Zygomatic Swetaa.A Undergraduate student Saveetha Dental College, Saveetha

Zygomatic complex fracture Type of manuscript- review article Running title- zygomatic complex fracture Swetaa.AUndergraduate student Saveetha Dental College,Saveetha university Chennai,India.Mr. K. Yuvaraj BabuAssistant professor Department of Anatomy Saveetha Dental College Saveetha university, Corresponding authorChennai,India.

Corresponding author-Email- [email protected] number- 9566047924Author name- Swetaa.A Guide Name- Mr. K.

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Yuvaraj BabuTelephone number- 9840210597Year of the study- I BDS 2017-2018Total no.of words- Abstract- Aim- To create awareness on zygomatic complex fracture.Objective- To review and establish about zygomatic complex fracture. INTRODUCTION Zygomaticomaxillary complex (ZMC) fractures are a group of fractures that can significantly alter the structure, function, and appearance of the midface, including the globe. Like other facial fractures, the optimal management of operative ZMC fractures requires anatomic reduction of all fractures followed by rigid internal fixation.

However, surgical treatment of these fractures can be quite challenging with the potential for high rates of complications.The zygomaticomaxillary complex (ZMC) functions as a buttress for the face and is the cornerstone to a person’s aesthetic appearance, by both setting midfacial width and providing prominence to the cheek. It can best be anatomically described as a “tetrapod” as it maintains four points of articulation with the frontal bone, temporal bone, maxilla, and greater wing of the sphenoid, at the zygomaticofrontal (ZF) suture, zygomaticotemporal (ZT) suture, zygomaticomaxillary buttress (ZMB), and zygomaticosphenoid (ZS) suture.

This tetrapod configuration then lends itself to complex fractures, as fractures here rarely occur in isolation. Additionally, the zygoma serves as the attachment point for muscles of both mastication and facial animation, but among these, it is the masseter that provides the most significant intrinsic deforming force on the zygomatic body and arch, albeit a small one. The zygoma plays an integral role with the orbit, as it buttresses the orbit and forms the majority of the lateral orbital wall and floor.

The cause is usually a direct blow to the Malar eminence of the cheek during assault. The paired zygomas each have two attachments to the cranium, and two attachments to the maxilla, making up the orbital floors and lateral walls. These complexes are referred to as the zygomaticomaxillary complex.

The upper and transverse maxillary bone has the zygomaticomaxillary and zygomaticotemporal sutures, while the lateral and vertical maxillary bone has the zygomaticomaxillary and frontozygomatic sutures.The formerly used ‘tripod fracture’ refers to these buttresses, but did not also incorporate the posterior relationship of the zygoma to the sphenoid bone at the zygomaticosphenoid suture.There is an association of ZMC fractures with naso-orbito-ethmoidal fractures (NOE) on the same side as the injury. Concomitant NOE fractures predict a higher incidence of post operative deformity. Materials and methods- A total of 140 articles were identified through the database searches.

Data relevant to the demographic profile of the patients such as age and gender, cause of injury, other associated injuries (noncranio-facial), and surgical treatment provided was collected. Only those patients with iZMC fractures without any other facial bone injury were included in this study. Patients who presented with displaced iZMC fractures causing aesthetic or functional problems that needed surgical intervention underwent standard preoperative . Every article identified checked by one reviewer and subjected to pre-determined inclusion/exclusion criteria. Where abstracts were ambiguous, the article was obtained. These were found to be a review papers, summaries of other studies, or contained no data to inform the research questions. A total 42 articles were included in the review. Key words- zygomatic complex fracture, trauma, surgical procedure, patients.

 Discussion-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: the lateral orbital wall ,inferior wall, separation of the maxilla and zygoma along the anterior maxilla , the zygomatic arch, and the orbital floor  near the infraorbital. A patient with maxillofacial injuries presents with a clinical picture of gross facial swelling, usually from oedema and bleeding into the tissues. Clinical examination augmented with radiological investigation gives an accurate diagnosis regarding the extent of injuries. The rise in the motorized population accompanied by rash driving and disregard to traffic rules has resulted in a rise of zygomatic complex fracture .  The increase in interpersonal violence and accidental falls are also contributing to maxillofacial injuries.

The  Armed Forces are predisposed to various kinds of injuries. High-speed vehicles and increased violence account for a large number of maxillofacial injuries. Zygomaticomaxillary complex, due to its prominent position in the face bears the brunt of trauma in majority of the cases and has shown to have the highest incidence of fractures in the maxillofacial region in various studies, including this study.

Facial bones, especially of the middle third of the face, are composed of a network of fragile bones held together across sutures which give way in case of force to a lesser extent than other parts of the body. It is imperative to educate people regarding the importance of restraints and use of protective headgear/ seat belts while travelling in motorised transport, which will go a long way in preventing injuries to the facial region.BUTTRESS-The buttress system of the mid face is formed by strong frontal, maxillary, zygomatic and sphenoid bones  and their  attachments  to one  another. The central mid face contains fragile bones.These  fragile  bones  are  surrounded  by thicker  bones  of the  facial  buttress  system  lending it  some  strength  and stability.Horizontal buttress system- These  buttresses  interconnect  and  provide  support  for the  vertical  buttresses.  They include: 1.

Frontal  bar 2. Infraorbital  rim  nasal  bones 3. Hard palate  maxillary alveolusVertical buttress system- These  buttresses  are  very well  developed. They include: 1. Nasomaxillary 2.

Zygomaticomaxillay 3. Pterygomaxillay 4.  Vertical  mandible.

Majority  of the  forces  absorbed  by midface  are  masticatory in  nature.  Hence  the  vertical  buttresses are  well  developed  in humans.CLASSIFICATION-Non displaced,Displaced,Comminuted,Orbital  wall  fracture,Zygomatic  arch fracture Knight  North classification.Under Knight and north classification there are types of fractures.Types of fractures- There are six types of fracture.Group one fracture Group two fracture Group three fracture Group four fracture Group five fracture Group six fractureAmong these fractures group six fracture is complex fracture.

Majority of the patients belong to group 1 and group 2 fractures. CLINICAL FEATURES- 1.  Anaesthesia  /  Paraesthesia  of that  side  of the  face 2. Inability to  open the  mouth 3. Flattening of zygomatic  area 4. Diplopia 5. Subconjunctival  haemorrhage 6. Eye  lid oedema 7.

Periorbital  haemorrhage 8. Lateral  canthal  dystopia 9. Ipsilateral  epistaxis 10. Buccal  sulcus  haematomas 11. Enopthalmos  in orbital  floor  fractures.Masons classification of fracture zygoma:It is based on CT images to classify the different types of fractured zygoma. It has 3 types Low energy injury Medium energy injuryHigh energy injury Diagnosis- 1. CT scan imaging 2.

Endoscopy 3. Enophthalmos 4. Floor orbital fracture 5. Globe retraction 6. Medial wall orbital fracture TREATMENT-  It is always done in a surgical procedure.

Majority  of the patients  were  managed conservatively or Gillie’s  procedure.Only  few patients  needed  open reduction with three  point  fixation.It has gillies procedure, two point fixation, three point fixation and many.Gillie’s procedure:Small incision is made in temporal area. Superficial temporal artery is avoided dissection is continues deep temporal fascia.

 Two point fixation: It involves micro plates in zygomatico- frontal and zygomatic areas. Three point fixation: It includes frontozygomatic suture, infraorbital rim, zygomatico maxillary buttress. Conclusion- Facial bones are fragile bones most of the cases are caused due to trauma. Management of facial trauma is to treat as soon as possible. Surgical technique results in good bony alignment and esthetics. As told before lots of accidents lead to zygomatic complex fracture that to majority of the cases are bike accidents so awareness of wearing helmet is very important to avoid facial fractures.

 References- 1. Balasubramanian  Thiagarajan ,Seethalakshmi  Narashiman , Karthikeyan  Arjunan,Fracture zygoma and its management our experience,Stanley Medical  College,otolaryngology online journal,20132. H. Kobashi, S. Ishii, N. Yakushiji, Huge nasopalatine duct cyst treatment with the help of cystectomy and bilateral fenestration surgery of the nasal cavity: A case report,Oral and Maxillofacial Surgery Cases, 28 sept 2017.

3. Edward E,  Winai  K  (1996)  Analysis  of treatment  of the  isolated zygomaticomaxillary  complex fractures.  J  Oral  Maxillofac  Surg 54(4):386–400 4. Chowdhury SKR, Menon PS:  Etiology  and management  of zygomatico  maxillary  complex fractures  in the  armed forces. MJAFI 2005, 61:238-240. 5.

Nayyar MS:  Management  of zygomatic  complex  fracture. J  Coll  Physicians  Surg Pak 2002, 12:700-705. 6. Manson PN, Hoopes  JE, Su CT.  Structural  pillars  of the  facial  skeleton:  An approach  to the management  of Le  Fort  fractures. Plast  Reconstr Surg 1980;  66:54–7. 7.

  Knight  JS, North  JF.  The  classification  of malar  fractures:  An analysis  of displacement  as  a  guide to treatment. Br J  Plast  Surg. 1961;13:325. 8.

Manson PN, Markowitz  B, Mirvis  S, et  al.  Toward CTbased facial  fracture  treatment. Plast Reconstr Surg. Feb 1990;85(2):20212;  discussion 2134 9. Lin KY, Bartlett  SP,  Yaremchuk  MJ, et  al.

  The  effect  of rigid fixation on the  survival  of onlay bone  grafts:  an experimental  study. Plast  Reconstr Surg. Sep 1990;86(3):44956. 10.  Gosain  AK, Song L,  Corrao MA, et  al. Biomechanical  evaluation  of titanium,  biodegradable  plate and screw, and cyanoacrylate  glue  fixation systems  in  craniofacial  surgery.

  Plast  Reconstr  Surg. Mar 1998;101(3):58291 11.  Dingman RO, Natvig  P. Surgery of Facial  Fractures.  Philadelphia:  WB Saunders  Co;  1964. 12.  Kobienia  BJ, Sultz  JR, Migliori  MR, et  al.

Portable  fluoroscopy  in the  management  of zygomatic  arch fractures.  Ann Plast  Surg. Mar 1998;40(3):2604. 13.  Zingg M, Laedrach K, Chen J, et  al.  Classification  and treatment  of zygomatic  fractures:  a review  of 1,025 cases. J  Oral  Maxillofac  Surg.

  Aug 1992;50(8):77890.14. Longaker MT, Kawamoto HK. Evolving thoughts on correcting posttraumatic enophthalmos.

Plast Reconstr Surg 1998 Apr;101(4):899-906. 15. Karyouti SM. Maxillofacial injuries in Jordan University hospital; Int J Oral Maxillofacial Surgery 1987:16,262-5. 16. Ajagbe HA and Daramola JO.

Pattern of facial bone fracture seen at University College Hospital, Ibadan, Nigeria, East Africa Med J 1980,57:267-72. 17.  Oji C. Jaw fractures in Enugu, Nigeria, 1985-1995. British Journal of Oral and Maxillofacial Surgery (1999) 37,106-9.

 18.  NL Rowe and JLI Williams. Maxillofacial injuries. Vol I Churchill Livingstone 1985:363-558. 19.

  Mwaniki D, Radol JWO, Miniu E, Manji F. The occurance and pattern of facial bone fractures in Nairobi. East Afr Med J 1988:65,759-63. 20. Akama MK, Chindiu ML, Ndungu FI. Occurance and pattern of facial bone factures at Kissi District Hospital Kenya; East Afr.

Med J 1993;70:732-3. 21.  O’Hara DE, Del  Vecchio DA, Bartlett SP,  Whitaker LA.

  The role of micro fixation in malar fractures: a quantitative biophysical study.  Plast Reconstr Surg 1996 Feb;97(2):34550;discussion 351-3. 22.  Lee CH, Lee C,  Trabulsy PP, et al.  A  cadaveric and clinical evaluation  of  endoscopically  assisted  zygomatic  fracture repair.

Plast Reconstr Surg 1998 Feb; 101(2): 333-45; discussion 346-7.23. Swanson KS, Kaugars GE, Gunsolley JC. Nasopalatine duct cyst: an analysis of 334 cases. J Oral Maxillofac Surg 1991;49:268e71. 24. Falci SGM, Verli FD, Consolaro A, Dos Santos CRR.

Morphological characterization of the nasopalatine region in human fetuses and its association to pathologies. J Appl Oral Sci 2013;21:250e5. 25. Escoda Francolí J, Almendros Marques N, Berini Aytes L, Gay Escoda C. Nasopalatine duct cyst: report of 22 cases and review of the literature. Med Oral Patol Oral Cir Bucal 2008;13:E438e43. 26.

Aldelaimi TN, Khalil AA. Diagnosis and surgical management of nasopalatine duct cysts. J Craniofac Surg 2012;23, e472e4. 27. Suter VG, Sendi P, Reichart PA, et al. The nasopalatine duct cyst: an analysis of the relation between clinical symptoms, cyst dimensions, and involvement of neighboring anatomical structures using cone beam computed tomography. J Oral Maxillofac Surg 2011;69:2595.

 28. Elliott KA, Franzese CB, Pitman KT. Diagnosis and surgical management of nasopalatine duct cysts. Laryngoscope 2004;114:1336. 29.  Honkura Y, Nomura K, Oshima H, Takata Y, Hidaka H, Katori Y. Bilateral endoscopic endonasal marsupialization of nasopalatine duct cyst.

Clin Pract 2015;5:748. 30. Kang JW, Kim HJ, Nam W, Kim CH. Endoscopic endonasal marsupialization of nasopalatine duct cyst. J Craniofac Surg 2014;25, e155e6. 31.

Wu PW, Lee TJ, Huang CC, Huang CC. Transnasal endoscopic marsupialization for a huge nasopalatine duct cyst with nasal involvement. J Oral Maxillofac Surg 2013;71:891e3.32. Lieblich  SE, Piecuch  JF.  Orbital-zygomatic  trauma.  In: Kelly JP  (Ed).  Oral  and  maxillofacial  surgery  knowledge update.

  Vol  1,  part  II.  Rosemont,  Ill:  AAOMS,  1995;  pp 165-176. 33.  Stewart MG  (Ed).  Head,  neck,  and  face  trauma.  New  York: Thieme, 2005; pp 68-76. 34.  Bailey  JS,  Goldwasser MS.

  Management  of  zygomatic complex  fractures.  In:  Miloro M,  (Ed).  Peterson’s  principles of  oral  and  maxillofacial  surgery,  Hamilton:  BC  Decker, 2004; pp 445-462. 35.  Wong MEK,  Johnson JV.  Management  of  mid  face  injuries. In:  Fonseca R, Marciani R, Hendler B  (Eds).  Oral  and maxillofacial  surgery.

  Vol  3.  Philadelphia:  WB  Saunders, 2000; pp 245-299. 36.  Prein  J.  Manual  of  internal  fixation  in  the  craniofacial skeleton. New  York: Springer-Verlag, 1998; pp 133-148.

 37.  Chotkowski  G, Eggleston  TI, Buchbinder  D.  Lagscrew fixation  of  a  nonstable  zygomatic  complex  fracture:    A  case report.  J Oral Maxillofac Surg,  1997; 55:183-185. 38.  Gruss  JS, Van Wyck L, Phillips JH, et al.  The  importance of  the  zygomatic  arch  in  complex  midfacial  fracture  repair and  correction  of  post-traumatic  orbitozygomatic  fracture deformities.  Plast Reconstr Surg, 1990; 85:878-890.

39. Kushner GM.  Surgical  approaches  to  the  infraorbital rim  and  orbital  floor:  the  case  for  the  transconjunctival approach.  J Oral Maxillofac Surg, 2006; 64:108-110. 40.  Ellis E, Kittidumkerng W.

Analysis  of  treatment  for  isolated zygomaticomaxillary  complex  fractures.  J Oral Maxillofac Surg, 1996; 54:386-400, discussion 400-401. 41.  Hoelzle F, Klein  M, Schwerdtner O, et al.  Intraoperative computed  tomography  with  the  mobile  CT  Tomoscan  M during  surgical  treatment  of  orbital  fractures.  Int J Oral Maxillofac  Surg, 2001; 30:26-31.42.

  Bagheri  SC,  Meyer  RA,  Khan  HA,  et  al.  Microsurgical repair  of  peripheral  trigeminal  nerve  injuries  from maxillofacial  trauma.  J  Oral Maxillofac  Surg,  200043.

Gokulnath B.V, Gokul.V, SCALP, Anatomy,Saveetha Dental College,201044.

Jothika Mohan, stem cell research, Anatomy, Saveetha Dental College, 2010


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