The main causes of fractures are trauma due to rtas, assaults, falls, sports related injuries, and. Herniation of the buccal fat pad into the maxillary antrum. 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. The inadequate reduction of zmc fracture leads to asymmetrical facial contouring, diplopia. Zygomatic complex zmc fractures result when disarticulation of the zygomatic bone at the zygomaticofrontal suture along the lateral orbital rim and the. Even minimally displaced zmc fractures can result in functional and. The authors present a retrospective study analyzing the epidemiology and surgical management using openreduction and internal fixation of 27 isolated zmc fracture cases in. The zygomaticomaxillary complex zmc can account for up to 40% of midface fractures. A casebased approach, 2nd edition, covers all the material you need to know for the board, inservice. Oral and maxillofacial surgery secrets 3rd edition pdf. Ocular injuries in patients of zygomaticocomplex zmc. 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.
A curious case of zygomaticomaxillary complex fracture. Kittidumkerng, analysis of treatment for isolated zygomaticomaxillary complex fractures. Many authors have devised classification schemes for zygomaticomaxillary complex zmc fractures. The paper aims to study the types of ocular injuries in patients with zmc fractures. Figure 21a figure 21b figure 21c figure 21d findings figures 21a and 21b. Overlooking a fracture may not have immediate consequences, but can result in disfigurement and permanent disability. Zygomaticmaxillary zmc complex fractures are a common consequence of facial trauma. Zygomaticomaxillary complex fracture tripod fracturereturn to.
Facial fracture management handbook iowa head and neck. Classification systems, principles of reduction, and common complications1 the advent of titanium hardware, which provides firm threedimensional positional control, and the. Pure fracture of the zygomatic arch is rare, owing to the strength and thickness of the zygoma. The frequency of zmc fractures is second only to nasal fractures, which are the most common type of facial fracture. In the present study, 11 0 patients of zmc fracture were randomly assigned into two point group 1 or three point fixation group 2. Not only does this result in a disgruntled patient, it may affect their. To reconstruct a zygomaticomaxillary complex zmc fracture, zygomaticofrontal zf suture is the most reliable site to assess anatomical alignment and to secure rigidity.
In this retrospective study, we present a novel method of zmc fracture pattern analysis, utilizing. Efficacy of altered twopoint fixation in zygomaticomaxillary. 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. A study of 67 patients, who had sustained facial trauma sufficient to lead to a facial. 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. The chapter presents a case that illustrates the importance of early surgical intervention. Surgical management of zygomatic complex fractures in a. Zygomaticomaxillary complex zmc fractures result from blunt trauma to the periorbital area viz. There were 40 zmc fractures and isolated zygomatic arch fractures. A number of studies had shown zmc fractures to be the second most. Incidence and evaluation of recovery of neurosensory. A new classification of zygomatic fracture featuring zygomaticofrontal suture. Zygomatic complex fracture tripod fracture iowa head and.
Management of isolated zygomaticomaxillary mafiadoc. The purpose of this study was to evaluate the adequacy of reduc tion and stability of fixation of isolated zygomaticomaxillary complex zmc. The fixation points used in the open reduction and internal fixation orif of zmc fractures are shown in figure 2. Peterson evaluation of results with threepoint visualization of zygomaticomaxilllary complex fractures. Isolated zygoma and zygomaticomaxillary complex zmc. Department of oral and maxillofacial surgery, sree balaji.
The key suture in evaluating the reduction of zmc fractures is the zygomaticosphenoid suture. A number of studies had shown zmc fractures to be the second most common facial fracture, after nasal bone or mandible fractures 36. Threedimensional analysis of zygomaticmaxillary complex. Edema and bleeding into the loose connective tissue of the eyelids and periorbital areas.
Surgical management of zygomatic complex fractures in a major. This manual is written to be used as a rapid reference source in the management of facial bony. Obeng clinical history 29yearold male involved in a motor vehicle accident. 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. Pdf management of isolated zygomaticomaxillary complex. Despite the efforts by the authors to assess the surgical management of zmc. The term malar complex fracture refers to a fracture which in its classic form primarily involves the suture lines of the zygomatic bone. They can account for approximately 40% of midface fractures. The patient does not recall striking his head, but complains of tenderness over the right zygomatic arch and maxilla.
In the present study, the most common facial fracture is zmc. One zmc fracture case was excluded from the points of fixation and surgical incision analysis. In the retrospective study, a total of 40 patients with zmc fracture were divided. This study suggests altered twopoint fixation of zmc fracture without accessing the zf suture.
Zmc fractures refer to traumatic disruption of the four buttresses that make up the zmc. 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. Zmc fractures requires anatomic reduction of all fractures followed by rigid internal. Petersons principles of oral and maxillo facial surgery. Each patient with zmc fracture should be evaluated individually. The incidence of zmc fractures varies with geographical location, socioeconomic trends, and incidence of road traffic collisions rtcs, alcohol abuse and drug abuse. Zygomaticomaxillary complex fracture dr ayla al kabbani and dr nasir siddiqui et al. Feasibility of a craniometry in a comminuted zygomaticomaxillary. They are the second most common facial fracture following nasal bone fractures.
In the retrospective study, a total of 40 patients with zmc fracture were. Road traffic accident was the cause of zygomatic fractures. 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. Versatility of gillies temporal approach in the management of zmc fractures. Poswillo described zmc fractures as per their displacement in different directions. 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. Few studies have reported on using craniometry for comminuted zygomaticomaxillary complex zmc fracture management. Evaluation of results with threepoint visualization of. Management of tripod fractures zygomaticomaxillary. We help you diagnose your midface case and provide detailed descriptions of how to manage this and hundreds of other pathologies. Commentary on surgical management of zygomatic complex. Management of maxillofacial trauma is a challenging task for an anaesthesiologist.
They are the second most common facial bone fracture after. Facial fracture management handbook malar complex fractures. The zygomaticomaxillary complex zmc plays a key role in the structure, function, and esthetic appearance of the facial skeleton. 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. 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. Evaluation of onepoint fixation for zygomaticomaxillary 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. Management of tripod fractures zygomaticomaxillary complex 1 point and 2 point fixations. 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. This study suggests altered twopoint fixation of zmc.
Surgical management of zygoma fractures in patients with. 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. Herniation of the buccal fat pad into the case report. Injury mechanism and a guide to treatment hisao ogata, yoshiaki sakamoto and kazuo kishi. 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. Note a fracture of the posterolateral wall of the left maxillary antrum allowing herniation of the buccal fat pad into the antrum. Thus, the term zygomaticomaxillary complex zmc fracture often is used when describing fractures involving the zygoma. 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. A new classification of zygomatic fracture featuring. 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. Analysis of treatment for isolated zygomaticomaxillary. Jeffrey marsh and chad perlyn, is designed to make this decisionmaking process easier. Anesthetic challenges and management of maxillofacial trauma.
It requires a prompt and skillful response from the anaesthesia team. Do you want to use the redesigned ao sr like an app. The goal of treating zmc fractures is to achieve stability and restore aesthetic appearance through threedimensional reduction and rigid fixation. From september 2011 to october 2018, 43 patients with comminuted zmc. 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. 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.
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