They are the second most common facial bone fracture after nasal bone fractures pathology. These fractures also run through the lateral orbital wall and the orbital floor. A substantial number of postoperative functional and cosmetic complications can arise from the surgical management of these fractures. It provides normal cheek contour and separates the orbital contents from the temporal fossa and the maxillary sinus. Oct 15, 2019 a study by farber et al indicated that no consensus exists in the treatment of zmc fractures.
Zygomatic complex fractures or the tetrapod fractures are common to occur followed by the nasal bone fractures because of its prominent location. The gillies procedure in the treatment of zygomatic. Management of zygomaticomaxillary complex zmc fractures should be based on injury patterns and not on training background. Many publications have appeared on intraoperative imaging for trauma surgery, but in most hospitals intraoperative imaging is not routinely performed for zmc fracture repair. Zygomaticomaxillary complex fracture radiology reference. A retrospective study article pdf available in the open dentistry journal 121. Treatment and complications of orbitozygomatic fractures scielo. If you do not have it you can download adobe reader free of charge. Zmc complex fracture right zygomaticomaxillary complex fracture with disruption of the. Skull base fractures are of high importance in neurotrauma.
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. The treatment of the zygomatic complex fractures is. The zygoma is the origin for the masseter, thus affecting mastication. The term zygomaticomaxillary zygomaticomalar complex zmc fractures refers to the osseous disruption of the malar eminence at 4 buttresses. Type b involves a fracture where all three processes of zygoma. Surgical methods of zygomaticomaxillary complex fracture. Zmc files and zonealarm antivirus were created by zone labs and are currently developed by checkpoint software technologies. Pdf zygomaticomaxillary complex fracture researchgate. Primary surgical treatment is required in case of dislocation of the zmc to restore facial symmetry. Aug 19, 2019 zygomaticomaxillary complex zmc and zygomatic arch za fractures are common injuries resulting from facial trauma and frequently require surgical management huang et al. Slide zmc frac free download as powerpoint presentation.
Skull base fracture incidence is increased with orbital wallrim fractures 36% and zmc fractures %. Shaped like an empty ice cream cone it is composed of 7 facial bones. Intraoperative imaging seems to be the next step to improve surgical outcome in the treatment of zygomaticomaxillary complex zmc fractures. They can account for approximately 40% of midface fractures. Prospective blind comparative clinical study of two point. The fracture will be realigned and then fixed together using titanium plate and screws. Application of a computerassisted navigation system. These files will have pdf in brackets along with the filesize of the download. A prospective short clinical study ramesh candamourty 1, vinod narayanan 2, mf baig 2, mr muthusekar 2, manoj kumar jain 3, ramesh m. Figure 21a figure 21b figure 21c figure 21d findings figures 21a and 21b. Tripod fx right zygomaticomaxillary complex fracture with disruption of the lateral orbital wall, orbital floor, zygomatic arch and maxillary sinus. From september 2011 to october 2018, 43 patients with comminuted zmc fracture receiving open reduction internal fixation under coronal incision were enrolled. What is an orbitozygomatic maxillary fracture repair. Case report threepoint fixation of displaced tripod.
The patient does not recall striking his head, but complains of tenderness over the right zygomatic arch and maxilla. Treatment of zygomatic complex fractures using two point. Jul 03, 2019 zygomaticomaxillary complex zmc fractures, also known as a tripod, tetrapod, quadripod, malar or thoracolumbar spinal fracture classification systems. Management of tripod fractures zygomaticomaxillary complex.
Zygomaticomaxillary complex zmc fractures are a group of fractures that can significantly alter the structure, function, and appearance of the midface, including the globe. Zmc fractures occur from blunt trauma to the cheek or side of the face. To open a pdf file you will need compatible software such as adobe reader. The zygomatic maxillary complex zmc fractures are one of the most frequent injuries of the facial skeleton due to its position and facial contour. Modalities of zygomaticomaxillary complex fracture. Zmc fracture repair, and it simplified exposure of the lateral orbital rim, without the need for overzealous tissue retraction. Application of a computerassisted navigation system cans. Reduction of fractured zygoma is done by manipulating the broken cheek bone to restore the contour and appearance of the face. Information about the degree and severity of the overall injury can be extrapolated from the location of the fractures. The postreduction stable fractures 78% treated solely with the gillies procedure have given satisfactory symmetric results in 72% of the patients. The ultimate goal in treating zygomaticomaxillary complex zmc fractures is to obtain an accurate stable reduction while minimizing external scars and functional deformity.
A new classification of zygomatic fracture featuring zygomaticofrontal suture. Typically patients will develop pain with chewing and a flattening of the cheek from the fracture. Assaults, road traffic accidents and falls are the principal etiologic factors that may cause fractures of zygomatic bone. Like other facial fractures, the optimal management of operative zmc fractures requires anatomic reduction of all fractures followed by rigid internal fixation. Fractures of the zygomatic complex are among the most frequent in maxillofacial trauma. 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. Fractures of the zygomatic complex and arch pocket. Zygomaticomaxillary complex zmc and zygomatic arch za fractures are common injuries resulting from facial trauma and frequently require surgical management huang et al. Classification of mandible, midface, zmc and noe fractures. These bones include the lateral orbital wall, orbital rim, orbital floor, the anterior and lateral maxillary sinus walls, and a structure called the zygomatic arch.
Fortyeight patients with isolated, unilateral zmc fractures that had at least 6. The term zmc fracture describes a spectrum of injuries that includes nondisplaced fractures, fractures displaced at an isolated buttress, and severely comminuted fractures with bone loss. These goals are accomplished more easily several days after the injury, when much of the tissue edema has resolved and any residual deformity can be appreciated more readily. The zygomaticomaxillary complex zmc plays a key role in the structure, function, and esthetic appearance of the facial skeleton. A fracture through the orbital roof can result in a dural tear, with resultant csf leakage or brain herniation.
Fractures typically occur across these three buttressrelated sutures, leading to the term tripod fracture. Treatment of zygomatic complex fractures with surgical or nonsurgical intervention. In most cases, there is loss of sensation in the cheek and upper lip due to infraorbital nerve injury. Lowenergy fractures were found to result in minimal or no displacement, and had a continuous zf. Surgical methods of zygomaticomaxillary complex fracture ncbi. Zmc fractures is a frequent challenge in plastic surgery. Incidence and evaluation of recovery of neurosensory.
Orbital trauma and facial fracture repair denver eye surgeons. Orbital trauma and facial fracture repair denver eye. 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. Zygomaticomaxillary complex fracture dr ian bickle and dr nasir siddiqui et al. Orbital trauma and facial fracture repair what is the orbit.
Because the point of least resistance to fracture is not at the zygomaticotemporal suture, but approximately 1. At the same time, it is difficult to obtain perfect reduction and contour postoperatively because of its complex involvement with four bones namely maxillary, temporal, orbital and greater wing of sphenoid bone. For example, among physicians in various surgical specialties surveyed plastic and reconstructive surgeons, oral and maxillofacial surgeons, otolaryngologists, the percentage of plastic surgeons who recommended an operation in the case of a minimally displaced fracture was significantly higher than. Zygomaticomaxillary complex fracture linkedin slideshare. Zygomaticomaxillary complex fracture deepak k gupta 2. Unstable fracture with great displacement and distruption at the frontozygomatic suture and comminuted fracture. On evaluation, she complained of leftsided facial swelling, cheek. Numerous techniques have been described for the reduction of zmc fracture.
Reduction of zygomatic complex fracture using combination. The present study showed that the neurosensory deficit was. A study on assessing the etiology and different treatment. Babu 4 1 department of oral and maxillofacial surgery, indira gandhi institute of dental sciences, mahatma gandhi medical college and research institute campus, pillaiyarkuppam. Classification and treatment of zygomatic fractures. Bennett fracturedislocation fractures of the hand intraarticular fracture of the proximal end of the first metacarpal, with dorsal and lateral dislocation of the distal segment. 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. The malar complex refers to the zygoma and maxillary bones and therefore forms part of the orbital floor and lateral orbital wall. In the analysis of the control group the ages varied from 16 to 62 mean 37. The primary outcome measurement was the absolute bilateral differences of the zmc eminence and width based on computed tomographic. Orbitozygomatic fractures represent a type of maxillofacial injury that happens very often due to the.
Incidence and evaluation of recovery of neurosensory changes. A new classification of zygomatic fracture featuring. 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. From march 2014 to december 2014, 34 patients with zmc fractures were treated by onepoint fixation in the zm buttress using unsintered hydroxyapatite uhapolyllactide plla plates. Pdf treatment of zygomatic complex fractures with surgical. Zygoma or cheek bone fracture of zygoma is not usually present alone, its find mostly in the conjunction with adjacent structure i. The gillies procedure in the treatment of zygomatic fractures. Jul 15, 2019 fraktur wajah, trauma oral dan maksilofasial. Zmc fractures treated by various methods over a 5year period. Reduction of zygomatic complex fracture using combination of. 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.
A zmc fracture is also known as a tripod, tetrapod, or quadripod fracture, trimalar fracture or malar fracture 1,2. Intraoperative imaging for the repair of zygomaticomaxillary. 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. Oct 15, 2019 the zygomaticomaxillary complex zmc plays a key role in the structure, function, and aesthetic appearance of the facial skeleton. They are the second most common facial bone fracture after nasal bone injuries. A cut is made around the eyes and inside the mouth to access the fracture. 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 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. Obeng clinical history 29yearold male involved in a motor vehicle accident.
They occur in 24% of head injuries and are often related to brain injury in 50% of the cases. The zmc file extension is a data file format associated to an antivirus program called zonealarm mailsafe antivirus. 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. 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%. Pdf surgical methods of zygomaticomaxillary complex fracture.
What are the indications for operative management for zmc fractures. A substantial number of postoperative functional and cosmetic complications can arise from the surgical management of. Open reduction and internal skeletal fixation of zmc fractures accelerated the neurosensory recovery. This term fails to recognize the posterior relationship of the zygoma with the sphenoid bone of the skull base and its extension inferiorly down the lateral wall of the maxillary sinus. The neurosensory recovery occurred within 3 to 6 months in almost all cases. Medium or highenergy injuries resulted in fractures of all buttresses, including the zf. Stable fracture other types of zygomatic fractures, which requires reduction, but no fixation. The surgical procedures of fixation with miniplates and screws of 1. Management of tripod fractures zygomaticomaxillary.
The different fixation methods are applied to treat the zygomatic bone fractures, with many more classifications which have. The combination of these fractures is also referred to as a tripod fracture or a. The trapdoor fracture is an inferior orbital blowout fracture in which the inferior rectus muscle herniates into the underlying maxillary sinus before the fractured fragment returns to its original position, entrapping the muscle. Additionally, the fracture components may result in. Fractures of the zygomatic arch alone minimum or no. Surgical management of zygomatic complex fractures in a major. Zygomaticomaxillary complex fractures orthopedics jama. These will stay in place unless they cause problems, in which case a second operation will be required to remove them. Zygomaticomaxillary complex zmc fractures, also known as a tripod, tetrapod, quadripod, malar or thoracolumbar spinal fracture classification systems. Fractured and hinged on maxillary attachment type 3. From march 2014 to december 2014, 34 patients with zmc fractures were treated by onepoint fixation in the zm buttress using unsintered hydroxyapatite uhapolyl. This plays a key role in the structure and function of.
Treatment modalities in zygomatic complex fractures. The different fixation methods are applied to treat the zygomatic bone fractures, with many. There are risks and complications with this procedure. A zmc fracture that follows this pattern usually has one additional fracture line through the zygomatic arch. This case report presents a 21yearold man who was involved in a traffic accident and who subsequently presented with a zmc fracture. Facial bruising, periorbital ecchymosis, soft tissue gas, frakutr, trismusaltered masticationdiplopiaand ophthalmoplegia are other indirect features of the injury. Few studies have reported on using craniometry for comminuted zygomaticomaxillary complex zmc fracture management. 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. Pdf most of the documents on the racgp website are in portable document format pdf. Zmc complex fracture right zygomaticomaxillary complex fracture with disruption of the lateral orbital wall, orbital floor, zygomatic arch and maxillary sinus.
A zmc fracture is also known as a tripod, tetrapod or quadripod fracture, trimalar fracture or malar fracture. 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. Other fracture patterns, include isolated zygomatic arch fractures, or zmc fractures with associated panfacial fractures, such as le fort ii and iii. Spectrum of critical imaging findings in complex facial. Sep 06, 2015 zygomaticomaxillary complex fracture 1.
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