Facial fracture aftercare instructions what you need. They stated that two point fixation is sufficient in a majority of patients. The zygoma has 4 bony attachments to the skull, and zmc fractures are sometimes known as tetrapod fractures. Neglected orbitozygomaticomaxillary fractures with complications. Pdf delayed treatment of zygomatic tetrapod fracture. Fractures of zygomatic complex and orbit maxfac tutorial.
Pdf causes and management of zygomatic bone fractures at. Apr 12, 2012 the zygoma plays an important role in the facial contour for both cosmetic and functional reasons. The vast majority of zygomatic fractures occur in men in their third decade of life. Symptoms include flattening of the face, trismus reduced opening of the jaw and lateral subconjunctival hemorrhage. Zygomaticomaxillary complex fracture radiology reference. This is most commonly seen after assault, but any blow to the cheek may give rise to a fracture. A new classification of zygomatic fracture featuring. According to the site of fracture, the patients were divided into three groups.
This pdf is available for free download from a site hosted by medknow publications. Mccain, king kim, in current therapy in oral and maxillofacial surgery, 2012. Jun 07, 20 zygoma plays an imp role in facial contour. Using free navigation reference points and prefabricated bone. Tripod fracture fracture of zygomatic arch, lateral and inferior orbital rims, and lateral wall of maxillary sinus. Zygomatic arch reduction gillies approach springerlink. Often this will be insignificant, but if the floor is comminuted andor deficient, then late 6 months plus enophthalmos is probable. Right zygomaticomaxillary complex fracture with disruption of the lateral orbital wall, orbital floor, zygomatic arch and maxillary sinus. The ages of the patients ranged from 10 to 76 years old, mean age was 32.
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. The cheekbone, or zygoma, can be fractured or completely broken, and the appropriate treatment can vary widely. Comparing the symptomatic side with the asymptomatic side can help reveal an abnormal contour of the zygomatic arch. Therefore an examination of the orbit and the globeincluding assessment of extraocular movements. Treatment goals focus on reduction to reestablish normal orbital volume and. Management of tripod fractures zygomaticomaxillary. Late correction following zygoma fracture thanks for your question. There are risks and complications with this procedure. Fractures of the zygomatic complex and arch pocket. Midface diagnosis zygoma, zygomatic complex fracture ao. Pdf analysis of facial symmetry after zygomatic bone fracture.
Zygoma fractures are easy to miss and displaced fractures require treatment within 10 days. Evaluation of treatment of zygomatic bone and zygomatic. It also forms part of the eye socket lateral and inferior margins and connects to the frontal bone forehead and maxilla upper jaw. Facial fracture aftercare instructions what you need to know. Then, the cylindrical object data were merged with the. A zygomatic complex fracture is a fracture that involves the zygoma and its surrounding bones.
The mechanism of injury usually involves a blow to the side of the face from a fist, from an object, or secondary to motor vehicle accidents. Surgical anatomy the term tripod fracture attributed to a specific type of zygomatic fracture is a misnomer because, along with its frontal, maxillary, and temporal articulations, the orbital extension of the zygoma has a broad abutment against the greater wing of the sphenoid, thus rendering it a tetrapod. Treatment of zygomatic complex fractures with surgical or. Pdf treatment of zygomatic complex fractures with surgical or. Trauma xray axial skeleton gallery 1 face zygomatic. Feb 03, 2020 provides accurate and independent information on more than 24,000 prescription drugs, overthecounter medicines and natural products.
The malar complex refers to the zygoma and maxillary bones and therefore forms part of the orbital floor and lateral orbital wall. Must distinguish zygomatic arch fracture from zygomaticomaxillary tripod fracture. A clinical sign of unilateral fracture of the body of the zygoma is a patients 4 mandibular incisors were traumatized 3 years ago in an accident. 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. A specialist confirmed that surgery would not be needed, and said there wasnt much else to be done. Zygomatic fractures impinging on the infraorbital nerve cause paresthesia or dysesthesia of the second division of the trigeminal nerve v2. Precise reconstruction with rigid internal fixation of the zygoma at 3 points across the frontozygomatic suture, the inferior orbital rim, and the lateral midfacial buttress is needed to counter the force of the masseter muscle.
Fractures of the cheek bone zygomatic complex fractures. 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. Comparison of various surgical approaches and their complications can only be done objectively using outcome measurements which in turn require protocol management. A zmc fracture is also known as a tripod, tetrapod or quadripod fracture, trimalar fracture or malar fracture. A prospective short clinical study ramesh candamourty 1, vinod narayanan 2, mf baig 2, mr muthusekar 2, manoj kumar jain 3, ramesh m. Fibrous or bony adhesion between the coronoid process and the zygoma is a rare cause of extracapsular ankylosis. To assess the causes and management of zygomatic bone fractures at abbasi shaheed hospital, karachi. Surgical management of zygomatic complex fractures in a major. May 15, 2016 fractures of zygomatic complex and orbit. Fracture du zygoma dr barriere chirurgie maxillofaciale. They are the second most common facial bone fracture after nasal bone fractures pathology. The delayed treatment of zygomatic complex zmc fracture presents a difficult challenge to. Mildly displaced comminuted fracture of the left zygomatic arch shows up to 37 degrees of inwards angulation.
Zygomatic complex fractures can involve surrounding structures and cause. Data sources include ibm watson micromedex updated 10 apr 2020, cerner multum updated 6. Treatment of zygomatic complex fractures using two point. Jan 02, 2015 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. Fractures of the cheek bone zygomatic complex this leaflet has been designed to improve your understanding of your forthcoming treatment and contains answers to many of the common questions. Zygomatic branches of the facial nerve an overview. This article focuses on the zygomatic arch fracture. Introduction the zygoma has four projections, which create a quadrangular shape. Most zygomatic complex fractures can be treated solely by an intraoral approach. Zygomatic fractures are common in facial trauma and, as is the case with other facial fractures, occur primarily among men in their third decade of life. The incidence of isolated bilateral zygomatic fractures has not been reported secondary to rta apart from one such report of a bilateral zygomatic arch fracture.
If displaced fracture, a surgeon does the wiring of the bone, which can be an ent surgeon, a plastic surgeon or. A zygoma fracture is often the result of facial trauma such as violence, falls or automobile accidents. Doctor answers on symptoms, diagnosis, treatment, and more. Look for the elephants trunk appearance of the zygomatic arch. The zygomatic bone is attached to the maxilla at the zygomaticomaxillary zm suture and alveolus forming the zygomaticomaxillary buttress. Combining the results of data analysed by the geomagic studio 11. Moreover the importance of zygomatic complex in facial skeleton lies inprotecting globe of eye and absorbing and redistributing masticatory andexternal load. These fractures occur most commonly as the result of assaults or motor vehicle collisions. The location of the zygomatic bone plays an important. All zygomatic fractures will have an orbital floor component.
Ballistic impact to the forehead, zygoma, and mandible. As the fracture is behind the equator of the eye enophthalmos is highly likely. Trauma to the zmc can result in multiple fractures ie, tetrapod, but solitary bony disruption may occur, as with isolated zygomatic arch fracture. Zygomatic arch fracture treatment answers on healthtap. Among facial fractures, the zygomaticomaxillary complex fracture is one. Hence, combining computerassisted surgical navigation for. Fracture segments can be directly visualized, reduced and fixed using this approach. They treated 82 patients for a period of 3 years 20102012. Zygomatic fractures american academy of ophthalmology. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. The zygoma is the main buttress between the maxilla and the skull, but, in spite of its sturdiness, its prominent location makes it prone to fracture. Mar 21, 2019 the zygoma has 4 bony attachments to the skull, and zmc fractures are sometimes known as tetrapod fractures. 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.
An ice pack and pain relievers may be recommended to manage pain and swelling as the fracture heals. The zygomatic arch is the third most common fractured facial bone, with a high majority of those cases being male. If you have any other questions that the leaflet does not answer or would like further explanation please ask a member of the medical or nursing staff. The zygomatic bone occupies a prominent and important position in the facial skeleton. Diagnosis and management of common maxillofacial injuries in. On the left the noninjured side overlying structures give the impression of a fracture, but careful scrutiny shows the cortex is intact. 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. If you just want to display multiple pdfs as merged into a single document in the browser, this is surely possible with pdf. Additionally, the fracture components may result in impingement of the temporalis muscle, trismus difficulty with mastication and may compromise the infraorbital foramennerve.
Dec 03, 2018 the zygomatic bone occupies a prominent and important position in the facial skeleton. In all cases, we have used the lateral eyebrow approach to expose the fracture in the fronto zygomatic suture region. A clinical sign of unilateral fracture of the body of the. 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. The incidence, cause, age, and gender predilection of. Complications of zygomatic bone and zygomatic arch plastic. Patient information leaflet fractured zygoma cheekbone this leaflet has been designed to explain your type of fracture and it contains answers to many frequently asked questions. Most zygomatic complex fractures can be treated solely by an intraoral approach and rigid. Eight zygomatic fractures were created in four skull models, and. Because these ideal measurements are not always found, an examination of the contralateral zygoma will determine the correct position of the injured zygoma in every patient who has no craniofacial anomalies. Early stabilization is important to maximize both cosmetic integrity and anatomical functionality 1. Therefore for cosmetic and functional reasons it is imperative to diagnoseand treat zygomatic fractures adequately.
All zygomatic complex fractures involve the orbital floor and therefore. The typical lines of a zygomatic complex fracture are. A new classification of zygomatic fracture featuring zygomaticofrontal suture. Other possible functional deficits that may occur include limitation of mouth opening and lower eye lid retraction. Radiographs now show apical radiolucencies associated with all 4 teeth. 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. Face zygomatic arch fracture om30 view same patient as image above the zygomatic arch fracture is more easily seen on the om30 occipitomental 30 image. Fractures of the zygomatic complex are among the most frequent in maxillofacial trauma. The zygoma plays an important role in the facial contour for both cosmetic and functional reasons. Zygoma is the second most common site of facial bone fracture. Generally no followup is needed to check things during the healing. Dec 28, 2011 fracture of the zygomatic bone is a common fracture of the facial skeleton. Diagnosis and management of common maxillofacial injuries.
Untreated fractures may cause a cosmetic deformity flattening of the cheek or limited mandibular movement caused by the depressed zygoma impinging on the coronoid process of. Poor reduction and fixation of zygomatic fractures will result in a number of functional and aesthetic complications, the most disturbing of which is the persistence of diplopia. Management of zygomatic fractures pocket dentistry. Apr 12, 2012 fracture segments can be directly visualized, reduced and fixed using this approach. Ipsilateral eye may appear to tilt due to pulling of lateral canthus. A zygoma fracture zygomatic fracture is a form of facial fracture caused by a fracture of the zygomatic bone. An ice pack and pain relievers may be recommended to manage pain and swelling as. If you have any other questions that the leaflet does not answer, or if you would like. Anatomical fracture patterns and the nuances of clinical presentations are discussed. The complication is believed having some connections with the improper selection of surgical method or surgical procedure and deformity or weakening of the zygomatic bone and zygomatic arch. For complex zygomatic fractures, multiple approaches are often needed for visualizing the fracture sites and applying internal fixation. Other fracture patterns, include isolated zygomatic arch fractures, or zmc fractures with associated panfacial fractures, such as le fort ii and iii. For example, a hairline fracture in the cheekbone may simply require time to heal. Correlation of the human and dummy responses allows injury risk assessment for munitions used in the field.
Do i need to schedule followups during the healing process. Reduction of fractured zygoma is done by manipulating the broken cheek bone to restore the contour and appearance of the face. Facial impacts to the forehead, zygoma, and mandible of. Comparison of various surgical approaches and their complications can only be done objectively using outcome measurements which in turn require protocol management and longterm follow up. Surgical treatment of zygomatic bone fracture using two.
Classification and treatment of zygomatic fractures. For secondary facial bone reductions, combining surgical navigation with. The short answer is that your zygoma can be put into a better position without the use of an implant but it is a bit of an ordeal and you will need plates and screws to hold the bones in place. A nondisplaced zygoma fracture will heal fine on its own. Midface diagnosis zygoma, zygomatic complex fracture. The relatively severe complication of the zygoma reduction plastic surgery is the zygomatic bone and zygomatic arch displacement or defect. N2 the zygomaticomaxillary complex zmc has integral structure and function in the bony skeleton of the face. Damage to cranial nerve vii and facial palsy and atony. Surgical navigation improves reductions accuracy of unilateral. A fracture emanating from the inferior orbital fissure superiorly along the sphenozygomatic suture to the frontozygomatic suture where it crosses the lateral orbital rim. Babu 4 1 department of oral and maxillofacial surgery, indira gandhi institute of dental sciences, mahatma gandhi medical college and research institute campus, pillaiyarkuppam. This plays a key role in the structure and function of. When approaching the tmj for a glenoid fossa portal puncture, the frontotemporal branch of the facial nerve should be anterior, whereas for an eminence or working portal puncture it is located posterior. Fixation was done at fronto zygomatic region and infra orbital region.