Treatment of zygomatic complex fractures with surgical or. Fracture of the zygomatic complex is one of the most common facial injuries in maxillofacial trauma and predominately appears in young adult males 1 5. Treatment of zygomatic complex fractures using two point. Epidemiologic data and characteristics of treatment such as the type of material. N2 the zygomaticomaxillary complex zmc has integral structure and function in the bony skeleton of the face. Retrospective clinical and radiographic evaluation of tilted implants used in the. Pdf surgical methods of zygomaticomaxillary complex fracture. Evaluation of onepoint fixation for zygomaticomaxillary complex. Case report threepoint fixation of displaced tripod. Complicated zygomaticomaxillary complex fracture, known as one of the most. This technique is limited to arch noncomplex fracture in young patients.
Maxillofacial computed tomographic scan, demonstrating a depressed zygomaticomaxillary complex fracture with loss of projection top left, displacement at the sphenozygomatic suture top right. The zygoma may be separated from its 4 atriculations. Zygomaticomaxillary complex, bone fracture, sphenozygomatic suture, internal fixation, modification introduction due to the prominent position of the zygomatic region, the zygomaticomaxillary complex zmc. The zygomatic maxillary complex zmc fractures are one of the most frequent injuries of the facial skeleton due to its position and facial contour. Maxillofacial trauma presentations in 2011 at the royal brisbane hospital. Get a printable copy pdf file of the complete article. Surgical navigation improves reductions accuracy of unilateral. In the united states, zygomatic fractures are the second most common fracture of the facial bones following nasal bone fractures. Occasionally, a direct blow can produce an isolated depressed fracture of the arch only. Though the incidence varies, isolated zygomatic arch fractures constitute fewer than 10% of zygomatic injuries. Infraorbital nerve damageis common dueto itsproclivityof having the.
Zygomaticomaxillary complex fractures by dara liotta, md. An elevator is inserted through this incision, navigated to a location medial to the zygomatic arch, and used to reduce the zygomatic arch to its anatomic position. Fractures of zygomatic complex and orbit maxfac tutorial. According to the site of fracture, the patients were divided into three groups. The zygoma forms a significant portion of the floor and lateral wall of the orbit and forms a portion of the zygomatic arch, otherwise known as the malar eminence, which plays a key role in the determination of facial morphology. The zygoma anatomyguided approach zaga and the zygomatic success code zsc aparicio c, arevalo jx, ouazzani w, granados c. Reduction of zygomatic complex fracture using combination. Other fracture patterns, include isolated zygomatic arch fractures, or zmc fractures with associated panfacial fractures, such as le fort ii and iii. Reduction and fixation of zygomatic complex fractures. Comparative evaluation of different radiographic projections of. The ages of the patients ranged from 10 to 76 years old, mean age was 32. The different fixation methods are applied to treat the zygomatic bone fractures, with many more classifications which have.
The etiology of zygomatic complex fractures primarily. Pdf zygomaticomaxillary complex fracture researchgate. Case example zygomatic complex fracture tripod fracture. All zygomatic complex fractures involve the orbital floor and therefore understanding of. Surgical approaches and fixation patterns in zygomatic. Depending upon the extent of the bone displacement, the zygomatic complex can be refractured osteotomized and reposiitoned back.
Results the identified 694 patients who were admitted for zygomatic fractures from which 192. These fractures occur most commonly as the result of assaults or motor vehicle collisions. Current study was done to compare the stability of zygomatic complex fracture using biodegradable. Classification and treatment of zygomatic fractures. A free powerpoint ppt presentation displayed as a flash slide show on id.
Zygomatic complex zmc fractures result when disarticulation of the zygomatic bone at the zygomaticofrontal suture along the lateral orbital rim and the zygomaticomaxillary suture medially, as well as along the zygomatic arch to the temporal bone, permit rotation of the zygoma. Zygomaticomaxillary complex, zygomaticomaxillary compound, 31 zygomaticoorbital, 26 zygomatic complex, 32,33 malar, trimalar, and tripod fractures are terms that have been used to describe the clinical entity of fractures involving the zygoma and adjacent bones. The main complication of this procedure is facial asymmetry or contour deformity. Fractures of zygomatic complex and orbit introduction zygomatic bone forming the lateral wall of the orbit and giving prominence to the cheek is commonly involved in facial injuries, representing either the most common facial fracture or the second in frequency after nasal fractures. The zygomatic complex zc is a key component of structural facial. A new classification of zygomatic fracture featuring zygomaticofrontal suture. Surgical intervention is an effective treatment modality of depressed zygomatic complex fractures, whereas a nonsurgical approach is often. Zygomatic complex fractures with no or minimal displacement are often treated without surgical intervention. Synonyms tripod fracture, tetrapod fracture, trimalar fracture, zygomatic complex fracture, malar complex fracture, maxillary complex fracture, orbitozygomaticomaxillary fracture definition the most common zygomaticomaxillary. Om 15 showing distraction at fz, mb, and zt articulations. Plain occipitomental om view demonstrating a low energy henderson type 4 fracture. Fracture of the lateral orbital rim, zygomatic arch, inferior orbital rim and anterior and posterior maxillary sinus walls are identified.
The zygomaticomaxillary complex fracture, also known as a quadripod fracture, quadramalar fracture, and formerly referred to as a tripod fracture or trimalar fracture, has four components. This site is best for rigid fixation, because it directly antagonizes the pull of the masseter muscle. This is zygomatic arch fracture reduction using a temporal approach. Full text full text is available as a scanned copy of the original print version.
Zygomaticomaxillary complex, bone fracture, sphenozygomatic suture, internal. Evaluation of treatment of zygomatic bone and zygomatic. Management of zygomatic fractures pocket dentistry. These files will have pdf in brackets along with the filesize of. Injury mechanism and a guide to treatment hisao ogata, yoshiaki sakamoto and kazuo kishi department of plastic and reconstructive surgery, keio university school of medicine, shinjukuward, tokyo, japan. Fractures of the zygomatic complex and arch pocket. Reduction of zygomatic complex fracture using combination of microplate and miniplate osteosynthesis. The zygomatic bone occupies a prominent and important position in the facial skeleton. Blow out fracture emergency entrapment trap door or white eyed blowout usually pediatric. Displacement of the malar complex does not occur because the remaining pillars are intact fig 1 ac. Reconstructive procedures protocols general considerations. Ppt zygomatic complex fractures powerpoint presentation. A zygomatic complex fracture is normally impacted into the facial.
The zygomatic complex also helps in transmitting the occlusal forces to the skull base. Medially displaced zygomatic arch fractures may impinge on the coronoid process or temporalis tendon, resulting in trismus. Stl format to help with intraoperative and postoperative analysis. Babu 4 1 department of oral and maxillofacial surgery, indira gandhi institute of dental sciences, mahatma gandhi medical college and research institute campus, pillaiyarkuppam, pondicherry, india.
Prospective blind comparative clinical study of two point. Zygomatic complex fractures are one of the frequently occurring maxillofacial injuries owing to its position and facial contour. The zygomatic complex is responsible for the protection of the orbital contents and the midfacial contour. The etiology of facial fractures differs from one country to another worldwide. Management of zygomaticomaxillary complex zmc fractures should be based on injury patterns and not on training background. Traumatic findings demonstrate a left zygomaticomaxillary complex fracture or tripod configuration fracture from direct blow to the malar eminence. Generally, closed reduction is the treatment of choice for type a fractures. Usually, a displaced fracture involves the orbitozygomatic complex. Zygomaticomaxillary complex zmc fractures, also known as tripod, tetrapod, quadripod, malar or trimalar fractures, are seen in the setting of traumatic injury to the face. Assaults, road traffic accidents and falls are the common causes leading to. A zygoma fracture is often the result of facial trauma such as violence, falls or automobile accidents symptoms include flattening of the face, trismus reduced opening of the jaw and lateral subconjunctival hemorrhage see also. Consideration 1 indications second most common mid face fracture nasal fracture is first, usually from lateral blunt force like a blow from a fist. Assaults, road traffic accidents and falls are the principal etiologic factors that may cause fractures of zygomatic bone.
Patients with single zygomatic arch fracture were excluded. Zygomaticomaxillary complex fracture radiology case. Surgical management of zygomatic complex fractures in a major. Zmc complex fracture right zygomaticomaxillary complex fracture with disruption of the lateral orbital wall, orbital floor, zygomatic arch and maxillary sinus. If the zygomatic complex is likely to be unstable after reduction, the plate is placed along the fracture line at the zygomatic buttress. Type b complete monofragment zygomatic fracture tetrapod fracture. Diagnosis of zygomaticomaxillary fractures is a major problem in radiographic interpretation. It is always challenging for maxillofacial surgeons who are specialized in treating this part of the human body to achieve the lost functions and regain proper facial contour. The zygomatic arch, or cheek bone, is formed by the zygomatic process of the temporal bone a bone extending forward from the side of the skull, over the opening of the ear and the temporal process of the zygomatic bone the side of the cheekbone, the two being united by an oblique suture zygomaticotemporal suture. Surgical approaches and fixation patterns in zygomatic complex fractures article in the journal of craniofacial surgery 214.
Zygomatic arch reduction gillies approach springerlink. Lateral orbital wall and zygomatic arch fracture an isolated lateral wall fracture of the orbit is rare, as this is the strongest of the orbital walls. Due to its prominent convexity, the zygomaticomaxillary complex is very vulnerable to injuries. The integrity of the zygomatic complex is fundamental in maintaining normal facial width and prominence of the cheek. Among facial fractures, the zygomaticomaxillary complex fracture is one of.
The latter two terms are misnomers because the zygoma has not three but four. Treatment and complications of orbitozygomatic fractures scielo. The aim of this research was to analyze the surgical approaches and methods of rigid fixation used to treat zygomatic complex zc fractures over a 10year period. A new classification of zygomatic fracture featuring.
The goal of treatment for zygomaticomaxillary zm complex zmc fractures is to achieve stability and restore aesthetic appearance through. Aalborg universitet treatment of zygomatic complex. Treatment modalities in zygomatic complex fractures. Reposition of the fractured bone by means of limberg hook.
The prominent convex shape of the zmc makes it particularly vulnerable to injury. Zygomatic complex fracture tripod fracture iowa head. Flexible bones, greenstick fracture entrapped muscle is pinched in the fracture causing ischemia, possible oculocardiac reflex, nv, severe pain both passive and active movement is restricted. Two point fixation in zygomatic complex fractures doi. A prospective short clinical study ramesh candamourty 1, vinod narayanan 2, mf baig 2, mr muthusekar 2, manoj kumar jain 3, ramesh m. Zygomatic fractures rotate down and inward resulting in a cheek deficiency and an orbital lowering if left unrepaired. Classification and management of zygomatic complex fractures including lateral wall of the orbit. The malar bone represents a strong bone on fragile support and its processes frontal, orbital, maxillary and zygomatic are frequently the site of fracture. Orbital fractures in which the zygomatic bone was not involved were excluded.
Zygomaticomaxillary complex fracture tripod fracture return to. Retrospective clinical and radiographic evaluation of tilted implants used in the treatment of the severely resorbed edentulous maxilla. Pdf most of the documents on the racgp website are in portable document format pdf. However, isolated bilateral fractures of the arches without other injuries do occur when a force is applied directly from the lateral aspect of the midface.
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