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What is the zygomatic Complex facture? How do you classify this facture? Mention its symptomatology. What are the different surgical approaches for zygomatic complex fracture? Mention its indications, advantages and disadvantages?

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Zyngomaticomaxillary complex fractures (ZMC) are a group of fracture that disrupt the lateral middle third of the face which comprise of “tetrapod” as it maintains 4 points of articulation with the

  • frontal bone at the zygomaticofrontal suture
  • Maxillary bone at the zygomatico maxillary suture.
  • Greater wing of sphenoid at the zygomatico sphenoid suture  and
  • Temporal bone at zygomaticotemporal  suture.

The body and processes of the zygomatic bone make up the lateral middle third of the facial skeleton. These injuries were originally termed “tripod fractures” because of the disruption of the 3 commonly recognized articulations.

  • Fronto-zygomatic
  • Infra-orbital rim
  • Zygomaticomaxillary buttress

Other two articulation worthy of consideration are

  • zygomatic arch
  • Zygomaticsphnoid.

Classification

  • There is no universally accepted scheme
  • There fracture are probably best classified according to their rotation about vertical and horizontal axes:
    • Vertical axis fracture: It runs between the frontozygomatic suture and the 1st molar tooth.
    • Horizontal axis is the plane of zygomatic arch.

Larsen and Thomsen:

A) Stable fracture→ no/minimal displacement, no intervention

B) Stable fracture with displacement→ Requires reduction and fixation

Fracture of zygomatic arch:

  • minimum/no displacement
  • V type fracture
  • Communicated fracture

Rowe and killey’s classification.

Type I: no significant displacement

Type II: Fracture of zygomatic arch

Type III: Rotation around vertical axis

  • Inward displacement of orbital rim
  • Outward displacement of orbital rim.
  • Medial displacement of frontal process.
  • Lateral displacement of frontal process.

Type V: Displacement of complex en-bloc

Type VI: Displacement of orbital floor

Type VII: Displacement of orbital rim

Type VIII: Complex commuted fracture.

Symptomatology

Local s/sorbital s/sother s/sFace examination (signs)
swellingsubconjunctival HaemorrhageAlteration of sensation of cheek due to damage to zygomatico temporal.Tenderness
BruisingPeriorbital oedema, Restricted eye movements(upward gaze if orbital floor dehiscence and blow out of orbital contents)Limitation of mouth openingStep deformity of the infraorbital margin
DiplopiaepstaxisReduced zygomatic projection (flat face)
Periorbital oedema

The different approaches→indication, advantages and disadvantages are following:

Approach (GDPKC)IndicationAdvantageDisadvantage
GilliesMedially displaced bodyElevating site distant from fixation siteRequire skin incision.
Zygomatic arch
DingmanMedially displaced bodyUses common incision to that of frontozygomatic access.Difficult to plate frontozygomatic suture and elevate simultaneously
Incision may become stretched.
Poswille hookPosteriorly displacedGood mechanical advantageAccess point of hook is prominent on the lateral cheek prominence and may be noticeable.
Quick only one suture required
KeenMedially displacedAvoid cutaneous scarDoesn't address Frontozygomatic suture
ArchElevating and plating at the site is difficult simultaneously.
contaminating of site with oral micro organism
CoronalLaterally displaced archOnly approachExtensive surgical expenses.

 

 

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