The management of the ophthalmic injuries must be considered as the first priority. Because of the complex anatomy and sutures of the zygoma, the pattern of fractures involving this bone is rather diverse. Jun 07, 20 zygoma plays an imp role in facial contour. Figure 2 area of reduced skin sensation in fracture of the orbitozygomatic complex. The orbitozygomatic oz approach is an extension of the basic frontotemporal ft approach, which is associated with an oz osteotomy and eventually with zygomatic arch resection. Great care should be taken to achieve proper alignment and fixation in the primary management of these fractures in order to avoid these postoperative complications. Evaluation of the lateral orbital approach in management of. Appropriate managment depends on an accurate diagnosis, focusing on the physical examination and data from. Management of orbitozygomatic fractures, anz journal of. Diagnosis and management of common maxillofacial injuries in. A soft cervical collar is recommended for stabilisation, not the traditional barrel bandage. Not only does this result in a disgruntled patient, it may affect their ability to continue to perform their occupation. Assessment of zygomatic fractures should proceed only after standard protocols for evaluating blunt head trauma have been executed figures 2 and 3. Diagnosis and management of common maxillofacial injuries in the emergency department.
Type iii fractures are called orbitozygomatic and differ from type ii because they present the need for reconstruction of the orbit usually the floor, due to loss of bone substance, fracture line on the zygomatic body, or the need to fixate the zygomatic arch due to intermediary fragments figs. Orbitozygomatic fracture repairsfer free download as powerpoint presentation. Moreover the importance of zygomatic complex in facial skeleton lies inprotecting globe of eye and absorbing and redistributing masticatory andexternal load. Dec 03, 2018 the zygomatic bone occupies a prominent and important position in the facial skeleton. A balance must be struck between adequate exposure and acceptable cosmetic result. The interesting concepts of the article are the advancement of the concept of postoperative analysis to. The purpose of this study is to evaluate the functional and esthetic outcome following this lateral orbital approach in the management of zygoma fracture.
Maxillofacial injury diagnosis and management of common. Appropriate management depends on an accurate diagnosis, focusing on the physical examination and. Unfortunately, the incidence of maxillofacial trauma is increasing at an alarming rate. Patients were retrospectively analyzed for gender, age, mechanism of injury. 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. 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. Stanley describes the initial frustration with positioning the patients and with the time necessary for. Orbitozygomatic craniotomy brain tumor surgery johns. Management of orbitozygomatic fractures request pdf. Open fractures are often the result of highenergy trauma and can lead to significant longterm morbidity and disability. Jun 01, 2008 read nasoorbitoethmoid fracture management, operative techniques in otolaryngologyhead and neck surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Management of posttraumatic zygomatic orbital deformity.
These will stay in place unless they cause problems, in which case a second operation will be required to remove them. Nasoorbitoethmoid fracture management, operative techniques. The role of pharmacological treatment for orbitozygomatic bone fracture. The orbitozygomatic craniotomy involves making an incision in the scalp behind the hairline and removing the bone that forms the contour of the orbit and cheek. Moreover, patient should be informed not to blow the nose to prevent the emphysema for 4 to 6 weeks after the injury. The higher velocity of impact required to generate a comminuted orbitozygomatic fracture leads to an increased number of ocular findings and injuries in this group when compared with. Treatment of zygomatic complex fractures with steinmann pins. Child developmentinjuries 172 reprinted from australian family physician vol. Diagnosis and management of common maxillofacial injuries. Tripod fracture consists of a zygomatic arch fracture, b fracture of the lateral orbital wall, and c fracture of the inferior orbital floor. Fractures involving zygoma should be repaired at the earliest because it can cause both functional and. Ice packs and head elevation are recommended for the patient with orbital floor fracture for 48 hours to reduce the swelling 10,11. Technical nuances for orbitozygomatic craniotomy including performance of a frontotemporal craniotomy with supraorbital osteotomy i. Computed tomography ct, plain radiography, and conventional tomography were performed on 30 patients with facial trauma.
The zygomatic bone occupies a prominent and important position in the facial skeleton. As aspects of management vary among surgeons who treat such injuries, this. Often times the reasons sited in literature for these deformities are inadequate management or misdiagnosis at. Eye injuries, pediatric facial trauma, and other aspects of facial trauma management are discussed separately. Noe fracture management in children and the elderly, and novel. Fractures of the zygomaticomaxillary complex and their. Diagnosis and management of common maxillofacial injuries in the. Appropriate managment depends on an accurate diagnosis, focusing on the physical examination and data from computed. Design twentyfive patients undergoing open reduction of a unilateral displaced. Therefore for cosmetic and functional reasons it is imperative to diagnoseand treat zygomatic fractures adequately. For full access to this pdf, sign in to an existing account, or purchase an. If the fracture can be stabilized with only 1 or 2 points of fixation there is no need to go for another point. Management of zygomaticomaxillary complex fractures treatment number percentage conservative management 31 25. Ophthalmic injuries are a common complication of orbitozygomatic fractures occurring in about 20% of patients in this study, most frequent in the orbital blow fractures subgroup.
Pattern and significance of ocular injuries associated with. Many specialists encounter and treat orbital fractures. In the same way, six patients had undergone zmc fracture repair via closed reduction with a steinmann pin table 1. Ocular findings in patients with orbitozygomatic complex.
Orbitozygomatic craniotomy the neurosurgical atlas, by. Computed tomography use and repair of orbitozygomatic. Coronal and axial computed tomography is essential for identifying fracture extent and orbital involvement. Design twentyfive patients undergoing open reduction of a unilateral displaced fracture of the zygoma andor repair of a blowout fracture of the orbit with cranial bone. Orbitozygomatic fractures are one of the most common maxillofacial injuries encountered. C, endoscopic view of the right lateral orbit fracture. They are the second most common facial bone fracture after. When an orbital floor fracture is encountered in conjunction with an orbitozygomatic fracture, it probably is best to use a coronal flap to stabilize the lateral orbital wall and to expose the orbital wall. Orbitozygomatic fractures are frequently encountered in plastic surgery. The purpose of this retrospective study was to investigate treatment options for orbital floor fractures at a level 1 trauma center in southern california. Apr 27, 2014 the zygoma may be separated from its 4 atriculations. They can account for approximately 40% of midface fractures.
Classification and management of zygomatic complex fractures including lateral wall of the orbit. Management depends on a thorough preoperative physical examination, with attention to the ophthalmologic assessment. A and b, appearance showing absence of incisions or scars. Orbitozygomatic injuries are among the most common fractures encountered by the plastic surgeon. Management stabilisation of the fracture is important to minimise pain and.
Pattern and significance of ocular injuries associated. Have a basic understanding of the most common complications arising from orbitozygomatic fracture treatment and the methods of managing these complications. Treatment of zygomatic complex fractures with steinmann. Area of reduced skin sensation in fracture of the orbitozygomatic complex.
Management of tripod fractures zygomaticomaxillary. An abrasion from the original trauma is visible over the lateral malar region. Zmc fracture repair by open reduction with internal fixation orif table 1. Overlooking a fracture may not have immediate consequences, but can result in disfigurement and permanent disability. The orbit is a pearshaped cavity, with an apex directed posteriorly, medially and slightly upward. To summarize our experiences with the optimum management of orbitozygomatic fractures. Fractures of the zygomaticomaxillary complex are the second most common of all facial fractures.
Mar 02, 2020 technical nuances for orbitozygomatic craniotomy including performance of a frontotemporal craniotomy with supraorbital osteotomy i. These fractures occur most commonly as the result of assaults or motor vehicle collisions. Zygomatic fractures american academy of ophthalmology. Risks of a orbitozygomatic maxillary fracture repair there are risks and complications with this procedure. Management stabilisation of the fracture is important to minimise pain and discomfort. Several fixation methods have been used over the years, including wire osteosynthesis, lag screw fixation, transfacial kirschner wire fixation, titanium plate and screw fixation, and more recently, resorbable plating system. A retrospective audit of hundred patients of orbitozygomatic.
The reported incidence of ocular injuries in patients with orbital fractures varies widely, ranging from 2. The management of orbitozygomatic fractures request pdf. A physicians manual will be an invaluable reference and guide for ophthalmologists, maxillofacial surgeons, neurosurgeons, otolaryngologists, radiologists, and emergency. Orbitozygomatic fracture repairsfer surgery antibiotics. Jan 02, 2015 about zygomatic arch and orbital fractures. Results 3 months after lateral retrocanthal lrc approach for orbital endoscopy and repair of right orbitozygomatic fracture. There is a recognized association between orbitozygomatic fractures and ocular injuries. Ophthalmology consultation is recommended for patients presenting with midface fractures. Temporarily removing this bone allows surgeons to reach deeper and difficult parts of the brain while minimizing severe damage to the brain. Orbitozygomatic craniotomy for giant anterior communicating artery aneurysm. The fracture will be realigned and then fixed together using titanium plate and screws. P o ceallaigh, k ekanaykaee, c j beirne, and d w patton. Zygomatic fractures are often accompanied by a noe fracture or are a component of a more extensive craniofacial injury le fort ii and iii fractures, the panfacial fracture.
This retrospective study was aimed at investigating indications and surgical. Orbitozygomatic fracture that most commonly accompanies craniofacial injury is a challenge for medical science to reduce complications and to attain aesthetically satisfying results. Stanleys article presents a very stimulating discussion by a north american practitioner with extensive experience in facial injury management whose judgment and advice can always be respected. The described approach to fracture management is multidisciplinary in nature and the advice is evidence based, drawing on the latest published data. Using developed and refined craniofacial techniques such as a coronal flap and osteotomy to reposition the malpositioned zygoma is the key element and first step. Objective to assess the practicality and potential benefits of intraoperative computed tomography using a mobile scanner in the operating room during repair of orbitozygomatic fractures. The age of those patient who received orif repair ranged from 22 to 58 years.
The zygomaticomaxillary complex zmc plays a key role in the structure, function, and esthetic appearance of the facial skeleton. A small fracture of the aneurysm neck was identified, and cotton was applied with subsequent tamponade utilizing a fenestrated clip to maintain hemostasis. Computed tomography use and repair of orbitozygomatic fractures. Zygomaticomaxillary complex fracture radiology reference. Type i fractures include a singlesegment central fragment in which the medial canthal ligament is attached to a relatively large segment of fractured bone. Management of zygomatic fractures pocket dentistry. Use of intraoperative computed tomography during repair of. The age of those patient who received orif repair ranged from 22 to 58 years table 1.