Note the preservation of the inner margin of the zygomatic bone and sphenoid bone, this will simplify anatomical reduction. Therefore, diagnose and properly management of the zygomatic bone injury is important. This is most commonly seen after assault, but any blow to the cheek may give rise to a fracture. Considering high incidence of zygomatic complex fractures and its high morbidity complications, this study had been planned to find out the important clinical and epidemiological features in patients with zygomatic complex fracture, presented in pims hospital. Zygomaticomaxillary complex fracture radiology reference. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Regarding the results in group a patient with zygomatic bone fracture were divided into. For example, a hairline fracture in the cheekbone may simply require time to heal. 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. Due to the prominent position of the zygomatic region, the zygomaticomaxillary complex zmc fracture is one of the most common facial frac ture. Impingement is suspected clinically in the presence of trismus with limited mouth opening and is confirmed.
The zygomatic process of the temporal bone is a long, arched process projecting from the lower part of the squamous portion of the temporal bone. The body of the zygoma is sturdy, but its articulations are frequently the site of. It adjoins the frontal bone at the outer edge of the orbit and the sphenoid and maxilla within the orbit. However, your oral surgeon will need to perform a clinical exam with ct scan. The use of the carrollgirard screw in the management of zygomatic complex fractures has been well documented. Often mentioned in textbooks and literature, they are not routinely available for the indian maxillofacial surgeon. The characteristic clinical signs of zygomatic bone fracture include flattening of the cheek, infraorbital nerve paraesthesia, diplopia, and trismus.
Such landmarks are shown and discussed in sequence with the key surgical steps. Orbital fractures in which the zygomatic bone was not involved were excluded. Diagnosis and management of common maxillofacial injuries. Zygomatic complex fractures and its management acta scientific.
Temporal gillies approach to a zygomatic arch fracture. Analysis of outcome of zygomatic fracture management. The prominence of zygomatic bone predisposes it to bear the brunt of facial injuries. Pdf reconstruction of complex zygomatic bone defects. Interruption in zygomatic position has psychological, aesthetic and functional effects which impairs the function of mandible and ocular tissue.
Strong buttress of lateral midface lying between zygomatic process of frontal bone and maxilla. The second most common area of fracture in the face is the zygoma, especially the left frontal process of the zygomatic bone, e. Fractures involving zygoma is very common, in fact it is the second most common facial bone to the fractured following facial trauma next only to nasal bones. Osteomyelitis and fracture callus abscessation secondary. Road traffic accident was the leading factor causing zygomatic bone fracture. Inferior and posterior displacements of the zygoma produce varying degrees of disorganization of the soft tissue of the orbital cavity with bone expansion see figure 7.
Additionally, the fracture components may result in impingement of the. We recommend threepoint rigid fixation of fractured zygoma after accurate reduction. Untreated fractures may cause a cosmetic deformity flattening of the cheek or limited mandibular movement caused by the depressed zygoma impinging on the. Fractures of zygomatic complex and orbit maxfac tutorial. Rests are com bined and secondary to a fractured zygoma 4. A study on assessing the etiology and different treatment. 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. This video documents the steps typically followed during open reduction of isolated, depressed zygomatic arch fractures. The temporal process, which forms zygomatic arch a1frontal process, which forms lateral orbital wall a2maxillary process, which forms infraorbital rim a3category bfracture of all three processes, detaching zygomatic bone from facial skeleton i. Epistaxis can occur when the turbinate bones are fractured, and nasolacrimal duct obstruction can result from a. Depending on the severity of the dislocation, the bone can either move slightly along its sutures or more severely in an anterior, medial, lateral or posterior direction. Zygomatic fractures rotate down and inward resulting in a cheek deficiency and an orbital lowering if left unrepaired.
It articulates with the zygomatic process of the temporal bone, and together they make up the zygomatic arch. The patients hair was shaven for clarity and for proper marking of key anatomic landmarks. How can i reduce my zygomatic bones to give my face a. If displaced fracture, a surgeon does the wiring of the bone, which can be an ent surgeon, a plastic surgeon or general surgeon. Pdf choosing the adequate treatment for zygomatic bone. This often prevents the regular use of this approach. This pdf is available for free download from a site hosted. Surgical management of zygomatic complex fractures in a major.
Zygomatic bone definition of zygomatic bone by the free. Treatment of the zygomatic bone fracture is meant to restore the symmetry of the face, make certain that the eye moves normally in the orbit and address any potential nerve damage. The lower portion of the bone articulates with the mandible, forming the temporomandibular joint of the jaw. Patient perspective in the management of zygomatic fractures. An ice pack and pain relievers may be recommended to manage pain and swelling as the fracture heals. Clinical features of any fracture are mostly related to the sur gical anatomy of the.
A 26yearold male was struck on the left side of his face while playing baseball. Related pathology le fort type 3 fracture zygomaticomaxillary complex fra. In zygomaticomaxillary complex zmc fracture many incisions lateral. It contains the middle and inner portions of the ear, and is crossed by the majority of the cranial nerves. A zygoma fracture zygomatic fracture is a form of facial fracture caused by a fracture of the zygomatic bone. Zygoma fractures are easy to miss and displaced fractures require treatment within 10 days. Doctor answers on symptoms, diagnosis, treatment, and more. Classic tripod fracture, but anatomically these fractures are actually. In patients with zygomatic arch fractures and limited mouth opening interincisal distance 40 mm, the arch may be in direct boneonbone contact with the coronoid process of the mandible, and urgent open reduction is indicated. The high incidence of zygomatic complex fracture relates to its prominent position within the facial skeleton. The zygomatic bone occupies a prominent and important position in the facial skeleton. Our study showed that displacement at any of the fractured site on. Evaluation of treatment of zygomatic bone and zygomatic.
It forms the central part of the zygomatic arch by its attachments to the maxilla in front and to the zygomatic process of the temporal. Treatment and complications of orbitozygomatic fractures scielo. Cheek bone fracture tx depends on the extent of the fracture. The technique of mini plate osteo synthesis for stable fixation of zygomatic bone fracture was first described by michelet, ian jackson, fain et al.
In this study, the researchers describe a new means of classifying zygomatic fractures based on 3dct and the type of trauma inflicted, which could be used to inform surgical strategy. All zygomatic complex fractures involve the orbital floor and therefore understanding of. The zygomatic bone has a prominent and im portant position in the. A, attempted waters projection showing a vertical radiopaque density in the area of the left zygomatic arch. The zygomatic arch is formed by the union of the temporal process of the zygomatic bone and the zygomatic process of the temporal bone at the zygomaticotemporal suture.
The temporal bone is the bone that goes around your ear, in your skull. C, caldwells projection showing the density superimposed on the petrous portion of the temporal bone. 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. It protects the part of your brain that controls hearing, speech, memory, and behavior. The researchers consider the previous classification system should be improved. The instrument provides an excellent degree of control over the movements of the disrupted zygomatic bone. A small bone in vertebrates on each side of the face below the eye socket, forming the prominence of the cheek. The zygomatic bone fracture and coronoid process impingement lead to restricted mouth opening. A new classification of zygomatic fracture featuring. The zygomatic bone is small and quadrangular, and is situated at the upper and lateral part of the face. The malar complex refers to the zygoma and maxillary bones and therefore forms part of the orbital floor and lateral orbital wall. It articulates with the zygomatic bone this process is at first directed lateralward, its two surfaces looking upward and downward.
This plays a key role in the structure and function of. The dog suffered a bite wound two months previously, causing puncture wounds dorsal to the orbit where radiographs demonstrated a minimally displaced fracture of the zygomatic arch and surrounding soft, fluctuant swelling. You have two temporal bones, one on each side of your head. The temporal bone contributes to the lower lateral walls of the skull. Zygoma arch fracture an overview sciencedirect topics. Chapter 12 zygomatic malar fractures ct scan 3d fig. Clinical and epidemiological presentation of patients with. From the photos, your cheeks are flat anteriorly in the front with high points on the lateral aspect of the malar bone, not the zygomatic arch. Zmc fracture is also known as a tripod, tetrapod, or quadripod fracture, trimalar fracture or malar fracture 1,2. Case report threepoint fixation of displaced tripod.
The zygomatic process of the frontal bone and the zygomatic arch, which form the dorsal orbital rim, are prone to fracture and resultant opening into the frontal and caudal maxillary sinuses. They are the second most common facial bone fracture after nasal bone fractures pathology. Pdf surgical methods of zygomaticomaxillary complex fracture. In this article, we shall look at the different parts of the temporal bone, their articulations, and any. Facial trauma nasal maxillary z neurosurgery resident. The obvious advantage to bone plate is that it provides stabilization in three planes. Fracture zygoma and its management our experience core. Zygomatic complex fractures, facial fracture, etiolo gy, surgical approach. Collapsing the zygomatic arch creates an in fracture of the arch in an attempt to narrow the face. Depending upon the extent of the bone displacement, the zygomatic complex can be refractured osteotomized and reposiitoned back. Treating the zygomatic arch fracture depends upon whether it is displace or caved in. Zygomatic bone, also called cheekbone, or malar bone, diamondshaped bone below and lateral to the orbit, or eye socket, at the widest part of the cheek.
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. Choosing the adequate treatment for zygomatic bone fracture. Surgical methods of zygomaticomaxillary complex fracture. B if zygomatic bone does not snap into place or remain reduced probably soft tissue interposed or osseous comminution open reduction and wire fixation in at least two fracture areas usually at zygomaticofrontal suture and zygomaticomaxillary suture along infraorbital rim. Zygomatic arch fracture treatment answers on healthtap. Other fracture patterns, include isolated zygomatic arch fractures, or zmc fractures with associated panfacial fractures, such as le fort ii and iii.
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