Isolated zygoma and zygomaticomaxillary complex zmc. From september 2011 to october 2018, 43 patients with comminuted zmc. Even minimally displaced zmc fractures can result in functional and. To reconstruct a zygomaticomaxillary complex zmc fracture, zygomaticofrontal zf suture is the most reliable site to assess anatomical alignment and to secure rigidity. Overlooking a fracture may not have immediate consequences, but can result in disfigurement and permanent disability. The goal of treating zmc fractures is to achieve stability and restore aesthetic appearance through threedimensional reduction and rigid fixation. Do you want to use the redesigned ao sr like an app.
In the present study, the most common facial fracture is zmc. Injury mechanism and a guide to treatment hisao ogata, yoshiaki sakamoto and kazuo kishi. A new classification of zygomatic fracture featuring. Kittidumkerng, analysis of treatment for isolated zygomaticomaxillary complex fractures. Not only does this result in a disgruntled patient, it may affect their. Herniation of the buccal fat pad into the case report. Facial fracture management handbook malar complex fractures. Zygomaticmaxillary zmc complex fractures are a common consequence of facial trauma. In the retrospective study, a total of 40 patients with zmc fracture were.
The key suture in evaluating the reduction of zmc fractures is the zygomaticosphenoid suture. Casebased format prepares students and residents to pass the omssat, with the table of contents corresponding to the exams categories and questions 95 clinical cases focus on. It requires a prompt and skillful response from the anaesthesia team. The term malar complex fracture refers to a fracture which in its classic form primarily involves the suture lines of the zygomatic bone. Despite the efforts by the authors to assess the surgical management of zmc. The zygomaticomaxillary complex zmc plays a key role in the structure, function, and esthetic appearance of the facial skeleton. Type a injuries are isolated to one component of the tetrapod structure, including the zygomatic arch type a1, the lateral orbital wall type a2, and the inferior orbital rim type a3. The authors present a retrospective study analyzing the epidemiology and surgical management using openreduction and internal fixation of 27 isolated zmc fracture cases in. Surgical management of zygomatic complex fractures in a major.
The purpose of this article is to facilitate the involvement of radiologists in the delivery of individualized multidisciplinary care to adults who have sustained blunt trauma and have. It has been chosen primary site to be fixed, but approach through the lateral eyebrow incision may leave a visible scar. The variation in the patterns of facial bone fracture depends on variation in geographic, cultural, and socioeconomic environments of the countries in which studies are conducted. Classification systems, principles of reduction, and common complications1 the advent of titanium hardware, which provides firm threedimensional positional control, and the. This patient was a polytrauma patient who had surgery delayed by 49 days due to their concurrent injuries, and it was not possible to reduce the zmc fracture intraoperatively. Commentary on surgical management of zygomatic complex. Thus, the term zygomaticomaxillary complex zmc fracture often is used when describing fractures involving the zygoma. Surgical management of zygomatic complex fractures in a. Zygomaticomaxillary complex fracture tripod fracturereturn to.
A number of studies had shown zmc fractures to be the second most. Evaluation of onepoint fixation for zygomaticomaxillary complex. Management of tripod fractures zygomaticomaxillary. Efficacy of altered twopoint fixation in zygomaticomaxillary. Analysis of treatment for isolated zygomaticomaxillary. This study performs a structural optimization of anatomical thin titanium mesh attm plate and optimal designed attm plate fabricated using additive manufacturing am to verify its. A new classification of zygomatic fracture featuring zygomaticofrontal suture.
In the present study, 11 0 patients of zmc fracture were randomly assigned into two point group 1 or three point fixation group 2. Petersons principles of oral and maxillo facial surgery. They are the second most common facial fracture following nasal bone fractures. Herniation of the buccal fat pad into the maxillary antrum. To evaluate the incidence of neurosensory changes in infraorbital nerve follwoing zygomaticomaxillary complex zmc fractures posttrauma and to evaluate the recovery of neurosensory function subsequent to treatment of zmc. In the retrospective study, a total of 40 patients with zmc fracture were divided. Management of maxillofacial trauma is a challenging task for an anaesthesiologist. This patient was a polytrauma patient who had surgery delayed by 49 days due to their concurrent injuries, and it was not possible to reduce the zmc. Zygomaticomaxillary complex zmc fractures result from blunt trauma to the periorbital area viz.
Management of isolated zygomaticomaxillary mafiadoc. This study suggests altered twopoint fixation of zmc fracture without accessing the zf suture. Facial fracture refers to any injury that results in a broken bone or bones of the face, for example a broken nose, jaw, midface bones, cheekbone, eye socket, and. The purpose of this study was to evaluate the adequacy of reduc tion and stability of fixation of isolated zygomaticomaxillary complex zmc. Management of tripod fractures zygomaticomaxillary complex 1 point and 2 point fixations. Threedimensional analysis of zygomaticmaxillary complex. Fractures of the zmc may occur alone known as isolated zmc izmc fracture or in association with fractures of other bones of the craniofacial complex. Note a fracture of the posterolateral wall of the left maxillary antrum allowing herniation of the buccal fat pad into the antrum. The zygomaticomaxillary complex zmc can account for up to 40% of midface fractures.
In this retrospective study, we present a novel method of zmc fracture pattern analysis, utilizing. Edema and bleeding into the loose connective tissue of the eyelids and periorbital areas. The patient does not recall striking his head, but complains of tenderness over the right zygomatic arch and maxilla. A number of studies had shown zmc fractures to be the second most common facial fracture, after nasal bone or mandible fractures 36. The authors concluded that there is a lack of consensus in the repair methodology of zmc fractures likely due to surgeon preference, training, and experience. The fixation points used in the open reduction and internal fixation orif of zmc fractures are shown in figure 2. Zygomaticomaxillary complex fracture radiology reference. Versatility of gillies temporal approach in the management of zmc fractures. Figure 21a figure 21b figure 21c figure 21d findings figures 21a and 21b. The incidence of zmc fractures varies with geographical location, socioeconomic trends, and incidence of road traffic collisions rtcs, alcohol abuse and drug abuse. We help you diagnose your midface case and provide detailed descriptions of how to manage this and hundreds of other pathologies. Pdf management of isolated zygomaticomaxillary complex. Obeng clinical history 29yearold male involved in a motor vehicle accident. A curious case of zygomaticomaxillary complex fracture.
Zmc fractures refer to traumatic disruption of the four buttresses that make up the zmc. As previously mentioned, one zmc fracture case in a polytrauma patient who had surgery delayed 49 days due to concurrent injuries was managed with a bone graft as is was not possible to reduce the zmc fracture intraoperatively. The chapter presents a case that illustrates the importance of early surgical intervention. Zygomaticomaxillary complex fracture dr ayla al kabbani and dr nasir siddiqui et al. Department of oral and maxillofacial surgery, sree balaji. In this blog post, we are going to share a free pdf download of oral and maxillofacial surgery secrets 3rd edition pdf using direct links. Jeffrey marsh and chad perlyn, is designed to make this decisionmaking process easier. This manual is written to be used as a rapid reference source in the management of facial bony. Facial fracture management handbook iowa head and neck. The paper aims to study the types of ocular injuries in patients with zmc fractures. A casebased approach, 2nd edition, covers all the material you need to know for the board, inservice. Surgical management of zygoma fractures in patients with.
Oral and maxillofacial surgery secrets 3rd edition pdf. 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. Evaluation of results with threepoint visualization of. Treatment methods for the same have evolved over the years, and in spite of all the literature available, zmc fracture treatment varies from no intervention at all, to elevation of the fractured. This study suggests altered twopoint fixation of zmc. Pure fracture of the zygomatic arch is rare, owing to the strength and thickness of the zygoma.
Zygomatic complex zmc fractures result when disarticulation of the zygomatic bone at the zygomaticofrontal suture along the lateral orbital rim and the. Peterson evaluation of results with threepoint visualization of zygomaticomaxilllary complex fractures. There were 40 zmc fractures and isolated zygomatic arch fractures. Few studies have reported on using craniometry for comminuted zygomaticomaxillary complex zmc fracture management. The inadequate reduction of zmc fracture leads to asymmetrical facial contouring, diplopia. Many authors have devised classification schemes for zygomaticomaxillary complex zmc fractures. Zygomatic complex fracture tripod fracture iowa head and. One zmc fracture case was excluded from the points of fixation and surgical incision analysis. Zmc fractures requires anatomic reduction of all fractures followed by rigid internal. Preoperative radiographs revealed the zmc fracture with opacification of the inferior portion of the maxillary antrum and what was believed to be an airfluid level. They can account for approximately 40% of midface fractures. The main causes of fractures are trauma due to rtas, assaults, falls, sports related injuries, and. Ocular injuries in patients of zygomaticocomplex zmc. Each patient with zmc fracture should be evaluated individually.
Poswillo described zmc fractures as per their displacement in different directions. 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. The frequency of zmc fractures is second only to nasal fractures, which are the most common type of facial fracture. Road traffic accident was the cause of zygomatic fractures. Feasibility of a craniometry in a comminuted zygomaticomaxillary. The aim of this retrospective study was to determine the incidence and clinical significance of zmc fracture involving the glenoid fossa or articular eminence of the tmj with an emphasis on. Anesthetic challenges and management of maxillofacial trauma. A study of 67 patients, who had sustained facial trauma sufficient to lead to a facial. Incidence and evaluation of recovery of neurosensory. They are the second most common facial bone fracture after.