Must distinguish zygomatic arch fracture from zygomaticomaxillary tripod fracture. It is the purpose of this maintenance of certification article to provide updated recommendations for preoperative assessment, surgical care, and postoperative management of patients with. The high incidence of zygomatic complex fracture relate slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Pdf zygomatic bone is situated at the lateral part of the facial triangle, and is frequently exposed to maxillofacial traumas, since it forms the. Avoid and manage common complications associated with zygomatic fracture repair. Usually, the fracture occurs in more than one place. Fracture lines usually run through the infraorbital rim, involve the posterolateral orbit, and extend to the inferior orbital fissure. Case example zygomatic complex fracture tripod fracture.
Assaults, road traffic accidents and falls are the common causes leading to. The fracture line then continues to the zygomatic sphenoid suture area and on to the frontozygomatic suture line. Type a injuries are isolated to one component of the tetrapod structure, including the zygomatic arch type a1, the lateral orbital wall type a2, and the inferior orbital rim type a3. 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. Ipsilateral eye may appear to tilt due to pulling of lateral canthus. If you continue browsing the site, you agree to the use of cookies on this website. Pdf management of zygomatic complex fractures in a.
The zygomatic arch is formed by the articulation of the temporal process of the zygoma and the zygomatic process of the temporal bone. Type b complete monofragment zygomatic fracture tetrapod fracture. This is the socalled classic tripod fracture, but anatomically these fractures are actually tetrapod fractures and should be thus called fig. An ice pack and pain relievers may be recommended to manage pain and swelling as the fracture heals.
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. Many zygomatic fractures which have good bony alignment despite the fracture do not require any treatment at all. Advanced diagnostic imaging was considered essential for characterization of the condition and treatment planning. The zygomatic bone occupies a prominent and important position in the facial skeleton. Pdf causes and management of zygomatic bone fractures at. A retrospective study article pdf available in journal of maxillofacial and oral surgery 102. This is a report of mandibulozygomatic arch synostosis in a dog 7 mo after trauma to the maxilla. Other facial fractures in adults and children are discussed separately. Successful surgical treatment of mandibulozygomatic arch. In any instance you should avoid forceful closure of the mouth for a minimum of 3 weeks and often longer.
Treatment of the zygomatic bone fracture is meant to restore the symmetry of the face, make certain that the eye moves normally in the orbit and address any potential nerve damage. They are the second most common facial bone fracture after nasal bone fractures pathology. Zygomaticomaxillary complex fracture radiology reference. Blow out fracture emergency entrapment trap door or white eyed blowout usually pediatric. Zygomatic complex fractures with displacement of thefrontozygomatic suturetype 5. Broken zygomatic bone recovery doctor answers, tips.
However, your oral surgeon will need to perform a clinical exam with ct scan. Evaluation of treatment of zygomatic bone and zygomatic. Case report threepoint fixation of displaced tripod. The zygomatic complex also helps in transmitting the occlusal forces to the skull base. Surgical excision of the bony proliferation and physiotherapy resulted in improved function within 6 wk. 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. Pdf zygomatic complex fractures or the tetrapod fractures are common to occur followed by the nasal bone fractures because of its prominent. Management of tripod fractures zygomaticomaxillary. The ages of the patients ranged from 10 to 76 years old, mean age was 32. The temporal process, which forms zygomatic arch a1frontal process, which forms lateral orbital wall a2maxillary process, which forms infraorbital rim a3category bfracture of all three processes, detaching zygomatic bone from facial skeleton i.
Look at the orbits carefully, since 60 70 % of all facial fractures involve the orbit in some way. The zygomatic arch, or cheek bone, is formed by the zygomatic process of the temporal bone a bone extending forward from the side of the skull, over the opening of the ear and the temporal process of the zygomatic bone the side of the cheekbone, the two being united by an oblique suture zygomaticotemporal suture. This device must be placed into the body of the zygoma, thus requiring an. Fracture of only one of the pillars, zygomatic arch, lateral or inferior.
Additionally, the fracture components may result in impingement of the. These files will have pdf in brackets along with the filesize of. You should ask you surgeon because there are many different ways to stabilize a broken zygoma. Zygomatic fracture include zygomaticofrontal suture.
A zygomatic complex fracture is normally impacted into the facial. A, attempted waters projection showing a vertical radiopaque density in the area of the left zygomatic arch. For example, a hairline fracture in the cheekbone may simply require time to heal. A direct blow impacting the face, such as getting hit by a ball or a fist, results in this type of fracture.
Maxillofacial trauma presentations in 2011 at the royal brisbane hospital. The code is valid for the year 2020 for the submission of hipaacovered transactions. See initial evaluation and management of facial trauma in adults. The zygoma may be separated from its 4 atriculations. This is a tshaped device that has a handle at one end with a sharp screw portion perpendicular to it. The zygomatic arch is the third most common fractured facial bone, with a high majority of those cases being male. 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. Pdf most of the documents on the racgp website are in portable document format pdf.
Zygomaticomaxillary complex, bone fracture, sphenozygomatic suture, internal. C, caldwells projection showing the density superimposed on the petrous portion of the temporal bone. Flexible bones, greenstick fracture entrapped muscle is pinched in the fracture causing ischemia, possible oculocardiac reflex, nv, severe pain both passive and active movement is restricted. Download this books into available format unlimited. Zygomatic arch reduction gillies approach springerlink. It is especially important to examine the orbital borders and apex, as well as the optic canal. A zygoma fracture is often the result of facial trauma such as violence, falls or automobile accidents symptoms include flattening of the face, trismus reduced opening of the jaw and lateral subconjunctival hemorrhage see also. Mildly displaced comminuted fracture of the left zygomatic arch shows up to 37 degrees of inwards angulation. Describe the different operative approaches for zygomatic fractures and understand the essentials of proper reduction and fixation. A break in the bones of lower jaw is called a mandibular fracture. Other fracture patterns, include isolated zygomatic arch fractures, or zmc fractures with associated panfacial fractures, such as le fort ii and iii. Fractures of the zygomatic arch za or any of its bony articulations can cause. These fractures occur most commonly as the result of assaults or motor vehicle collisions. Zygomatic complex fractures but the frontozygomaticsuture is undisplacedtype 4.
Up to 50% of these fractures will heal with no surgery required. Definitions zygoma is a very crucial component which maintains facial contour. A zmc fracture is also known as a tripod, tetrapod or quadripod fracture, trimalar fracture or malar 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. 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. Fractures of the zygomatic complex are among the most frequent in maxillofacial trauma. I have a zygomatic arch fracture with no deformities. Management of zygomatic complex fractures in a tertiary hospital. Lateral wall fractures are therefore more commonly seen following significant maxillofacial trauma involving the malar complex too. All zygomatic complex fractures involve the orbit, making visual complications a frequent occurrence. The researchers consider the previous classification system should be improved. Facial fracture aftercare instructions what you need.
In these situations, the bone will heal completely and will not require surgery. Treatment of zygomatic complex fractures using two point. Consideration 1 indications second most common mid face fracture nasal fracture is first, usually from lateral blunt force like a blow from a fist. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Pdf treatment modalities in zygomatic complex fractures. Evaluation of the lateral orbital approach in management. The management of the zygomatic arch and zmc fractures should be. The integrity of the zygoma is critical in maintaining normal. 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. Depending upon the extent of the bone displacement, the zygomatic complex can be refractured osteotomized and reposiitoned back to its preinjury position long. Zygomatic complex fractures are one of the frequently occurring maxillofacial injuries owing to its position and facial contour. The patient was operated under general anaesthesia. A 26yearold male was struck on the left side of his face while playing baseball.
Zygomaticomaxillary complex zmc fractures are a group of fractures that can significantly alter the structure, function, and appearance of the midface, including. In this study, the researchers describe a new means of classifying zygomatic fractures based on 3dct and the type of trauma inflicted, which could be used to inform surgical strategy. Classic tripod fracture, but anatomically these fractures are actually. However, if the fracture is significantly depressed inward or displaced outward, this can potentially be visible as an external depression or as an. Methods for the evaluation and management of patients with zygomatic fractures continue to evolve. Classification and treatment of zygomatic fractures.
A zygoma fracture zygomatic fracture is a form of facial fracture caused by a fracture of the zygomatic bone. Data sources include ibm watson micromedex updated 4 may 2020, cerner multum updated 4 may 2020. Reduction of the zygomatic arch fractures were done by gilles temporal approach using rowes zygomatic elevator. Isolated bilateral zygomatic complex and arch fracture. According to the site of fracture, the patients were divided into three groups. Zygomaticomaxillary complex fracture tripod fracture return to. Reconstructive procedures protocols general considerations. Treating the zygomatic arch fracture depends upon whether it is displace or caved in.
Any information contained in this pdf file is automatically generated from digital. Md, who was the first in their group to suggest and routinely use the upper eyelid incision for zygomatic complex fracture reduction. Retrospective clinical and radiographic evaluation of tilted implants used in the. Tripod fracture consists of a zygomatic arch fracture, b fracture of the lateral orbital wall, and c fracture of the inferior orbital floor. The most direct approach in reducing a zygomatic fracture is to insert a carrollgirard screw. Tripod fracture fracture of zygomatic arch, lateral and inferior orbital rims, and lateral wall of maxillary sinus. This is zygomatic arch fracture reduction using a temporal approach. Many authors have devised classification schemes for zygomaticomaxillary complex zmc fractures. Zygomatic osteotomy for secondary correction of old fracture zygomatic fractures rotate down and inward resulting in a cheek deficiency and an orbital lowering if left unrepaired. A new classification of zygomatic fracture featuring. Management of zygomatic fractures pocket dentistry. Surgical management of zygomatic complex fractures in a major.
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