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Facial Plast Surg 2015; 31(04): 368-375
DOI: 10.1055/s-0035-1562885
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Zygomatic Fractures: Bone and Arch

Ralph Litschel
1   Department of Otorhinolaryngology—Head and Neck Surgery, Cantonal Hospital, St. Gallen, Switzerland
,
Gustavo A. Suárez
2   Department of Otolaryngology—Head and Neck Surgery, Bellvitge University Hospital, Barcelona, Spain
› Author Affiliations
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Publication History

Publication Date:
15 September 2015 (online)

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Abstract

Zygomatic bone and arch fractures are among the most common facial fractures treated by facial plastic surgeons. Controversy still remains regarding the optimal management of these fractures. Computed tomographic scanning (including three-dimensional reconstruction) represent a fundamental tool for diagnosis and treatment planning of zygomatic fractures. Main indications for treatment are functional impairment, cosmetic deformity, or both. Fracture reduction can be performed through an open or closed approach depending on the amount of exposure necessary to achieve accurate reduction. The common goal among all treatment plans is the exact three-dimensional restoration of the disturbed anatomy and function while minimizing complications.

Keywords

zygomatic fracture - orbitozygomatic fracture - zygomatic arch fracture - facial trauma - orbital fractures
 

  • References

  • 1 Kim J, Kim S, Chung S, Chung YK. Zygomatic arch fracture: a new classification and treatment algorithm with epidemiologic analysis. J Craniofac Surg 2014; 25 (4) 1389-1392
    CrossrefPubMedGoogle Scholar
  • 2 Zingg M, Laedrach K, Chen J , et al. Classification and treatment of zygomatic fractures: a review of 1,025 cases. J Oral Maxillofac Surg 1992; 50 (8) 778-790
    CrossrefPubMedGoogle Scholar
  • 3 Meslemani D, Kellman RM. Zygomaticomaxillary complex fractures. Arch Facial Plast Surg 2012; 14 (1) 62-66
    CrossrefPubMedGoogle Scholar
  • 4 Adam AA, Zhi L, Bing LZ, Zhong Xing WU. Evaluation of treatment of zygomatic bone and zygomatic arch fractures: a retrospective study of 10 years. J Maxillofac Oral Surg 2012; 11 (2) 171-176
    CrossrefPubMedGoogle Scholar
  • 5 Ellis III E, Perez D. An algorithm for the treatment of isolated zygomatico-orbital fractures. J Oral Maxillofac Surg 2014; 72 (10) 1975-1983
    CrossrefPubMedGoogle Scholar
  • 6 Werner JA, Frenkler JE, Lippert BM, Folz BJ. Isolated zygomatic arch fracture: report on a modified surgical technique. Plast Reconstr Surg 2002; 109 (3) 1085-1089
    CrossrefPubMedGoogle Scholar
  • 7 Kelley P, Hopper R, Gruss J. Evaluation and treatment of zygomatic fractures. Plast Reconstr Surg 2007; 120 (7) (Suppl. 02) 5S-15S
    PubMedGoogle Scholar
  • 8 Covington DS, Wainwright DJ, Teichgraeber JF, Parks DH. Changing patterns in the epidemiology and treatment of zygoma fractures: 10-year review. J Trauma 1994; 37 (2) 243-248
    CrossrefPubMedGoogle Scholar
  • 9 Ellis E. Discussion: the concept and method of closed reduction and internal fixation: a new approach for the treatment of simple zygoma fractures. Plast Reconstr Surg 2013; 132 (5) 1241-1242
    CrossrefPubMedGoogle Scholar
  • 10 Ellis III E, el-Attar A, Moos KF. An analysis of 2,067 cases of zygomatico-orbital fracture. J Oral Maxillofac Surg 1985; 43 (6) 417-428
    CrossrefPubMedGoogle Scholar
  • 11 Ellis III E, Kittidumkerng W. Analysis of treatment for isolated zygomaticomaxillary complex fractures. J Oral Maxillofac Surg 1996; 54 (4) 386-400 , discussion 400–401
    CrossrefPubMedGoogle Scholar
  • 12 Ramneesh G, Gulzar G, Sanjeev U, Rajinder M, Ranabir P, Nikhil G. A retrospective audit of hundred patients of orbitozygomatic fractures with brain injury. J Clin Diagn Res 2014; 8 (7) NC04-NC06
    PubMedGoogle Scholar
  • 13 Brisco J, Fuller K, Lee N, Andrew D. Cone beam computed tomography for imaging orbital trauma—image quality and radiation dose compared with conventional multislice computed tomography. Br J Oral Maxillofac Surg 2014; 52 (1) 76-80
    CrossrefPubMedGoogle Scholar
  • 14 Marinho RO, Freire-Maia B. Management of fractures of the zygomaticomaxillary complex. Oral Maxillofac Surg Clin North Am 2013; 25 (4) 617-636
    CrossrefPubMedGoogle Scholar
  • 15 Kassel EE, Noyek AM, Cooper PW. CT in facial trauma. J Otolaryngol 1983; 12 (1) 2-15
    PubMedGoogle Scholar
  • 16 Carr RM, Mathog RH. Early and delayed repair of orbitozygomatic complex fractures. J Oral Maxillofac Surg 1997; 55 (3) 253-258 , discussion 258–259
    CrossrefPubMedGoogle Scholar
  • 17 Kochhar A, Byrne PJ. Surgical management of complex midfacial fractures. Otolaryngol Clin North Am 2013; 46 (5) 759-778
    CrossrefPubMedGoogle Scholar
  • 18 Ellstrom CL, Evans GR. Evidence-based medicine: zygoma fractures. Plast Reconstr Surg 2013; 132 (6) 1649-1657
    CrossrefPubMedGoogle Scholar
  • 19 Evans BG, Evans GR. MOC-PSSM CME article: zygomatic fractures. Plast Reconstr Surg 2008; 121 (1, Suppl): 1-11
    PubMedGoogle Scholar
  • 20 Czerwinski M, Martin M, Lee C. Quantitative comparison of open reduction and internal fixation versus the Gillies method in the treatment of orbitozygomatic complex fractures. Plast Reconstr Surg 2005; 115 (7) 1848-1854 , discussion 1855–1857
    CrossrefPubMedGoogle Scholar
  • 21 Breuer T, Grossenbacher R. [Blindness following reduction of a malar fracture]. HNO 2007; 55 (3) 211-216
    CrossrefPubMedGoogle Scholar
  • 22 Bezuhly M, Lalonde J, Alqahtani M, Sparkes G, Lalonde DH. Gillies elevation and percutaneous Kirschner wire fixation in the treatment of simple zygoma fractures: long-term quantitative outcomes. Plast Reconstr Surg 2008; 121 (3) 948-955
    CrossrefPubMedGoogle Scholar
  • 23 Uda H, Kamochi H, Sugawara Y, Sarukawa S, Sunaga A. The concept and method of closed reduction and internal fixation: a new approach for the treatment of simple zygoma fractures. Plast Reconstr Surg 2013; 132 (5) 1231-1240
    CrossrefPubMedGoogle Scholar
  • 24 Appling WD, Patrinely JR, Salzer TA. Transconjunctival approach vs subciliary skin-muscle flap approach for orbital fracture repair. Arch Otolaryngol Head Neck Surg 1993; 119 (9) 1000-1007
    CrossrefPubMedGoogle Scholar
  • 25 Mullins JB, Holds JB, Branham GH, Thomas JR. Complications of the transconjunctival approach. A review of 400 cases. Arch Otolaryngol Head Neck Surg 1997; 123 (4) 385-388
    Google Scholar
  • 26 Rohner D, Tay A, Meng CS, Hutmacher DW, Hammer B. The sphenozygomatic suture as a key site for osteosynthesis of the orbitozygomatic complex in panfacial fractures: a biomechanical study in human cadavers based on clinical practice. Plast Reconstr Surg 2002; 110 (6) 1463-1471 , discussion 1472–1475
    CrossrefPubMedGoogle Scholar
  • 27 Kaufman Y, Stal D, Cole P, Hollier Jr L. Orbitozygomatic fracture management. Plast Reconstr Surg 2008; 121 (4) 1370-1374
    CrossrefPubMedGoogle Scholar
  • 28 Gierloff M, Seeck NG, Springer I, Becker S, Kandzia C, Wiltfang J. Orbital floor reconstruction with resorbable polydioxanone implants. J Craniofac Surg 2012; 23 (1) 161-164
    CrossrefPubMedGoogle Scholar
  • 29 Potter JK, Malmquist M, Ellis III E. Biomaterials for reconstruction of the internal orbit. Oral Maxillofac Surg Clin North Am 2012; 24 (4) 609-627
    CrossrefPubMedGoogle Scholar
  • 30 Westendorff C, Gülicher D, Dammann F, Reinert S, Hoffmann J. Computer-assisted surgical treatment of orbitozygomatic fractures. J Craniofac Surg 2006; 17 (5) 837-842
    CrossrefPubMedGoogle Scholar
  • 31 Gillies HD, Kilner TP, Stone D. Fractures of the malar-zygoma compound with a description of a new x-ray position. Br J Surg 1927; 14: 65
    PubMedGoogle Scholar
  • 32 Keen WW. Surgery: Its Principles and Practice. Philadelphia, PA: WB Saunders; 1909: 1906-1921
    Google Scholar
  • 33 Stanley Jr RB. The zygomatic arch as a guide to reconstruction of comminuted malar fractures. Arch Otolaryngol Head Neck Surg 1989; 115 (12) 1459-1462
    CrossrefPubMedGoogle Scholar
  • 34 Chen CT, Lai JP, Chen YR, Tung TC, Chen ZC, Rohrich RJ. Application of endoscope in zygomatic fracture repair. Br J Plast Surg 2000; 53 (2) 100-105
    CrossrefPubMedGoogle Scholar
  • 35 Czerwinski M, Lee C. The rationale and technique of endoscopic approach to the zygomatic arch in facial trauma. Facial Plast Surg Clin North Am 2006; 14 (1) 37-43
    CrossrefPubMedGoogle Scholar
  • 36 Knepil GJ, Loukota RA. Outcomes of prophylactic antibiotics following surgery for zygomatic bone fractures. J Craniomaxillofac Surg 2010; 38 (2) 131-133
    CrossrefPubMedGoogle Scholar
  • 37 Bhatt V, Chhabra P, Dover MS. Removal of miniplates in maxillofacial surgery: a follow-up study. J Oral Maxillofac Surg 2005; 63 (6) 756-760
    CrossrefPubMedGoogle Scholar
  • 38 Nagase DY, Courtemanche DJ, Peters DA. Plate removal in traumatic facial fractures: 13-year practice review. Ann Plast Surg 2005; 55 (6) 608-611
    CrossrefPubMedGoogle Scholar
  • 39 Dolynchuk KN, Tadjalli HE, Manson PN. Orbital volumetric analysis: clinical application in orbitozygomatic complex injuries. J Craniomaxillofac Trauma 1996; 2 (2) 56-63 , discussion 64
    PubMedGoogle Scholar
  • 40 Freihofer HP. Effectiveness of secondary post-traumatic periorbital reconstruction. J Craniomaxillofac Surg 1995; 23 (3) 143-150
    CrossrefPubMedGoogle Scholar
  • 41 Yaremchuk MJ. Orbital deformity after craniofacial fracture repair: avoidance and treatment. J Craniomaxillofac Trauma 1999; 5 (2) 7-16
    PubMedGoogle Scholar
  • 42 Ridgway EB, Chen C, Colakoglu S, Gautam S, Lee BT. The incidence of lower eyelid malposition after facial fracture repair: a retrospective study and meta-analysis comparing subtarsal, subciliary, and transconjunctival incisions. Plast Reconstr Surg 2009; 124 (5) 1578-1586
    CrossrefPubMedGoogle Scholar
  • 43 Vriens JP, Moos KF. Morbidity of the infraorbital nerve following orbitozygomatic complex fractures. J Craniomaxillofac Surg 1995; 23 (6) 363-368
    CrossrefPubMedGoogle Scholar
  • 44 Sakavicius D, Juodzbalys G, Kubilius R, Sabalys GP. Investigation of infraorbital nerve injury following zygomaticomaxillary complex fractures. J Oral Rehabil 2008; 35 (12) 903-916
    CrossrefPubMedGoogle Scholar