an excellent alternative to the traditional Carroll-Girard screw.

Application of computer-assisted surgery techniques in the management of zygomatic complex fractures.

Patients suffering from zygomatic complex fractures always present facial deformity and dysfunctions, and thereafter develop psychological and physiological problems. It is really hard to get an ideal prognosis for the zygomatic complex fractures because of the complicated anatomical structures. Computer-assisted surgery techniques, as the new emerging auxiliary methods, can optimize the surgical protocol, predict operation outcomes, and improve the accuracy and quality of the operation. Meanwhile the postoperative complications can be reduced effectively. This review aims to provide a comprehensive overview of the application of computer-assisted surgery techniques in the management of zygomatic complex fractures.

Application of computer-assisted surgery techniques in the management of zygomatic complex fractures / 中华创伤杂志(英文版)

Patients suffering from zygomatic complex fractures always present facial deformity and dysfunctions, and thereafter develop psychological and physiological problems. It is really hard to get an ideal prognosis for the zygomatic complex fractures because of the complicated anatomical structures. Computer-assisted surgery techniques, as the new emerging auxiliary methods, can optimize the surgical protocol, predict operation outcomes, and improve the accuracy and quality of the operation. Meanwhile the postoperative complications can be reduced effectively. This review aims to provide a comprehensive overview of the application of computer-assisted surgery techniques in the management of zygomatic complex fractures.