Classification and management of zygomatic complex fractures including lateral wall of the orbit. Zygomatic complex fractures and its management acta scientific. Use of mono cortical screws as an aid to zygomatic complex. At the same time, it is difficult to obtain perfect reduction and contour postoperatively because of its complex involvement with four bones namely maxillary, temporal, orbital and greater wing of sphenoid. The fracture will be realigned and then fixed together using titanium plate and screws. Due to its uniqueness, the malar bone plays a very important role in maintaining. Zygomatic complex fracture tripod fracture iowa head. The zygomaticomaxillary complex fracturealso known as a quadripod fracturequadramalar fractureand formerly referred to as a tripod fracture or trimalar fracturehas four components. Zygomatic complex fractures are one of the frequently occurring maxillofacial injuries owing to its position and facial contour. This is a tshaped device that has a handle at one end with a sharp screw portion perpendicular to it. Fifteen had been submitted to surgical treat ment of a noncomminuted unilateral fracture of the zygo maticomaxillary complex, and made up the treated group. Type b complete monofragment zygomatic fracture tetrapod fracture. Fractures of the zygomatic complex appear commoner in young adult males.
Patients treated for isolated zygomatic fractures at the keio univeristy hospital between 2004 and 2011 were recruited for this study. The term zygomaticomaxillary zygomaticomalar complex zmc fractures refers to the osseous disruption of the malar eminence at 4 buttresses. Evaluation of efficacy of microplates in the management of. 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. Orbital fractures in which the zygomatic bone was not involved were excluded. Surgical management of zygomatic complex fractures in a major. The zygomatic arch is formed by the union of the temporal process of the zygomatic bone and the zygomatic process of the temporal bone at the zygomaticotemporal suture. This device must be placed into the body of the zygoma, thus requiring an incision directly over the malar prominence. The most common zygomaticomaxillary complex zmc fracture pattern involves fracture of the frontozygomatic suture lateral orbital rim, the zygomatic arch, the lateral buttress zygomaticomaxillary buttress, and the inferior orbital rim cummings 2005. Zygoma bone is the strong buttress of lateral midface lying between zygomatic process of frontal bone and maxilla. Infra orbital rim had the highest success rate of 100. Method a new technique describing the use of reduction screw with a selfholding screwdriver in reduction of the zygomatic complex fracture. Moreover the importance of zygomatic complex in facial skeleton lies inprotecting globe of eye and absorbing and redistributing masticatory andexternal load.
Patients with only zygomatic arch fracture or multiple complex fractures were also excluded. 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. Fractures of the zygomaticomaxillary complex are the second most common of all facial fractures. Therefore for cosmetic and functional reasons it is imperative to diagnoseand treat zygomatic fractures adequately. Assessment of zygomaticoorbital complex fractures using. What is an orbitozygomatic maxillary fracture repair. Get a printable copy pdf file of the complete article 2. Pdf background zygoma is a major buttress of the midfacial skeleton, which is frequently injured because of its prominent location. Full text full text is available as a scanned copy of the original print version. Risks of a orbito zygomatic maxillary fracture repair there are risks and complications with this procedure. This patient was diagnosed with a left zygomaticomaxillary complex fracture and underwent open reduction and internal fixation via a gingivobuccal sulcus approach.
On physical exam, the fracture appears as a loss of cheek. Surgical methods of zygomaticomaxillary complex fracture. Additionally, the fracture components may result in. The zygomatic bone occupies a prominent and important position in the facial skeleton. Management of zygomatic fractures pocket dentistry. This study using microplates had given promising results, hence may be considered as a valid tool in the management of zygomatico complex fractures. Spectrum of critical imaging findings in complex facial. 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. Definitions zygoma is a very crucial component which maintains facial contour. 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. The most direct approach in reducing a zygomatic fracture is to insert a carrollgirard screw. Get a printable copy pdf file of the complete article. Several fixation methods have been used over the years, including wire osteosynthesis, lag screw fixation, transfacial kirschner wire fixation, titanium plate and screw fixation, and more recently, resorbable plating system. Of the 177 patients, the maxillary complex was involved in 70 classified as central and centrolateral fractures, the zygomaticmaxillaryorbital complex in another 70. This may be an isolated zygomatic arch fracture a 1, a lateral orbital wall fracture a2, or an infraorbital rim fracture a3. Zygomatic complex fractures or the tetrapod fractures are common to occur followed by the nasal bone fractures because of its prominent location. Lowenergy fractures were found to result in minimal or no displacement, and had a continuous zf. Zygomatic fractures are common facial injuries, representing the most common facial fracture 214 or the second in frequency after nasal fractures.
Zygomatic fractures are the second most common fractures of the facial skeleton, after nasal bone fractures. Abstract introduction zygomatic complex fractures by virtue of its anatomic area poses a great challenge in reduction of the fracture. Fractures of zygomatic complex and orbit maxfac tutorial. The zygomatic complex also helps in transmitting the occlusal forces to the skull base. A cut is made around the eyes and inside the mouth to access the fracture. Treatment modalities in zygomatic complex fractures. They are the second most common facial bone fracture after nasal bone fractures pathology. Lateral wall fractures are therefore more commonly seen following significant maxillofacial trauma involving the malar complex too.
Evaluation of zygomatic complex fractures based on three. 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. Related pathology le fort type 3 fracture zygomaticomaxillary complex fra. Displacement of the malar complex does not occur because the remaining pillars are intact fig 1 ac. These will stay in place unless they cause problems, in which case a second operation will be required to remove them. Depending upon the extent of the bone displacement, the zygomatic complex can be refractured osteotomized and reposiitoned back to its preinjury position long. Assaults, road traffic accidents and falls are the principal etiologic factors that may cause fractures of zygomatic bone. In most cases, there is loss of sensation in the cheek and upper lip due to infraorbital nerve injury. Pdf zygomaticomaxillary complex fracture researchgate. The cause for zygomatic bone fracture is usually a direct blow to the malar eminence of the cheek during assault. There is improved projection of the zygoma top middle compared with the preoperative.
A new classification of zygomatic fracture featuring. The different fixation methods are applied to treat the zygomatic bone fractures, with many. Fracture lines usually run through the infraorbital rim, involve the posterolateral orbit, and extend to the inferior orbital fissure. Zygomaticomaxillary complex fractures orthopedics jama. Uses of various methods have been mentioned in english literature. Thirty patients were analyzed clinically and radiogra phically. 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.
The high incidence of zygomatic complex fracture relate zygoma. Zygomatic osteotomy for secondary correction of old fracture zygomatic fractures rotate down and inward resulting in a cheek deficiency and an orbital lowering if left unrepaired. Treatment and complications of orbitozygomatic fractures scielo. Treatment of zygomatic complex fractures using two point. Zygomaticomaxillary complex fracture radiology reference. Other fracture patterns, include isolated zygomatic arch fractures, or zmc fractures with associated panfacial fractures, such as le fort ii and iii.
Fractures of the zygomaticomaxillary complex and their. The zygomatic arch is formed by the articulation of the temporal process of the zygoma and the zygomatic process of the temporal bone. Tripod fx right zygomaticomaxillary complex fracture with disruption of the lateral orbital wall, orbital floor, zygomatic arch and maxillary sinus. Reduction was achieved using a carrollgirard screw fig 2. Prospective blind comparative clinical study of two point. It serves as an attachment point for the masseter and plays a. Zygomatic arch reduction gillies approach springerlink. Zygomatic complex fractures, facial fracture, etiolo gy, surgical approach. Management of tripod fractures zygomaticomaxillary. The zygomaticomaxillary complex fracture known as a quadripod fracture, quadramalar fracture, referred to as a tripod fracture or trimalar fracture, has four components. Md, who was the first in their group to suggest and routinely use the upper eyelid incision for zygomatic complex fracture reduction. The zygomatic maxillary complex zmc fractures are one of the most frequent injuries of the facial skeleton due to its position and facial contour. The fracture line then continues to the zygomatic sphenoid suture area and on to the frontozygomatic suture line. Strong buttress of lateral midface lying between zygomatic process of frontal bone and maxilla.
All zygomatic complex fractures involve the orbit, making visual complications a frequent occurrence. Maxillofacial computed tomographic scan, demonstrating reduction of the zygomaticomaxillary complex fracture. Fractures of the zygomatic complex and arch pocket. A zygomaticomaxillary complex fracture extends through these four sutures figs 8, 9. The incidence, cause, age, and gender predilection of. Assaults, road traffic accidents and falls are the common causes leading to fracture of the zygomatic bone. All zygomatic complex fractures involve the orbital floor and therefore. This is zygomatic arch fracture reduction using a temporal approach. Zygomatic complex fracture is the second most common fracture of facial region just. 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. Though the incidence varies, isolated zygomatic arch fractures constitute fewer than 10% of zygomatic injuries. A zygoma fracture zygomatic fracture is a form of facial fracture caused by a fracture of the zygomatic bone. 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.
The fractures through the lateral buttress and the inferior orbital rim are commonly connected by an anterior. Once reduction was established, fixation was accomplished using an lshaped plate at the zygomaticomaxillary buttress and. The overall results demostrated a success rate of zygomatico complex fractures. Ubc medicine neurology clinical skills motor, sensory, and reflex examination duration. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Case example zygomatic complex fracture tripod fracture. Zmc complex fracture right zygomaticomaxillary complex fracture with disruption of the lateral orbital wall, orbital floor, zygomatic arch and maxillary sinus. Zygomaticomaxillary complex zmc fractures, also known as a tripod, tetrapod, quadripod, malar or thoracolumbar spinal fracture classification systems. Reconstructive procedures protocols general considerations. Any patient who did not undergo a preoperative ct scan with 0. Pdf surgical methods of zygomaticomaxillary complex fracture. Links to pubmed are also available for selected references.
Classification of 77 zygomatic fractures according to the method of knight and north z group classification no. The remaining 502 patients consisted of 439 males and 63 females, and total 532 zygomatic bone. Zygomaticomaxillary complex fracture tripod fracture return to. Management of zygomaticomaxillary complex zmc fractures should be based on injury patterns and not on training background. 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 fracture pattern was previously known as a tripod fracture because only three disrupted sutures the zygomaticofrontal, zygomaticomaxillary, and zygomaticotemporal sutures could be discerned at screenfilm radiography. Displaced fractures of the zygomatic bone can result in significant functional and aesthetic sequelae.