Management of isolated zygomaticomaxillary complex. The zygomaticomaxillary complex zmc plays a key role in the structure, function, and aesthetic appearance of the facial skeleton. Trigeminocardiac reflex in zygomaticomaxillary complex fractures. Etiology and management of zygomaticomaxillary complex. Zygomaticomaxillary complex fracture tripod fracture return to. Fractures of the zygomaticomaxillary complex are the second most common of all facial fractures. A fracture along the zygomaticomaxillary suture from the inferior orbital rim through the.
Generally, an ebook can be downloaded in five minutes or less. Other fracture patterns, include isolated zygomatic arch fractures, or zmc fractures with associated panfacial fractures, such as le fort ii and iii fracture patterns. The etiology of facial fractures differs from one country to another worldwide. A retrospective analysis of 25 patients was conducted to assess the outcomes of isolated zmc izmc. Fractures of the zygomatico maxillary complex zmc are commonly seen after traumatic injuries to the facial skeleton. The goal of treatment for zygomaticomaxillary zm complex zmc fractures is to achieve stability and restore aesthetic appearance through. Moreover the importance of zygomatic complex in facial skeleton lies inprotecting globe of eye and absorbing and redistributing masticatory andexternal load. The patients ranged in age from 16 to 68 years, with a mean age of 29 years. Download pdf maxillofacial plastic and reconstructive surgery. Patients with zmc fractures often present with tenderness, ecchymosis and edema over the malar prominence, lateral orbit, upper and lower. The procedure should be considered for patients with unilateral or bilateral displacement of the zygomaticomaxillary complex with malar flattening, trismus, canthal dystopia, diplopia, globe malposition, or enophthalmos. Application of computerassisted surgery techniques in the. The zygomaticomaxillary complex zmc can account for up to 40% of midface fractures. Management of zygomaticomaxillary complex fractures.
Once reduction was established, fixation was accomplished using an lshaped plate at the zygomaticomaxillary buttress and. However, indications for the use of coronal incisions must be strictly applied. A study protocol for a randomised controlled trial. 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. Management of zygomatic complex fracture in armed forces.
A zygoma fracture zygomatic fracture is a form of facial fracture caused by a fracture of the zygomatic bone. Zygomatic complex fracture tripod fracture iowa head. Surgical management of zygomatic complex fractures in a. Request pdf management of zygomaticomaxillary complex fractures zygomaticomaxillary fractures account for approximately 25% of all facial fractures. They are the second most common facial fracture following nasal bone fractures. Surgical management of zygomatic complex fractures in a major.
Fracture of the zygomaticomaxillary complex zmc is one of the. The aim of this study was to assess the activity of the masseter and temporalis muscles using surface electromyography emg in patients with zygomaticomaxillary complex zmc fractures. Numerous techniques have been described for the reduction of zmc fracture. Displaced fractures of the zygomatic bone can result in significant functional and aesthetic sequelae. Zygoma fractures are classified according to knight and north based on the direction of anatomic displacement and the pattern created by the fracture. Investigate the risk of earassociated diseases after zygomaticomaxillary complex zmc fracture in a populationbased retrospective cohort study. The difference in softtissue malar height was evaluated with photogrammetric analysis using a threedimensional camera morpheus3d scanner. Reduction of zygomatic complex fracture using combination. Zygomaticomaxillary complex fracture dr ayla al kabbani and dr nasir siddiqui et al. Zygomaticomaxillary complex zmc fracture is the second most common facial bone fractures after nasal bone and has been extensively described in the literature. Displaced fractures of the zygomaticomaxillary complex often increase orbital volume due to angulation of the lateral orbital wall at the zygomaticosphenoid suture.
The zygomaticomaxillary complex fracture an anthropometric appraisal of surgical outcomes. Pdf surgical methods of zygomaticomaxillary complex fracture. Zygomaticomaxillary complex fracture and inferior orbital. Plastic and aesthetic research original article management of isolated zygomaticomaxillary complex fractures with an individualized approach. Zygomaticomaxillary complex fracture radiology reference. 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. It provides normal cheek contour and separates the orbital contents from the temporal fossa and the maxillary sinus. Zygomaticomaxillary complex zmc fractures are a group of fractures that can significantly alter the structure, function, and appearance of the midface, including the globe. A total of 478 patients with unilateral zygomaticomaxillary complex fractures were treated. As zygomaticomaxillary complex fracture is the second most common fracture of the. Zygomaticomaxillary complex how is zygomaticomaxillary. Thus, fractures of the zygomatic complex inevitability lead to a certain degree of orbital defect. Case example zygomatic complex fracture tripod fracture.
Pdf on aug 21, 2014, srinivas m susarla and others published zygomaticomaxillary complex fracture find, read and cite all the research you need on researchgate. Investigation of infraorbital nerve injury following. Zygoma or cheek bone fracture of zygoma is not usually present alone, its find mostly in the conjunction with adjacent structure i. The clinical course of diplopia associated with zygomaticomaxillary complex fractures before and after surgery. Like other facial fractures, the optimal management of operative zmc fractures requires anatomic reduction of all fractures followed by rigid internal fixation. A total of 1,330 zmc fracture patients and 5,320 nonzmc fracture participants were included and newly developed ear. In addition, statistics on the main sources responsible for the injury differs depending on the prevailing socioeconomic, cultural, and environmen tal. Interesting case series zygomatic arch fracture with coronoid impingement gerhard s. This retrospective cohort study examines the rates and outcomes of concomitant orbital floor fracture repair during zygomaticomaxillary complex fracture reducti skip to content. Risk of earassociated diseases after zygomaticomaxillary. This study suggests altered twopoint fixation of zmc fracture without accessing the zf. 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 present report describes a case of displaced zygomaticomaxillary complex zmc fracture eliciting tcr during reduction.
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. A zmc fracture is also known as a tripod, tetrapod or quadripod fracture, trimalar fracture or malar fracture. Electromyography assessment in zygomaticomaxillary complex. Surgical management of zygoma fractures in patients with. Evaluation of onepoint fixation for zygomaticomaxillary. Spectrum of critical imaging findings in complex facial. Patients should have been evaluated and deemed appropriate for such surgical intervention. Zygomaticomaxillary complex fractures orthopedics jama. Reduction was achieved using a carrollgirard screw fig 2. To reconstruct a zygomaticomaxillary complex zmc fracture, zygomaticofrontal zf suture is the most reliable site to assess anatomical alignment and to secure rigidity. Trends in concurrent orbital floor repair during zygomaticomaxillary complex. This is a retrospective cohort study using taiwans national health insurance research database of reimbursement claims.
Optimizing the surgical management of zygomaticomaxillary. Summary the aim of this study was to investigate the severity of infraorbital nerve injury following zygomaticomaxillary complex fractures and to estimate the treatment methods facilitating its functional recovery. A new classification of zygomatic fracture featuring zygomaticofrontal suture. It has been chosen primary site to be fixed, but approach through the lateral eyebrow incision may leave a visible scar. Zygomaticomaxillary complex fractures by dara liotta, md.
Changing trends in the treatment of zygomaticomaxillary complex. A zygomaticomaxillary complex fracture extends through these four sutures figs 8, 9. Infraorbital nerve sensory disturbances were diagnosed in 644% of the patients. 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. Treatment of zygomatic complex fractures with surgical or nonsurgical. Coronal approach to zygomaticomaxillary complex fractures.
Accurate reduction is the key to successful treatment of bone fractures. Therefore for cosmetic and functional reasons it is imperative to diagnoseand treat zygomatic fractures adequately. A 23yearold female with a left zygomaticomaxillary complex fracture was treated with onepoint fixation using unsintered hydroxyapatite particlespolyllactide composites. The effects of zygomatic complex fracture on masseteric force, j oral maxillofac surg, 50 8 791799.
Complicated zygomaticomaxillary complex fracture, known as one of the most challenging facial bone fractures, is. Management of isolated zygomaticomaxillary mafiadoc. This patient was diagnosed with a left zygomaticomaxillary complex fracture and underwent open reduction and internal fixation via a gingivobuccal sulcus approach. Reconstructive procedures protocols general considerations. Zygomaticomaxillary complex fracture deepak k gupta 2. Zygomaticomaxillary complex fracture pubmed central pmc.
Many of these fractures require surgical reduction and fixation to restore either function or aesthetic form or a combination of the two. Zygomaticomaxillary complex fractures pocket dentistry. Twenty patients with unilateral complicated zygomaticomaxillary complex fractures were included and divided into experimental and control groups in the study, including men and 7 women, with a. The term zygomaticomaxillary zygomaticomalar complex zmc fractures refers to the quiz ref idosseous disruption of the malar eminence at 4 buttresses. The latter two terms are misnomers because the zygoma has not three but four. Multiple 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 systems.
Evaluation of onepoint fixation for zygomaticomaxillary complex. Pdf zygomaticomaxillary complex fracture researchgate. The etiology of zygomaticomaxillary complex fractures is shown. A new classification of zygomatic fracture featuring. Infraorbital nerve transpositioning into orbital floor.
Management of tripod fractures zygomaticomaxillary complex 1 point and 2 point fixations. The zygomaticomaxillary complex zmc plays a key role in the structure, function, and esthetic appearance of the facial skeleton. Furthermore, the zygoma is connected to the maxilla and sphenoid bone as part of the inferior orbital floor, and forms the lateral orbital margin with the frontal bone. Management of tripod fractures zygomaticomaxillary. Fractures of the zygomaticomaxillary complex and their. Treatment of zygomatic complex fractures with surgical or. Fracture diastasis of the right temporozygomatic and zygomaticomaxillary sutures, subtle buckling of the right lateral orbital wall and fractures of the anterior and lateral walls of the right maxillary sinus consistent with a zygomaticomaxillary complex fracture. This case report presents a 21yearold man who was involved in a traffic accident and who subsequently presented with a zmc fracture. The pulse rate pressure was recorded before the induction of general. One thousand two hundred seventyseven patients with fracture of the zygomaticomaxillary complex and 196 patients with fractures of the. Etiology and management of zygomaticomaxillary complex fractures in the armed forces. Other fracture patterns, include isolated zygomatic arch fractures, or zmc fractures with associated panfacial fractures, such as le fort ii and iii. Analysis of treatment for isolated zygomaticomaxillary complex fractures, j oral maxillofac surg, 54.
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. The coronal incisions should be the first choice in case of comminuted, multiple and late zygomaticomaxillary complex fractures. Fractures of the zygomaticomaxillary complex zmc are the second most common of all facial fractures. Consideration 1 indications second most common mid face fracture nasal fracture is first, usually from lateral blunt force like a blow from a fist.
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