Complications of zygomatic bone and zygomatic arch plastic. Zygoma fracture strength data from published experiments were. The diagnosis of zygomatic and maxillary fracture should be. For complex zygomatic fractures, multiple approaches are often needed for visualizing the fracture sites and applying internal fixation. Our patients are instructed to remain on a soft diet for 23 weeks after surgery and to avoid exertion for 36 weeks.
The zygoma may be separated from its 4 atriculations. Zygomatic complex fracture tripod fracture iowa head. 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. Historically, the waters view plain film was used to evaluate zmc. 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. Fractured cheekbone zygoma the zygoma or cheekbone is the name given to the bone that forms the prominence of the cheek. The treatment of zygomatic fractures varies among surgeons, and the cosmetic and functional results are. Zygoma arch fracture an overview sciencedirect topics. A new proposal of classification of zygomatic arch fractures. Fractures of zygomatic complex and orbit maxfac tutorial. Zygomaticomaxillary complex fracture tripod fracture return to. To code a diagnosis of this type, you must use one of the three child codes of s02. Patient information leaflet fractured zygoma cheekbone this leaflet has been designed to explain your type of fracture and it contains answers to many frequently asked questions. Loss of the prominence of the malar eminence is a frequent sequela of zygomatic fracture.
Tripod fracture fracture of zygomatic arch, lateral and inferior orbital rims, and lateral wall of maxillary sinus. I repair zygoma fractures all the time at our local trauma center. The zygoma has 4 bony attachments to the skull, and zmc fractures are sometimes known as tetrapod fractures. Comparing the symptomatic side with the asymptomatic side can help reveal an abnormal contour of the zygomatic arch. Indian j plast surg januaryjune 2007 vol 40 issue 1. Comparison of various surgical approaches and their complications can only be done objectively using outcome measurements which in turn require protocol management and longterm follow up. How can a zygomatic arch fracture be repaired weeks after. Private practice, lakewood oral and maxillofacial surgery specialists, lees summit. Consideration 1 indications second most common mid face fracture nasal fracture is first, usually from lateral blunt force like a blow from a fist. Fracture zygoma tripod fracture fracture fracture of facial bone pattern fracture direct blow to body of zygoma contour abnormalities. On the left the noninjured side overlying structures give the impression of a fracture, but careful scrutiny shows the cortex is intact. This flatness may be concealed partially by soft tissue swelling for the first days to 2 weeks. The stability of the reduction determines the type and number of fixation sites.
Mar 02, 2015 a quick trip for xrays, perhaps a face ct, and the diagnosis of zygomatic arch fracture was made. The optimal surgical technique represents a balance between accurate fracture reduction and softtissue morbidity. Eight zygomatic fractures were created in four skull models, and preoperative computed tomography ct image data were imported into 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.
The prominence of the zygomatic region predisposes it to bearing the brunt of the facial injuries. A deformity may be palpable along the orbital margins, the zygomatic arch, or intraorally at the region of the zygomatic buttress. The management of the zygomatic arch and zmc fractures should be. The purpose of this study is to develop injury risk functions that predict zygoma fracture based on baseball type and impact velocity. Reduction of fractured zygoma is done by manipulating the broken cheek bone to restore the contour and appearance of the face. Reposition of the fractured bone by means of limberg hook. Fracture of the zygomatic bone is a common fracture of the facial skeleton. Surgical treatment of zygomatic bone fracture using two points. This pdf is available for free download from a site hosted by medknow publications. Jun 11, 2014 reposition of the fractured bone by means of limberg hook.
Treatment of zygomatic complex fractures with surgical or nonsurgical. Tripod fracture consists of a zygomatic arch fracture, b fracture of the lateral orbital wall, and c fracture of the inferior orbital floor. Jun 07, 20 zygoma plays an imp role in facial contour. Fractures of the cheek bone zygomatic complex fractures. Evaluation of the lateral orbital approach in management. Symptoms include flattening of the face, trismus reduced opening of the jaw and lateral subconjunctival hemorrhage. It also forms the lateral wall and floor of the orbit, where the eye is located.
Dec 03, 2018 the zygomatic bone occupies a prominent and important position in the facial skeleton. Apr 27, 2014 the zygoma may be separated from its 4 atriculations. A new classification of zygomatic fracture featuring. 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. Zygomatic bone and zygomatic arch plastic surgery is a common plastic and cosmetic surgery. The surgery to repair it has already been completed. Look for the elephants trunk appearance of the zygomatic arch. This is a different bone than the zygomatic arch, which is formed by a prominence of the zygomatic bone in combination with the frontal bone. Fracture du zygoma dr barriere chirurgie maxillofaciale. Gillies elevation and percutaneous kirschner wire fixation. Jan 18, 2015 chapter 15 isolated zygoma and zygomaticomaxillary complex zmc fractures. Download full movie fracture download movies online hd.
This technique is limited to arch noncomplex fracture in young patients. Reconstructive procedures protocols general considerations. Neither restriction of eyeball movement nor visual disturbance was observed. Lacerations 43% orthopedic injuries 32% additional facial fractures 22% neurologic injury 27% pulmonary, abdominal, cardiac 7%, 4. Unfortunately, the commentary confused zygomatic arch with the. This pdf is available for free download from a site hosted by medknow. Zygomatic arch fracture treatment answers on healthtap. Because these ideal measurements are not always found, an examination of the contralateral zygoma will determine the correct position of the injured zygoma in every patient who has no craniofacial anomalies. Fractures of the cheek bone zygomatic complex this leaflet has been designed to improve your understanding of your forthcoming treatment and contains answers to many of the common questions. If you have any other questions that the leaflet does not answer or would like further explanation please ask a member of the medical or nursing staff. The mechanism of injury usually involves a blow to the side of the face from a fist, from an object, or secondary to motor vehicle accidents. If you have any other questions that the leaflet does not answer, or if you would like. Moreover the importance of zygomatic complex in facial skeleton lies inprotecting globe of eye and absorbing and redistributing masticatory andexternal load.
The precise approach will depend upon the injuries seen on the ct film and open surgical. Pdf patient perspective in the management of zygomatic fractures. The zygomatic bone is attached to the maxilla at the zygomaticomaxillary zm suture and alveolus forming the zygomaticomaxillary buttress. Therefore for cosmetic and functional reasons it is imperative to diagnoseand treat zygomatic fractures adequately. Facial bone computed tomography ct revealed a right tetrapod fracture with posterior displacement due to fractures of the anterior and posterior walls of the right maxilla and the right zygoma fig. The zygoma plays an important role in the facial contour for both cosmetic and functional reasons. Case example zygomatic complex fracture tripod fracture.
Evaluation of the lateral orbital approach in management of. Late correction following zygoma fracture thanks for your question. Face zygomatic arch fracture om30 view same patient as image above the zygomatic arch fracture is more easily seen on the om30 occipitomental 30 image. How can a zygomatic arch fracture be repaired weeks after injury. Mar 21, 2019 the zygoma has 4 bony attachments to the skull, and zmc fractures are sometimes known as tetrapod fractures. 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. All zygomatic complex fractures involve the orbital floor and therefore understanding of.
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. Duma1 1impact biomechanics laboratory, mechanical engineering, virginia tech. 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. Must distinguish zygomatic arch fracture from zygomaticomaxillary tripod fracture. Zygomatic fractures american academy of ophthalmology. Sacks, md department of plastic and reconstructive surgery, johns hopkins hospital, baltimore. Gillies elevation and percutaneous kirschner wire fixation i.
The code is valid for the year 2020 for the submission of hipaacovered transactions. Pdf management of zygomaticmaxillary fracture the principles. The complication rate of zygomatic boen and zygomatic arch plastic surgery is lower than other principles of surgeries. Broken zygomatic bone recovery doctor answers, tips. Feb 27, 2019 following fractures of the nasal bone, zygomatic fractures are the second most common fractures of the face and predominantly occur in males during their twenties and thirties. The researchers establish a new classification system for zygomatic fractures. The second most common area of fracture in the face is the zygoma, especially the left frontal process of the zygomatic bone, e. Risk of zygoma fracture for the adult and two selected age groups adult 911 years 1214 years mass mass 31.
The relatively severe complication of the zygoma reduction plastic surgery is the zygomatic bone and zygomatic arch displacement or defect. There are risks and complications with this procedure. This article focuses on the zygomatic arch fracture. A new classification of zygomatic fracture featuring zygomaticofrontal suture. Poor reduction and fixation of zygomatic fractures will result in a number of functional and aesthetic complications, the most disturbing of which is the persistence of diplopia. Surgical treatment of zygomatic bone fracture using two. Sometimes patients are given antihistamines and nasal decongestants as well. 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. Doctor answers on symptoms, diagnosis, treatment, and more. This is zygomatic arch fracture reduction using a temporal approach. Zingg m1, laedrach k, chen j, chowdhury k, vuillemin t, sutter f, raveh j. Early stabilization is important to maximize both cosmetic integrity and anatomical functionality 1. Before the beginning of the study, written informed consent was obtained from each. The malar complex refers to the zygoma and maxillary bones and therefore forms part of the orbital floor and lateral orbital wall.
Pdf predicting zygoma fractures from baseball impact. Zygomatic fractures should be evaluated with axial and coronal ct scans including both soft tissue and bone windows for assessment of the orbital soft tissue and its relation to the fracture. If you have any other questions that the leaflet does not answer, or if you would like further information, please ask us. Zygomatic arch fractures often occur as part of a zygoma fracture or le fort type iii fractures of the maxillary. Other possible functional deficits that may occur include limitation of mouth opening and lower eye lid retraction. A fracture of the orbital inferior wall was also noted. Zygoma fracture strength data from published experiments were mapped with the force exerted by a baseball on the orbit as a function of ball velocity. Chapter 15 isolated zygoma and zygomaticomaxillary complex zmc fractures. These fractures occur most commonly as the result of assaults or motor vehicle collisions. However like other surgeries this surgery do have some risks of surgical complication and unsatisfactory rate. If displaced fracture, a surgeon does the wiring of the bone, which can be an ent surgeon, a plastic surgeon or general surgeon.
The zygomatic arch is the third most common fractured facial bone, with a high majority of those cases being male. Evaluation of treatment of zygomatic bone and zygomatic. Cheek bone fracture tx depends on the extent of the fracture. The objective of zygoma fracture repair is to restore preinjury function and appearance. The zygoma is the main buttress between the maxilla and the skull, but, in spite of its sturdiness, its prominent location makes it prone to fracture. The short answer is that your zygoma can be put into a better position without the use of an implant but it is a bit of an ordeal and you will need plates and screws to hold the bones in place. Isolated fractures of the zygomatic arch comprise around 10% of all zygoma fractures. Related pathology le fort type 3 fracture zygomaticomaxillary complex fra. On the risk of zygoma fracture from baseball loading joel d. Ipsilateral eye may appear to tilt due to pulling of lateral canthus.
A case of delayed bilateral fracture of zygoma and maxilla is presented here to give illustration on. Management of zygomatic fractures pocket dentistry. The complication is believed having some connections with the improper selection of surgical method or surgical procedure and deformity or weakening of the zygomatic bone and zygomatic arch. Using free navigation reference points and prefabricated bone. Trauma to the zmc can result in multiple fractures ie, tetrapod, but solitary bony disruption may occur, as with isolated zygomatic arch fracture. Isolated zygoma and zygomaticomaxillary complex zmc. The face occupies the most prominent position in the human body rendering it vulnerable to injuries quite commonly. Classification and treatment of zygomatic fractures. Unlike mandibular fractures, maxillary and zygoma fractures rarely become infected. A zygoma fracture is often the result of facial trauma such as violence, falls or automobile accidents.
Ibima publishing a new classification of zygomatic fracture. The purpose of this study is to evaluate the functional and esthetic outcome following this lateral orbital approach in the management of zygoma fracture. The orbit is a pearshaped cavity, with an apex directed posteriorly, medially and slightly upward. A zygoma fracture zygomatic fracture is a form of facial fracture caused by a fracture of the zygomatic bone. Treatment of zygomatic complex fractures with surgical or. Trauma xray axial skeleton gallery 1 face zygomatic. Dec 28, 2011 regarding the results in group a patient with zygomatic bone fracture were divided into.
Interesting case series zygomatic arch fracture with coronoid impingement gerhard s. The zygomatic bone occupies a prominent and important position in the facial skeleton. It also forms part of the eye socket lateral and inferior margins and connects to the frontal bone forehead and maxilla upper jaw. For many years, 2point fixation at the frontozygomatic suture and the infraorbital rim using interosseus wiring was the mainstay for treating zygoma fractures. Risk of zygoma fracture versus peak baseball impact force for the adult, 911, and 1214 year old populations table 1. The result is that the arch is depressed about 4 to 5mms.
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