A zygoma fracture is often the result of facial trauma such as violence, falls or automobile accidents. These fractures occur most commonly as the result of assaults or motor vehicle collisions. Because of the various defects of malarplasty, including a large incision, much bleeding, visible scars after the operation, and so on, caused by the conventional coronal incision or the temporal incision with. Jun 07, 20 zygoma plays an imp role in facial contour. 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. There are risks and complications with this procedure. The relatively severe complication of the zygoma reduction plastic surgery is the zygomatic bone and zygomatic arch displacement or defect. 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. I ended up going to the emergency room where i was told that i had a cheekbone zygoma fracture and would have to see a specialist for its repair.
Pdf open reduction of zygoma fractures with the extended. 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. Here the fractured zygoma is part of a wider fracture configuration. Head and facial trauma the atlas of emergency medicine, 4e. Anatomical fracture patterns and the nuances of clinical presentations are discussed. To open a pdf file you will need compatible software such as adobe reader.
All patients were treated by open reduction and rigid. Apr 27, 2014 the zygoma may be separated from its 4 atriculations. 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. Injury to this facial bone was most likely recognized for many years before the appearance of records on the subject. Reduction of fractured zygoma is done by manipulating the broken cheek bone to restore the contour and appearance of the face. Retrospective clinical and radiographic evaluation of tilted implants used in the.
Open reduction of zygoma fractures with the extended transconjunctival approach and tbar screw reduction article pdf available in archives of plastic surgery 454. There were 552 86% zygoma frac tures and 90 14% zygomatic arch fractures. Complications of zygomatic bone and zygomatic arch plastic. Evaluation of treatment of zygomatic bone and zygomatic. 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. I went to see my doctor and he said that i most likely had a zygoma cheekbone fracture but that it would heal on its own. 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.
This is a retrospective cohort study using taiwans national health insurance research database of. 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. Jul 15, 2019 definitions zygoma is a very crucial component which maintains facial contour. 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.
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. The surgical treatment of fracturedislocations of the zygoma and zygomatic arch has a long and interesting development. Tripod fracture fracture of zygomatic arch, lateral and inferior orbital rims, and lateral wall of maxillary sinus. Fractures can involve any of the four articulations of zygoma which include zygomaticomaxillary complex, zygomatic complex proper, orbitozygomatic complex. 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. Bony union between the coronoid process cp and the zygoma is a very rare cause of extraarticular temporomandibular joint ankylosis1. Lateral wall fractures are therefore more commonly seen following significant maxillofacial trauma involving the malar complex too. The initial pain was severe and i felt like there was a popping sensation. Jan 02, 2015 fracture of the zygoma may or may not be painful to palpation and running a finger along the zygomatic arch may give a feel of a depressed fracture or a small dimple. Zygomatic fractures are common facial injuries, representing the most common facial fracture 214 or the second in frequency after nasal fractures. Other fracture patterns, include isolated zygomatic arch fractures, or zmc fractures with associated panfacial fractures, such as le fort ii and iii. Other possible functional deficits that may occur include limitation of mouth opening and lower eye lid retraction. 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.
Although studies differ regarding the incidence of these fractures, our experience in the adult population has demonstrated that. And because of its prominent and projected position, it is one of the most prevalent sites of fracture in face, maybe the most prevalent after nasal. The zygoma anatomyguided approach zaga and the zygomatic success code zsc aparicio c, arevalo jx, ouazzani w, granados c. A basilar skull fracture is basically a linear fracture of the skull base. Fractures of the cheek bone zygomatic complex fractures.
A few days ago i was playing soccer with my friends and was accidentally kicked in the face. Broken zygomatic bone recovery doctor answers, tips. Zygomatic complex fractures and its management acta scientific. Fraktur zygomatic pdf definitions zygoma is a very crucial component which maintains facial contour. 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. 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.
Mildly displaced comminuted fracture of the left zygomatic arch shows up to 37 degrees of inwards angulation. Related pathology le fort type 3 fracture zygomaticomaxillary complex fra. Moreover the importance of zygomatic complex in facial skeleton lies inprotecting globe of eye and absorbing and redistributing masticatory andexternal load. A new classification of zygomatic fracture featuring. For many years, 2point fixation at the frontozygomatic suture and the infraorbital rim using interosseus wiring was the mainstay for treating zygoma fractures. When a forearm fracture is identified, dedicated imaging of both the elbow and the wrist is important and good quality ap and lateral views are essential. Zygomatic complex fracture is the second most common fracture of facial region just. Late correction following zygoma fracture thanks for your question. Dec 28, 2011 regarding the results in group a patient with zygomatic bone fracture were divided into. Management of tripod fractures zygomaticomaxillary. Orbitozygomatic fractures represent a type of maxillofacial injury that happens very often due to the. The fracture of the zygomatic arch usual ly presents a figure 3 on xray with 2. The majority of cases of cheekbone fracture, such as this specific golf injury, fall into the second scenario where there has been fragment displacement but no damage to vital or critical structures. Pdf most of the documents on the racgp website are in portable document format pdf.
Sep 28, 2019 definitions zygoma is a very crucial component which maintains facial contour. Fracture zygoma and its management our experience core. Classification and treatment of zygomatic fractures joms. Surgical management of zygomatic complex fractures in a major. Fractures of the zygomatic complex and arch pocket.
Ipsilateral eye may appear to tilt due to pulling of lateral canthus. The code is valid for the year 2020 for the submission of hipaacovered transactions. Of the 47 fracturedislocations of the zygoma, only 3 6% in which the zygo matic arch was also fractured and depressed showed this sign. Zygoma, zygomatic fracture, blindness, orbit, optic nerve. The zygoma may be separated from its 4 atriculations. The zygomatic arch is the third most common fractured facial bone, with a high majority of those cases being male. If you do not have it you can download adobe reader free of charge. The stability of the reduction determines the type and number of fixation sites.
Early stabilization is important to maximize both cosmetic integrity and anatomical functionality 1. Zygoma is a four quadrant bone, which is located in middle part of face. 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. If you have any other questions that the leaflet does not answer, or if you would like. 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. Anatomic, clinical, surgical, and radiographic correlation of the. Analysis of outcome of zygomatic fracture management. Dec 03, 2018 the zygomatic bone occupies a prominent and important position in the facial skeleton. 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. Evaluation of treatment of zygomatic bone and zygomatic arch. 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. Fractures of the zygomatic arch za or any of its bony articulations can cause significant functional and cosmetic morbidity.
Pdf management of zygomaticmaxillary fracture the principles. A new classification of zygomatic fracture featuring zygomaticofrontal suture. Pdf mechanical trauma to the face may cause complex fracture of the zygoma and the maxilla. Displaced fractures of the zygomatic bone can result in significant functional and aesthetic sequelae. I repair zygoma fractures all the time at our local trauma center. Basilar skull fracture blowout fracture mandibular omnteggia nasal fracture le fort fracture of skull zygomaticomaxillary complex fracture zygoma fracture. For complex zygomatic fractures, multiple approaches are often needed for visualizing the fracture sites and applying internal fixation.
We present a case of fracture zygoma who developed epiphora after reduction and fixation of the inferior orbital margin by a miniplate. These will stay in place unless they cause problems, in which case a second operation will be required to remove them. Definitions zygoma is a very crucial component which maintains facial contour. It may result from facial fractures caused by gunshots, 2 treated or untreated fractures of the zygoma complex 3 4 5 with or. The ages of the patients ranged from 10 to 76 years old, mean age was 32. 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. Zygomatic fractures american academy of ophthalmology. Facial fracture management handbook malar complex fractures. Fractures typically occur across these three buttressrelated sutures, leading to the term tripod fracture.
Arch fractures are more likely to involve some form of lateral. Management of zygomatic fractures pocket dentistry. Treatment and complications of orbitozygomatic fractures scielo. Therefore for cosmetic and functional reasons it is imperative to diagnoseand treat zygomatic fractures adequately. Classification and treatment of zygomatic fractures. For complex zygomatic fractures, the coronal approach allows for extensive degloving of the facial bones. Fractures of zygomatic complex and orbit maxfac tutorial. These files will have pdf in brackets along with the filesize of the download. Management of tripod fractures zygomaticomaxillary complex 1 point and 2 point fixations.
Zygomatic fractures are common in facial trauma and, as is the case with other facial fractures, occur primarily among men in their third decade of life. What are my treatment options for a cheek fracture. The zygomatic bone occupies a prominent and important position in the facial skeleton. Jun 28, 2019 basilar skull fracture blowout fracture mandibular omnteggia nasal fracture le fort fracture of skull zygomaticomaxillary complex fracture zygoma fracture. Risks of a orbito zygomatic maxillary fracture repair there are risks and complications with this procedure. Pdf surgical methods of zygomaticomaxillary complex fracture. The term malar complex fracture refers to a fracture which in its classic form primarily involves the suture lines of the zygomatic bone. The lack of comparative studies is likely explained by the high number of patients needed to attain the appropriate study power. The zygomatic arch and complex play a significant role in the structure and function of the face. A zygoma fracture zygomatic fracture is a form of facial fracture caused by a fracture of the zygomatic bone.
Limitation of jaw movement and flattening of the cheek are produced by depressed fractures of the. The fracture will be realigned and then fixed together using titanium plate and screws. The malar complex refers to the zygoma and maxillary bones and therefore forms part of the orbital floor and lateral orbital wall. Sometimes patients are given antihistamines and nasal decongestants as well. Frequency of blindness due to zygomatic fracture in hazrat. Note the bone graft arrow this was to make good a continuity defect. Investigate the risk of earassociated diseases after zygomaticomaxillary complex zmc fracture in a populationbased retrospective cohort study. Our patients are instructed to remain on a soft diet for 23 weeks after surgery and to avoid exertion for 36 weeks. 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. I was standing too close during his backswing and was hit in the cheek by his driver. Risk of earassociated diseases after zygomaticomaxillary. According to the site of fracture, the patients were divided into three groups.
Treatment goals focus on reduction to reestablish normal orbital volume and adequate fixation, preferably threepoint. 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. Trauma resulting in fractures to this area typically does not have localizing symptoms. The incidence, cause, age, and gender predilection of zygomatic. Pdf background zygoma is a major buttress of the midfacial skeleton, which is frequently injured because of its prominent location. The effect of intraoperative imaging on restoration of facial symmetry and fracture reduction in zmc fracture repair has, to our knowledge, not been assessed comparatively or longitudinally in any paper. Must distinguish zygomatic arch fracture from zygomaticomaxillary tripod fracture.