Secondary Reconstruction of the Zygomaticomaxillary Complex

Abstract

Zygomaticomaxillary (ZMC) fractures are the second most common facial fractures after nasal bone fractures. The zygoma, with its location and multiple points of articulations, lends itself to both facial structure and esthetics. Secondary ZMC deformities are complications of inadequate primary correction, delayed repair, or lack of repair. Secondary revisions of ZMC aim to correct ZMC displacement and projection and to address orbital discrepancies. Extensive correction involving significant orbital and malar defects requires zygomatic repositioning osteotomies and would greatly benefit from the utilization of virtual surgical planning, intraoperative navigation, and imaging. Minor corrections in malar projection can be corrected by onlay grafting and soft tissue augmentation and resuspension. Isolated or minor orbital corrections can be managed by autogenous or alloplastic material to restore lost orbital volume and anatomy.

Keywords

ZMC - secondary reconstruction - enophthalmos - onlay graft - surgical navigation

Publication History

Article published online:
24 December 2020

• References

• 1 Dorafshar A. Facial Trauma Surgery- From Primary Repair to Reconstruction. Philadelphia, PA: Elsevier - Health Sciences Division; 2019
• 2 Yu H, Shen G, Wang X, Zhang S. Navigation-guided reduction and orbital floor reconstruction in the treatment of zygomatic-orbital-maxillary complex fractures. J Oral Maxillofac Surg 2010; 68 (01) 28-34
• 3 Chepurnyi Y, Chernogorskyi D, Kopchak A, Petrenko O. Clinical efficacy of peek patient-specific implants in orbital reconstruction. J Oral Biol Craniofac Res 2020; 10 (02) 49-53
• 4 Gerbino G, Zavattero E, Zenga F, Bianchi FA, Garzino-Demo P, Berrone S. Primary and secondary reconstruction of complex craniofacial defects using polyetheretherketone custom-made implants. J Craniomaxillofac Surg 2015; 43 (08) 1356-1363
• 5 Malik AH, Shah AA, Ahmad I, Shah BA. Ocular injuries in patients of zygomatico-complex (ZMC) fractures. J Maxillofac Oral Surg 2017; 16 (02) 243-247
• 6 Pearl RM. Enophthalmos correction: Principles guiding proper treatment. Oper Tech Plast Reconstr Surg 1998; 5 (04) 352-356
• 7 Manson PN, Grivas A, Rosenbaum A, Vannier M, Zinreich J, Iliff N. Studies on enophthalmos: II. The measurement of orbital injuries and their treatment by quantitative computed tomography. Plast Reconstr Surg 1986; 77 (02) 203-214
• 8 Ebrahimi A, Kalantar Motamedi MH, Rasouli HR, Naghdi N. Enophthalmos and orbital volume changes in zygomaticomaxillary complex fractures: is there a correlation between them?. J Oral Maxillofac Surg 2019; 77 (01) 134.e1-134.e9
• 9 Kontio R, Lindqvist C. Management of orbital fractures. Oral Maxillofac Surg Clin North Am 2009; 21 (02) 209-220 , vi
• 10 Ellis III E, Tan Y. Assessment of internal orbital reconstructions for pure blowout fractures: cranial bone grafts versus titanium mesh. J Oral Maxillofac Surg 2003; 61 (04) 442-453
• 11 Tideman H, Samman N, Cheung LK. Functional reconstruction of the mandible: a modified titanium mesh system. Int J Oral Maxillofac Surg 1998; 27 (05) 339-345
• 12 Liss J, Stefko ST, Chung WL. Orbital surgery: state of the art. Oral Maxillofac Surg Clin North Am 2010; 22 (01) 59-71
• 13 Glassman RD, Manson PN, Vanderkolk CA. et al. Rigid fixation of internal orbital fractures. Plast Reconstr Surg 1990; 86 (06) 1103-1109 , discussion 1110–1111
• 14 Romano JJ, Iliff NT, Manson PN. Use of Medpor porous polyethylene implants in 140 patients with facial fractures. J Craniofac Surg 1993; 4 (03) 142-147