Classic tripod fracture, but anatomically these fractures are actually. 3mm infra orbital rim order of fixation zygomatic arch zygomaticofrontal suture infraorbital rim zygomatic buttress. Ct should be considered in every zygomatic fracture other than the most trivial. Postoperative management of zygomatic arch fractures. Surgical management of zygoma fractures in patients with preinjury facial asymmetry. Modern techniques of fracture management allow easy access to the whole craniofacial skeleton, accurate fracture. Due to remodeling process, most of the landmarks for proper positioning are lost. Direct url citations appear in the printed text and are provided in the html and pdf versions of this article on the journals web site. A new classification of zygomatic fracture featuring zygomaticofrontal suture. After maxillofacial injuries, the possibility of fractures of the zygoma and zygomatic arch should always be considered and adequately investigated. This can be achieved with a coronal approach, where the entire zygomatic. Current therapy in oral and maxillofacial surgery eds bagheri sc, bell br, khan ah. Also described was an approach to the zygomatic arch by way of a plane between the temporalis muscle and deep temporalis fascia. Diagnosis and management of common maxillofacial injuries in.
Management of zygomaticmaxillary fracture journal unair. A digital exploration was then made to the right temporal region which revealed that the coronoid process movement was not restricted indicating that the zygomatic arch was not displaced medially. Many zygomatic fractures which have good bony alignment despite the fracture do not require any treatment at all. Treatment of zygomaticomaxillary complex zmc fractures involves exposure, reduction, and immobilization with plate and screw fixation.
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. Having been formed by the joining of the infraorbital nerve, the zygomatic nerve, and nerves from the roof of the mouth, upper teeth and gums, and mucous membranes of the cheek, the maxillary nerve traverses the area between the maxilla and the sphenoid bone. This article focuses on the zygomatic arch fracture. This is most commonly seen after assault, but any blow to the cheek may give rise to a fracture. If the zygomatic arch is bowed laterally, the malar eminence is posteriorly displaced. Surgical management of zygomatic complex fractures in a. Shahzad hussain bds, fcps resident nishtar institute of dentistry. Stabilisation of the fracture is important to minimise pain and discomfort. 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 the mandible. Interruption in zygomatic position has psychological, aesthetic and functional effects which impairs the function of mandible and ocular tissue. The management of zygomatic arch fractures by intraoral open reduction and transbuccal fixation is an effective method to address zygomatic arch fractures. It is therefore understood that the force necessary to fracture the zygomatic arch is less than that required for a similar. Fracture of the zygomatic bone is a common fracture of the facial skeleton.
In order for a fracture to occur in the zygomatic bone, kinetic force is required. A new classification of zygomatic fracture featuring. Assessment of zygomatic fractures should proceed only after standard protocols for evaluating blunt head trauma have been executed figures 2 and 3. Zygomatic arch reduction gillies approach springerlink. On exam, in addition to a palpable left zygomatic arch step off deformity. Thus, fractures of the zygomatic complex inevitability lead to a certain degree of orbital defect.
May 14, 2019 the zygomatic bone fracture and coronoid process impingement lead to restricted mouth opening. Therefore, the main problem in the nonfixed treatment of zygomatic arch fractures is related to the difficulty in obtaining a stable reduction for a period long enough to guarantee the. A 10 year 20002010 retrospective study involving 310 patients admitted and treated for zygomatic bone and zygomatic arch fractures at the department of oral and maxillofacial surgery was done. I have a zygomatic arch fracture with no deformities. Zygomatic arch definition of zygomatic arch by the free. It serves as an attachment point for the masseter and plays a. Analysis of outcome of zygomatic fracture management. The zygomaticomaxillary complex zmc has important aesthetic, structural, and functional roles that need to be preserved andor restored during treatment of facial fractures. Management of posttraumatic zygomatic orbital deformity journal of postgraduate medicine.
The technique is simple and less invasive with reduced risk of facial nerve injury. The severity of the injury is directly proportional to force of the impact. The zygomatic arch, or cheek bone, is formed by the zygomatic process of the temporal bone a bone extending forward from the side of the skull, over the opening of the ear and the temporal process of the zygomatic bone the side of the cheekbone, the two being united by an oblique suture zygomaticotemporal suture. Dec 05, 2017 gillies hd, pomfret kilner t, stone dudley. Controversy still remains regarding the optimal management of these fractures. If tripartite or posterior arch fracture near temporal bone. Aetiology is usually blunt trauma to the cheek, such as involved in. Lateral wall fractures are therefore more commonly seen following significant maxillofacial trauma involving the malar complex too.
Not only does this result in a disgruntled patient, it may affect their ability to continue to perform their occupation. My advice for management of zygomatic bone and zygomatic arch is as below. Management of fractures of the zygomaticomaxillary complex. Nondisplaced isolated zygomatic arch fractures can be treated nonoperatively unless there is trismus. A new classification system and algorithm of zygomatic arch fractures is described that provides the surgeon with a useful starting point from which to organize a valid treatment plan and management of zygomatic arch fractures. These fractures have the potential to result in either a cosmetic deformity andor a functional issue. Because the point of least resistance to fracture is not at the zygomaticotemporal suture, but approximately 1. Zygoma arch fracture an overview sciencedirect topics. Ipsilateral eye may appear to tilt due to pulling of lateral canthus.
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. This fracture can be managed easily without the necessity of internal fixation splinting if reduction is performed within the span of 72 hours following injury. The zygomatic bone fracture and coronoid process impingement lead to restricted mouth opening. These fractures can be reduced using gillies temporal. Road traffic accidents were the leading cause of zygomatic bone and zygomatic arch fractures. Dec 31, 2016 the zygomatic arch is formed by the articulation of the temporal process of the zygoma and the zygomatic process of the temporal bone.
Fractures involving zygomatic arch can cause inability of movement of mandible. Dec 03, 2018 the zygomatic bone occupies a prominent and important position in the facial skeleton. Acute management of orbito zygomatic maxillary fractures. The fracture of the zygomatic arch is a traumatic solution of continuity of the lateral structure of the middle third of the face, formed by the zygomatic processes of the temporal bone and the temporal. Honig merten hm class i is defined as an isolated tripod fracture, hm. Contact sports less common assessment of potential fractures history.
The decision not to operate is extremely patientfocused. The vast majority of zygomatic fractures involve the orbit, apart from the isolated zygomatic arch fracture figure 4. Tell the patient not to blow their nose for 10 days. Acute management of orbitozygomaticmaxillary fractures.
Fracture of malar zygomatic compound with description of a new xray position. After the nasal bone, the zygoma is the second most common bone of the face to be fractured. The orbit is a pearshaped cavity, with an apex directed posteriorly, medially and slightly upward. Patient perspective in the management of zygomatic. A flat malar arch is best assessed from behind the patients head. Management of zygomatic fractures pocket dentistry. Zygomatic injuries may be part of a wider and more. The zygomatic arch is formed by the articulation of the temporal process of the zygoma and the zygomatic process of the temporal bone. A zmc fracture that follows this pattern usually has one additional fracture line through the zygomatic arch. Zygomatic fractures american academy of ophthalmology.
In 1751, dupuytren detailed an intraoral and external technique to reduce a medial displaced zygomatic arch. The surgical management of isolated zygomatic arch fractures usually requires open reduction treatment without fixation through an intraoral access. 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. In this study, the gillies approach was used for the majority 85% of the isolated zygomatic arch fractures in this trauma center. There were 40 zmc fractures and isolated zygomatic arch fractures. Reduction of zmc fractures should ensure that the malar eminence is properly projected anteriorly and, if the zygomatic arch is reconstructed, the procedure is done by keeping it flat. Management of zygomaticmaxillary fracture mandible. Lee ann remington od, ms, faao, in clinical anatomy and physiology of the visual system third edition, 2012. Surgical management of zygoma fractures in patients with. Unfortunately, the incidence of maxillofacial trauma is increasing at an alarming rate. Operative management of displaced zygomatic arch fractures isolated arch. Diagnosis and management of common maxillofacial injuries in the emergency department. Surgical management of zygomatic complex fractures in a major. Our study includes 16 consecutive patients who underwent.
Furthermore, the zygoma is connected to the maxilla and sphenoid bone as part of the inferior orbital floor, and forms the lateral orbital margin with the frontal bone. Must distinguish zygomatic arch fracture from zygomaticomaxillary tripod fracture. Introduction the fracture of the zygomatic arch is a traumatic solution of continuity of the lateral structure of the middle third of the face, formed by the zygomatic processes of the temporal bone and the temporal. Emergency management and therefore prognosis is dependent upon early diagnosis. A malar fracture should be suspected if periorbital oedema, ecchymosis of the lower lid, andor a lateral sub conjunctival haemorrhage bloodshot eye is present. Commentary on surgical management of zygomatic complex. These fractures occur most commonly as the result of assaults or motor vehicle collisions. The rowes zygomatic elevator is then passed beneath the periosteal elevator, as it is withdrawn. Diagnosis and management of common maxillofacial injuries. Fractures that involve the zygoma often occur at these four suture sites, leading to a tetrapod fracture pattern, known as a zygomatic complex fracture zmc. Other fracture patterns, include isolated zygomatic arch fractures, or zmc fractures with associated panfacial fractures, such as le fort ii and iii fracture patterns. Indications 1 depressed fractured zygomatic arch causing a cosmetic deformity. Evaluation of treatment of zygomatic bone and zygomatic. The high incidence of zygomatic complex fracture relates to its prominent position within the facial skeleton.
Interesting case series zygomatic arch fracture with coronoid impingement gerhard s. The zygomatic bone occupies a prominent and important position in the facial skeleton. Management of zygomatic maxillary fracture mandible. Treatment for zygomatic arch fractures really depends on the specific fracture. Temporal gillies approach to a zygomatic arch fracture. Zygomatic bone and arch fractures are among the most common facial fractures treated by facial plastic surgeons. 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. 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. Zygomatic arch fractures may produce a visible depression of the malar eminence leading to cosmetic asymmetry, enophthalmos, dystopia as well as trismus if the arch impinges upon the coronoid process. Having been formed by the joining of the infraorbital nerve, the zygomatic nerve, and nerves from the roof of the mouth, upper teeth and gums, and mucous membranes of the cheek, the maxillary nerve traverses the area between the maxilla.
Evaluation of treatment of zygomatic bone and zygomatic arch. Temporal gillies approach to a zygomatic arch fracture video type. The assessment of outcome helps in forming a protocol for the management of zygoma fractures and pinpoints the deficiencies existing in the management and the need to improve the already evolving management techniques. Management of zygomaticomaxillary complex fractures. One zmc fracture case was excluded from the points of fixation and surgical incision analysis. The aim of this study was to investigate the treatment of zygomatic bone and zygomatic arch fractures without other facial fractures. The zygomatic bone is attached to the maxilla at the zygomaticomaxillary zm suture and alveolus forming the zygomaticomaxillary buttress. Strong buttress of lateral midface lying between zygomatic process of frontal bone and maxilla. Sacks, md department of plastic and reconstructive surgery, johns hopkins hospital, baltimore, md correspondence. Management of isolated zygomatic arch fractures and a. Bone and arch zygomatic bone and arch fractures are among the most common facial fractures treated by facial plastic surgeons. Chart showing the number of patients who under went various procedures for the management of zygomatic fracture. We propose an innovative inhouse rapid prototyping rp protocol for the 3dzygoma mask manufacture of a patientspecific protective device to apply after zygomatic arch fracture reduction. Therefore, diagnose and properly management of the zygomatic bone injury is important.
A soft cervical collar is recommended for stabilisation, not the traditional barrel bandage. According to the site of fracture, various modalities of treatment were used and all patients achieved satisfactory results without any complications after operation. In this instance, the tip of the instrument must be placed medially until the medial aspect of the zygomatic arch is reduced. Tripod fracture fracture of zygomatic arch, lateral and inferior orbital rims, and lateral wall of maxillary sinus. Dec 28, 2011 road traffic accidents were the leading cause of zygomatic bone and zygomatic arch fractures. The zygomatic arch is fractured singly more often than the malar bone, 10 to 1. Jan 02, 2015 lateral orbital wall and zygomatic arch fracture an isolated lateral wall fracture of the orbit is rare, as this is the strongest of the orbital walls. Displaced zygomatic arch fractures with apparent deformity or trismus require reduction.
Alternatives to the coronal approach to zygomatic arch repair include the gillies approach, which is a temporal approach for reduction only of zygomatic arch fractures. The diagnosis of such fractures can be made by one or. Zygomatic arch fracture open reduction with stablization using micro plates wiring. Management of posttraumatic zygomatic orbital deformity. In medially displaced fracture, it may be difficult to pass the instrument medial to the zygomatic arch. Fractures of the zygomatic complex and arch pocket. These fractures are caused chiefly by automobile accidents, fist blows, and accidental falls. In patients with two process fracture, the infra orbital rim and zygomatic buttress were the most common sites of fracture accounting 27. Overlooking a fracture may not have immediate consequences, but can result in disfigurement and permanent disability. Classification system and treatment of zygomatic arch. Approach for open reduction of a zygomatic arch fracture. Management of zygomatic arch fractures by intraoral open. Patient perspective in the management of zygomatic fractures. Zygoma fractures are easy to miss and displaced fractures require treatment within 10 days.
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