Zygomatic complex fracture
Type of manuscript- review article
Running title- zygomatic complex fracture
Saveetha Dental College,
Mr. K. Yuvaraj Babu
Department of Anatomy
Saveetha Dental College
Email- [email protected]
Telephone number- 9566047924
Author name- Swetaa.A
Guide Name- Mr. K. Yuvaraj Babu
Telephone number- 9840210597
Year of the study- I BDS 2017-2018
Total no.of words- Abstract-
Aim- To create awareness on zygomatic complex fracture.
Objective- To review and establish about zygomatic complex fracture.
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 investigations. All patients were given peri-operative antimicrobial prophylaxis, adjunct . 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 37 articles were included in the review.
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.
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 alveolus
Vertical 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.
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.
TREATMENT- Majority of the patients were managed conservatively / Gillie’s procedure. Only few needed open reduction with three point fixation.