Zygomaticomaxillary complex fracture pubmed central pmc. If the fracture can be stabilized with only 1 or 2 points of fixation there is no need to go for another point. Figure 21a figure 21b figure 21c figure 21d findings figures 21a and 21b. A number of studies had shown zmc fractures to be the second most common facial fracture, after nasal bone or mandible fractures 36. This patient was a polytrauma patient who had surgery delayed by 49 days due to their concurrent injuries, and it was.
Risks of a orbitozygomatic maxillary fracture repair there are risks and complications with this procedure. Nasal bone fractures are the most common fracture of the midface. Overlooking a fracture may not have immediate consequences, but can result in disfigurement and permanent disability. Repair of a facial zygomaticomaxillary complex fracture. There were 40 zmc fractures and isolated zygomatic arch fractures. Orbital trauma and facial fracture repair denver eye surgeons.
Jun 07, 20 treatment algorithm for zmc fracture without need for internal orbitalreconstruction, by ellis and kittidumkerngreduce fracturefracture reduced andstablestopunsure of reductiontransoral openreductionfracture reductionbut unstablebone plate at zmbuttressfracture reduced andstablestopfracture reductionand stablestopunsure of reductionopen. Click, drag, and drop to reorder files or press delete to remove any content you dont want. The zygoma is the origin for the masseter, thus affecting mastication. Prospective blind comparative clinical study of two point. The second is related to the necessity to fix them or not after the reduc. Learn how to combine multiple files into a single pdf with adobe acrobat dc. The first concerns the best way for surgical reduction of the fractures. The researchers establish a new classification system for zygomatic fractures based on computed tomography and mechanism of injury, which could be used to inform treatment options. Max frye howard franklin jeffrey fiskin current revisions by glenn gers weinstock productions castle rock entertainment.
These will stay in place unless they cause problems, in which case a second operation will be required to remove them. Skull base fractures are of high importance in neurotrauma. You can merge pdfs or a mix of pdf documents and other files. Scribd is the worlds largest social reading and publishing site. Analysis of the fractured face requires a knowledge of not only normal anatomy, but also of common fracture patterns in the face. According to sergios experience, the 3point fixation approach was mandatory to.
C, d, preoperative coronal ct scans show fractures of the orbital floor. The diagnosis of maxillofacial fractures can be challenging, as haematoma and swelling can mask the extent of the underlying injury. Zygomaticomaxillary complex zmc fractures are a group of fractures that can significantly alter the structure, function, and appearance of the midface, including the globe. How to combine files into a pdf adobe acrobat dc tutorials. This type is the second most common facial fracture after nasal bonefractures with most resulting from assaults, falls, and automobile crashes. A new classification of zygomatic fracture featuring zygomaticofrontal suture. From september 2011 to october 2018, 43 patients with comminuted zmc fracture receiving open reduction. Basis cranii fracture pdf skull base fractures are of high importance in neurotrauma. Pdf surgical methods of zygomaticomaxillary complex fracture. One zmc fracture case was excluded from the points of fixation and surgical incision analysis. Evaluation of onepoint fixation for zygomaticomaxillary complex.
Follow these steps to quickly combine and arrange documents. Supra condylar femoral fracture has to multiple treatment options and may have different complications including. To present the treatment of zygomaticomaxillary complex zmc fractures with closedreduction steinmann pin fixation and to compare it to the reduction and aesthetic outcomes of openreduction techniques orif. The different fixation methods are applied to treat the zygomatic bone fractures, with many more classifications which have. The term zygomaticomaxillary zygomaticomalar complex zmc fractures refers to the osseous disruption of the malar eminence at 4 buttresses. These files will have pdf in brackets along with the filesize of the download. As can be seen in the preoperative facial photographs figures 1a1e and ct scans figure 2a2e, this patient sustained a compound comminuted zmc fracture, with marked anterior maxillary comminution.
Slide zmc frac free download as powerpoint presentation. Zygoma or zygomaticomaxillary complex zmc fracture c. Zygomatic complex fracture tripod fracture iowa head. The fracture will be realigned and then fixed together using titanium plate and screws. Bennett fracture dislocation fractures of the hand intraarticular fracture of the proximal end of the first metacarpal, with dorsal and lateral dislocation of the distal segment. How to merge pdfs and combine pdf files adobe acrobat dc. Jan 19, 2017 biomechanics of fracture the inferior orbital fissure is the key to remember the usual lines of zmc fractures.
Case example zygomatic complex fracture tripod fracture. Followup and advice should follow that given for a zmc fracture. Zmc fractures refer to traumatic disruption of the four buttresses that make up the zmc. In fact, a zmc fracture demonstrates five distinct fractures. Zygomaticomaxillary complex fracture dr ian bickle and dr nasir siddiqui et al. Learn how to combine files into a single pdf file using adobe acrobat dc. Ct of maxillofacial fracture patternsct of maxillofacial. If the fracture is operative, no functional deficit and closed, the patient should be seen in the morning or sent to the appropriate attendings clinic within one day, so surgery can be scheduled in a timely fashion e. You can combine multiple pdf documents or a wide variety of file types, including spreadsheets, images, and emails. This case report presents a 21yearold man who was involved in a traffic accident and who subsequently presented with a zmc fracture. Not only does this result in a disgruntled patient. If there is restriction of mouth opening due to trapping of the temporalis muscle or mandibular condyle, it is an indication for urgent referral to a maxillofacial surgeon. Here, we assessed whether specific approaches and fixation methods for displacement. Skull base fracture incidence is increased with orbital wallrim fractures 36% and zmc fractures %.
This retrospective study demonstrates the late results of 46 patients with an isolated zygomatic fracture andor dislocation, who have been treated with the gillies procedure alone or with stabilizing transosseous wires. Moreover the importance of zygomatic complex in facial skeleton lies inprotecting globe of eye and absorbing and redistributing masticatory andexternal load. Ct of maxillofacial fracture patternsct of maxillofacial fracture patterns stuart e. Recognition and management central connecticut state university sports medicine symposium march 5, 2019 mark c. Zmc fractures are usually repaired with open reduction and internal fixation within 34 weeks following injury. Presentations ppt, key, pdf logging in or signing up. Many publications have appeared on intraoperative imaging for trauma surgery, but in most hospitals intraoperative imaging is not routinely performed for zmc fracture repair. Zmc fracture repair, and it simplified exposure of the lateral orbital rim, without the need for overzealous tissue retraction. A study protocol for a randomised controlled trial. Advantages of intraoral and transconjunctival approaches for. A, b, preoperative threedimensional ct scans show a moderately displaced right zmc fracture.
The incidence of zmc fractures varies with geographical location, socioeconomic trends, and incidence of road traffic collisions rtcs, alcohol abuse and drug abuse. The maxillofacial trauma could have low, intermediate or high velocity. Therefore for cosmetic and functional reasons it is imperative to diagnoseand treat zygomatic fractures adequately. Most who deal with facial trauma are familiar with zygo maticomaxillary complex zmc, or tripod, fractures. The smith papyrus is likely the first document in which treatment of several types of zygomatic fractures are described. The patient does not recall striking his head, but complains of tenderness over the right zygomatic arch and maxilla. Attempts to treat facial fractures were recorded in the 25th to 30th centuries bc. A fifteen year retrospective study involving 123 patients with zmc fractures were selected from a pool of 219 patients who sustained maxillofacial fractures during the period under study. Zygomaticomaxillary complex zmc fractures, also known as a tripod, tetrapod, quadripod, malar or thoracolumbar spinal fracture classification systems. Zmc are the second most common type of facial fracture, behind nasal fractures. The treatment of the fractures of the zygomaticomaxil lary complex zmc is amply discussed in the literature, being that three great conflicts still persist in relation to the applied therapy 1. 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. Ct is critical in characterising angulation and comminution of the internal lateral orbital wall fracture, as well as determining if there is coexistent orbital floor fracture jamal, 2009.
Fractures of the zygomatic complex and arch pocket. Once reduction was established, fixation was accomplished using an lshaped plate at the zygomaticomaxillary buttress and. Zmc fractures are also frequently associated with orbital floor 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. Evidence from two or more moderate strength studies with consistent findings, or evidence from a single high quality study for recommending for or against the intervention. Fortyeight patients with isolated, unilateral zmc fractures that had at least 6. The etiology of facial fractures differs from one country to another worldwide. Zygomaticomaxillary complex, bone fracture, sphenozygomatic suture, internal. 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. Outcome of distal femoral locking plate in supracondylar fracture of femur mullar typea by mipo technique abdul rauf,1 muhammad zafar iqbal,1 zuhair bhatti,1 muhammad tahir shafi1 abstract background. They occur in 24% of head injuries and are often related to brain injury in 50% of the. Case report threepoint fixation of displaced tripod.
Fracture of the zygomaticomaxillary complex zmc is one of the most common facial injuries. Sequelae of these fractures can range from minimal displacement requiring no intervention to displaced nasal deformity requiring initial reduction and possible future reconstructive surgery. Three fracture lines extend from the inferior orbital fissure in an anteromedial, a superolateral, and an inferior direction. Sixtysixpercentofthesepatients70% of the patients with zmc fractures and 56% of the patientswithmidfacefractureswere managedwithout orbital exploration. Fracture by dan pyne revisions by tom pabst glenn gers e. Note the lateral displacement of zygomatic arch and posterior displacement of malar eminence. Assaults, road traffic accidents and falls are the principal etiologic factors that may cause fractures of zygomatic bone.
Zmc fractures have a high incidence of ocular injury 10% and a higher incidence of visual sequelae 41% than most other forms of midfacial injury 15%. Review committee for otolaryngology case log coding recommendations. Patients with zmc fractures often present with tenderness, ecchymosis and edema over the malar prominence, lateral orbit, upper and lower eyelids, loss of malar projection, and blunting of the lateral canthus relative to the unaffected side. Like other facial fractures, the optimal management of operative zmc fractures requires anatomic reduction of all fractures followed by rigid internal fixation. Orbital trauma and facial fracture repair what is the orbit. Intraoperative imaging seems to be the next step to improve surgical outcome in the treatment of zygomaticomaxillary complex zmc fractures. 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. Zygomaticomaxillary complex zmc and zygomatic arch za fractures are a relatively common injury in australia, with the royal brisbane and womens hospital managing approximately 160 patients per year.
Other fracture patterns, include isolated zygomatic arch fractures, or zmc fractures with associated panfacial fractures, such as le fort ii and iii. They are the second most common facial bone fracture after nasal bone fractures pathology. A previous study has performed 3d analyses of the parallel and rotational displacements that occur in a fractured zmc. To open a pdf file you will need compatible software such as adobe reader. The postreduction stable fractures 78% treated solely with the gillies procedure have given satisfactory symmetric results in 72% of the patients.
A survey was conducted regarding treatment of patients with different zmc fractures that included a minimally displaced fracture case 1, a displaced fracture without diplopia case 2, a. Facial fractures the bones of the skull and face collectively make up the most complex area of skeletal real estate in the body. Quantitative assessment of symmetry recovery in navigation. In 1909, keen was the first to depression and patients with paresthesia of the infra describe an intra oral upper buccal sulcus incision to orbital nerve with fractured zygomatic complex were. Patients treated for isolated zygomatic fracture at the keio university hospital between 2004 and 2011 were recruited for. The primary outcome measurement was the absolute bilateral differences of the zmc eminence and width based on computed tomographic ct measurements 48 to 72 hours after surgery. Reconstructive procedures protocols general considerations. Application of a computerassisted navigation system cans. Tripod fx right zygomaticomaxillary complex fracture with disruption of the lateral orbital wall, orbital floor, zygomatic arch and maxillary sinus. The zmc fracture was exposed using maxillary vestibular and upper eyelid approaches. Shaped like an empty ice cream cone it is composed of 7 facial bones. Incidence and evaluation of recovery of neurosensory. Intraoperative imaging for the repair of zygomaticomaxillary. With zmc fractures, displacement in the posterior direction occurred most frequently, while.
It provides normal cheek contour and separates the orbital contents from the temporal fossa and the maxillary sinus. Click add files and select the files you want to include in your pdf. But other forms of trauma such as falls and blows can also cause maxillofacial fractures. They occur in 24% of head injuries and are often related to brain injury in 50% of the cases. Download this books into available format unlimited. Zygomaticomaxillary complex fracture tripod fracture return to. Surgical management of zygomatic complex fractures in a major. Rearrange individual pages or entire files in the desired order. Zygomaticomaxillary complex fracture radiology reference. Facial fractures account for 418% of all sports injuries reehal, p. Reduction in the zmc fractures was considered ideal in 58 of the 65 patients. Patients with zmc fractures often present with tenderness, ecchymosis and edema over the malar prominence, lateral orbit, upper and lower. The value of cans used in the reduction of zmc fracture is highlighted.
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 fractures over period of six months. Surgical management of zygomatic complex fractures in a. See orbital roof fractures, orbital medial wall fractures, and orbital floor fractures for additional information. Classification of mandible, midface, zmc and noe fractures. Zygomaticomaxillary complex zmc fracture is the second most common facial bone fractures after nasal bone and has been extensively described in the literature. Many of these fractures require surgical reduction and fixation to restore either function or aesthetic form or a combination of the two.
Reduction was achieved using a carrollgirard screw fig 2. Pdf zygomaticomaxillary complex fracture researchgate. Biomechanics the most common cause of trauma leading to maxillofacial fractures is motor vehicle accident. If you do not have it you can download adobe reader free of charge. Zygomaticomaxillary complex fractures orthopedics jama. Surgical timing moderate evidence supports that hip fracture surgery within 48 hours of. Management of zygomaticomaxillary complex zmc fractures should be based on injury patterns and not on training background. Download pdf maxillofacial plastic and reconstructive surgery.
Zmc fractures treated by various methods over a 5year period. Treatment of zygomatic complex fractures using two point. Additionally, the fracture components may result in impingement of the. Use of computed tomography in orbital trauma diagnostic. Sports activities account for 329% of facial injuries viozzi, cf sports activities account for 1042% of all facial fractures romeo, et. Aug 21, 2014 this patient was diagnosed with a left zygomaticomaxillary complex fracture and underwent open reduction and internal fixation via a gingivobuccal sulcus approach. Zmc fractures are commonly associated with other orbital fractures. The zygomatic maxillary complex zmc fractures are one of the most frequent injuries of the facial skeleton due to its position and facial contour. Oct 15, 2019 the zygomaticomaxillary complex zmc plays a key role in the structure, function, and aesthetic appearance of the facial skeleton. Numerous techniques have been described for the reduction of zmc fracture. The goal of treating zmc fractures is to achieve stability and restore aesthetic appearance through threedimensional reduction and rigid fixation.
Consideration 1 indications second most common mid face fracture nasal fracture is first, usually from lateral blunt force like a blow from a fist. Review committee for otolaryngology case log coding. However, few studies have investigated adequate fixation methods according to these displacements. The gillies procedure in the treatment of zygomatic fractures. The following case log coding recommendations have been provided in an attempt to establish some. Carmguided reduction of zygomatic fractures revisited. Flexible bones, greenstick fracture entrapped muscle is pinched in the fracture causing ischemia, possible oculocardiac reflex, nv, severe pain both passive and active movement is restricted. Pdf most of the documents on the racgp website are in portable document format pdf. Obeng clinical history 29yearold male involved in a motor vehicle accident. A new classification of zygomatic fracture featuring. As for zmc fractures, the majority of zygomatic arch fractures do not need urgent surgical intervention. The eye socket, or orbit, is a bony cavity that houses the eye, the muscles that move the eye, the surrounding blood vessels, nerves, and fat.