Zygomatic complex fractures and its management acta scientific. An ice pack and pain relievers may be recommended to manage pain and swelling as the fracture heals. The technique of mini plate osteo synthesis for stable fixation of zygomatic bone fracture was first described by michelet, ian jackson, fain et al. This often prevents the regular use of this approach. Fracture zygoma and its management our experience core. Due to the prominent position of the zygomatic region, the zygomaticomaxillary complex zmc fracture is one of the most common facial frac ture. Clinical features of any fracture are mostly related to the sur gical anatomy of the. The zygomatic bone is small and quadrangular, and is situated at the upper and lateral part of the face.
If displaced fracture, a surgeon does the wiring of the bone, which can be an ent surgeon, a plastic surgeon or general surgeon. C, caldwells projection showing the density superimposed on the petrous portion of the temporal bone. Fractures of zygomatic complex and orbit maxfac tutorial. Clinical and epidemiological presentation of patients with. Choosing the adequate treatment for zygomatic bone fracture.
The zygomatic process of the temporal bone is a long, arched process projecting from the lower part of the squamous portion of the temporal bone. Pdf choosing the adequate treatment for zygomatic bone. A, attempted waters projection showing a vertical radiopaque density in the area of the left zygomatic arch. Zygoma fractures are easy to miss and displaced fractures require treatment within 10 days. Facial trauma nasal maxillary z neurosurgery resident. We recommend threepoint rigid fixation of fractured zygoma after accurate reduction. The researchers consider the previous classification system should be improved. A small bone in vertebrates on each side of the face below the eye socket, forming the prominence of the cheek. The obvious advantage to bone plate is that it provides stabilization in three planes. This plays a key role in the structure and function of. Orbital fractures in which the zygomatic bone was not involved were excluded. Zygomatic arch fracture treatment answers on healthtap.
Such landmarks are shown and discussed in sequence with the key surgical steps. All zygomatic complex fractures involve the orbital floor and therefore understanding of. Osteomyelitis and fracture callus abscessation secondary. Zygoma arch fracture an overview sciencedirect topics. Chapter 12 zygomatic malar fractures ct scan 3d fig. Regarding the results in group a patient with zygomatic bone fracture were divided into.
Patient perspective in the management of zygomatic fractures. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Considering high incidence of zygomatic complex fractures and its high morbidity complications, this study had been planned to find out the important clinical and epidemiological features in patients with zygomatic complex fracture, presented in pims hospital. The malar complex refers to the zygoma and maxillary bones and therefore forms part of the orbital floor and lateral orbital wall. Pdf background zygoma is a major buttress of the midfacial skeleton, which is. The characteristic clinical signs of zygomatic bone fracture include flattening of the cheek, infraorbital nerve paraesthesia, diplopia, and trismus. The instrument provides an excellent degree of control over the movements of the disrupted zygomatic bone. Inferior and posterior displacements of the zygoma produce varying degrees of disorganization of the soft tissue of the orbital cavity with bone expansion see figure 7. Surgical methods of zygomaticomaxillary complex fracture. It articulates with the zygomatic bone this process is at first directed lateralward, its two surfaces looking upward and downward. It protects the part of your brain that controls hearing, speech, memory, and behavior. Zygomatic complex fractures, facial fracture, etiolo gy, surgical approach. Management of zygomatic fractures pocket dentistry.
Strong buttress of lateral midface lying between zygomatic process of frontal bone and maxilla. Impingement is suspected clinically in the presence of trismus with limited mouth opening and is confirmed. Pdf reconstruction of complex zygomatic bone defects. Up to 50% of these fractures will heal with no surgery required. It forms a large portion of the orbit and, together with the sphenoid bone, forms part of the orbital floor. The patients hair was shaven for clarity and for proper marking of key anatomic landmarks. Treating the zygomatic arch fracture depends upon whether it is displace or caved in.
It contains the middle and inner portions of the ear, and is crossed by the majority of the cranial nerves. The dog suffered a bite wound two months previously, causing puncture wounds dorsal to the orbit where radiographs demonstrated a minimally displaced fracture of the zygomatic arch and surrounding soft, fluctuant swelling. However, your oral surgeon will need to perform a clinical exam with ct scan. Other fracture patterns, include isolated zygomatic arch fractures, or zmc fractures with associated panfacial fractures, such as le fort ii and iii. From the photos, your cheeks are flat anteriorly in the front with high points on the lateral aspect of the malar bone, not the zygomatic arch. Treatment of the zygomatic bone fracture is meant to restore the symmetry of the face, make certain that the eye moves normally in the orbit and address any potential nerve damage. The zygomatic bone occupies a prominent and important position in the facial skeleton. Depending on the severity of the dislocation, the bone can either move slightly along its sutures or more severely in an anterior, medial, lateral or posterior direction. Zmc fracture is also known as a tripod, tetrapod, or quadripod fracture, trimalar fracture or malar fracture 1,2. Depending upon the extent of the bone displacement, the zygomatic complex can be refractured osteotomized and reposiitoned back. Analysis of outcome of zygomatic fracture management.
It articulates with the zygomatic process of the temporal bone, and together they make up the zygomatic arch. Rests are com bined and secondary to a fractured zygoma 4. Note the preservation of the inner margin of the zygomatic bone and sphenoid bone, this will simplify anatomical reduction. Collapsing the zygomatic arch creates an in fracture of the arch in an attempt to narrow the face. Classic tripod fracture, but anatomically these fractures are actually. Related pathology le fort type 3 fracture zygomaticomaxillary complex fra.
Zygomatic fractures rotate down and inward resulting in a cheek deficiency and an orbital lowering if left unrepaired. Often mentioned in textbooks and literature, they are not routinely available for the indian maxillofacial surgeon. The body of the zygoma is sturdy, but its articulations are frequently the site of. The zygomatic bone fracture and coronoid process impingement lead to restricted mouth opening. Surgical management of zygomatic complex fractures in a major. Epistaxis can occur when the turbinate bones are fractured, and nasolacrimal duct obstruction can result from a. Pdf surgical methods of zygomaticomaxillary complex fracture. A study on assessing the etiology and different treatment. 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. In this article, we shall look at the different parts of the temporal bone, their articulations, and any. Therefore, diagnose and properly management of the zygomatic bone injury is important. A new classification of zygomatic fracture featuring.
In this study, the researchers describe a new means of classifying zygomatic fractures based on 3dct and the type of trauma inflicted, which could be used to inform surgical strategy. Road traffic accident was the leading factor causing zygomatic bone fracture. Temporal gillies approach to a zygomatic arch fracture. You have two temporal bones, one on each side of your head. The zygomatic bone has a prominent and im portant position in the. The zygoma forms part of the floor and lateral wall of the orbit and the zygomatic arch is an important feature in the structure and appearance of the face. 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. Case report threepoint fixation of displaced tripod. In patients with zygomatic arch fractures and limited mouth opening interincisal distance 40 mm, the arch may be in direct boneonbone contact with the coronoid process of the mandible, and urgent open reduction is indicated. The fracture complex results from a direct blow to the malar eminence and results in three distinct fracture components that disrupt the anchoring of the zygoma. The second most common area of fracture in the face is the zygoma, especially the left frontal process of the zygomatic bone, e. In zygomaticomaxillary complex zmc fracture many incisions lateral. Evaluation of treatment of zygomatic bone and zygomatic.
A 26yearold male was struck on the left side of his face while playing baseball. They are the second most common facial bone fracture after nasal bone fractures pathology. Additionally, the fracture components may result in impingement of the. For example, a hairline fracture in the cheekbone may simply require time to heal. The lower portion of the bone articulates with the mandible, forming the temporomandibular joint of the jaw. Treatment and complications of orbitozygomatic fractures scielo. This video documents the steps typically followed during open reduction of isolated, depressed zygomatic arch fractures. A zygoma fracture zygomatic fracture is a form of facial fracture caused by a fracture of the zygomatic bone. Untreated fractures may cause a cosmetic deformity flattening of the cheek or limited mandibular movement caused by the depressed zygoma impinging on the. The zygomatic process of the frontal bone and the zygomatic arch, which form the dorsal orbital rim, are prone to fracture and resultant opening into the frontal and caudal maxillary sinuses.
It forms the central part of the zygomatic arch by its attachments to the maxilla in front and to the zygomatic process of the temporal. Interruption in zygomatic position has psychological, aesthetic and functional effects which impairs the function of mandible and ocular tissue. Zygomatic bone definition of zygomatic bone by the free. The temporal process, which forms zygomatic arch a1frontal process, which forms lateral orbital wall a2maxillary process, which forms infraorbital rim a3category bfracture of all three processes, detaching zygomatic bone from facial skeleton i. Fractures involving zygoma is very common, in fact it is the second most common facial bone to the fractured following facial trauma next only to nasal bones. The use of the carrollgirard screw in the management of zygomatic complex fractures has been well documented. How can i reduce my zygomatic bones to give my face a.
Our study showed that displacement at any of the fractured site on. Doctor answers on symptoms, diagnosis, treatment, and more. The temporal bone contributes to the lower lateral walls of the skull. The prominence of zygomatic bone predisposes it to bear the brunt of facial injuries. Diagnosis and management of common maxillofacial injuries. Zygomaticomaxillary complex fracture radiology reference. 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. 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 is most commonly seen after assault, but any blow to the cheek may give rise to a fracture. B if zygomatic bone does not snap into place or remain reduced probably soft tissue interposed or osseous comminution open reduction and wire fixation in at least two fracture areas usually at zygomaticofrontal suture and zygomaticomaxillary suture along infraorbital rim. The temporal bone is the bone that goes around your ear, in your skull. It adjoins the frontal bone at the outer edge of the orbit and the sphenoid and maxilla within the orbit.