Dec 16, 2011 the zygomaticomaxillary complex zmc is comprised of zygoma and its articulations to the zygomatic arch and maxilla. Zygomaticomaxillary complex zmc fractures, also known as tripod, tetrapod, quadripod, malar or trimalar fractures, are seen in the setting of traumatic injury to the face. From september 2011 to october 2018, 43 patients with comminuted zmc fracture receiving open reduction internal fixation under coronal incision were enrolled. Zygomaticomaxillary complex fracture pubmed central pmc.
Management of tripod fractures zygomaticomaxillary. 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. Jan 02, 2015 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 complex fractures, facial fracture, etiolo gy, surgical approach. Open reduction internal fixation of zygomatic maxillary. The latter two terms are misnomers because the zygoma has not three but four.
Modalities of zygomaticomaxillary complex fracture. 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. Managing the treatment of a comminuted zygomaticomaxillary complex zmc fracture is challenging for all surgeons. The malar complex refers to the zygoma and maxillary bones and therefore forms part of the orbital floor and lateral orbital wall. Zygomaticomaxillary complex fracture in the management of facial fractures, threedimensional 3d imaging using computed tomography ct is an established procedure for preoperative diagnostics and surgical planning 20. Zygomatic complex fracture is the second most common fracture of facial region just. A zygoma fracture is often the result of facial trauma such as violence, falls or automobile accidents. As zygomaticomaxillary complex fracture is the second most common. With the high definition of the current scanners, even small fractures of the facial skeleton can be visualized. 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. Consideration 1 indications second most common mid face fracture nasal fracture is first, usually from lateral blunt force like a blow from a fist. Fractures of the zygomaticomaxillary complex zmc are the second most common of all facial fractures.
Jun 23, 2019 you can also scroll through stacks with your mouse wheel or the keyboard arrow keys. They are the second most common facial bone fracture after nasal bone fractures pathology. A new classification of zygomatic fracture featuring zygomaticofrontal suture. Feb 12, 2017 while large tertiary hospitals are impressive beasts of coordination and services they do not focus on the outpatient experience for the patient because their core business and role, is the care of acute illness and complex highly specialized procedures such as robotic surgery, heart surgery and neurological interventions.
Typically, a fracture line extends from the inferior orbital fissure anteromedially along the orbital floor predominantly through the orbital process of the maxilla, toward the infraorbital rim. Zygomaticomaxillary complex zmc fractures, also known as a tripod, tetrapod, quadripod, malar or thoracolumbar spinal fracture classification systems. Displaced fractures of the zygomaticomaxillary complex often increase orbital volume due to angulation of the lateral orbital wall at the zygomaticosphenoid suture. Diagnose zygomaticomaxillary complex fractures from physical.
Pdf on aug 21, 2014, srinivas m susarla and others published zygomaticomaxillary complex fracture find, read and cite all the research you need on researchgate. Zygomaticomaxillary complex fractures pocket dentistry. Spectrum of critical imaging findings in complex facial. Management of tripod fractures zygomaticomaxillary complex. Dec 24, 2019 definitions zygoma is a very crucial component which maintains facial contour. Fractures of the zygomaticomaxillary complex are the second most common of all facial fractures. Diplopia is a common complaint following zygomaticomaxillary complex zmc fractures. A new classification of zygomatic fracture featuring. Zmc complex fracture right zygomaticomaxillary complex fracture with disruption of the lateral orbital wall, orbital floor, zygomatic arch and maxillary sinus. Many of these fractures require surgical reduction and fixation to restore either function or aesthetic form or a combination of the two. Surgical management of zygomatic complex fractures in a major. Management of tripod fractures zygomaticomaxillary complex 1 point and 2 point fixations. Use of carm in assessing the innominate line zygomaticosphenoid suture in zygomaticomaxillary complex fractures author.
In complex midface injuries, it can be difficult for the radiologist to know which fractures are important to point out to the surgeon. Oct 15, 2019 the zygomaticomaxillary complex zmc plays a key role in the structure, function, and aesthetic appearance of the facial skeleton. Postoperative radiographs are the only way to assess the adequacy of reduction of these. Treatment and complications of orbitozygomatic fractures scielo. 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. Zygomaticomaxillary complex fracture dr ian bickle and dr nasir siddiqui et al. Trends in concurrent orbital floor repair during zygomaticomaxillary complex fracture repair. Management of zygomaticomaxillary complex zmc fractures should be based on injury patterns and not on training background. It provides normal cheek contour and separates the orbital contents from the temporal fossa and the maxillary sinus. A substantial number of postoperative functional and cosmetic complications can arise from the surgical management of these fractures. Ris zotero endnote bibtex medlars procite refworks.
Jul 15, 2019 fraktur wajah, trauma oral dan maksilofasial. Reduction was achieved using a carrollgirard screw fig 2. Aug 21, 2014 this patient was diagnosed with a left zygomaticomaxillary complex fracture and underwent open reduction and internal fixation via a gingivobuccal sulcus approach. While large tertiary hospitals are impressive beasts of coordination and services they do not focus on the outpatient experience for the patient because their core business and role, is the care of acute illness and complex highly specialized procedures such as robotic surgery, heart surgery and neurological interventions. The etiology of zygomatico maxillary complex fractures is shown in table i. Computed tomography is commonly used to evaluate patients with blunt facial trauma. Several fixation methods have been used over the years, including wire osteosynthesis, lag screw fixation, transfacial kirschner wire fixation, titanium plate and screw fixation, and more recently, resorbable plating system.
Pdf treatment of zygomatic complex fractures with surgical. Intraoperative imaging of zygomaticomaxillary complex. Zygomaticomaxillary complex fracture radiology case. This case shows zygomaticomaxillary complex fracture due to high energy trauma. Zygomaticomaxillary complex fracture radiology reference. Surgical methods of zygomaticomaxillary complex fracture. Aug 19, 2019 zygomaticomaxillary complex zmc and zygomatic arch za fractures are common injuries resulting from facial trauma and frequently require surgical management huang et al. Facial bruising, periorbital ecchymosis, soft tissue gas, frakutr, trismusaltered masticationdiplopiaand ophthalmoplegia are other indirect features of the injury. This retrospective cohort study examines the rates and outcomes of concomitant orbital floor fracture repair during zygomaticomaxillary complex fracture reducti. A total of 1,330 zmc fracture patients and 5,320 nonzmc fracture participants were included. Additionally, the fracture components may result in impingement of the. The zygoma is a quadrangular bone that provides the structural support of the malar eminence, makes up the anterolateral wall and inferotemporal floor of the orbit and the lateral aspect of the inferior orbital rim. A study protocol for a randomised controlled trial evaluating.
A fracture along the zygomaticomaxillary suture from the inferior orbital rim through the. To present the treatment of zygomaticomaxillary complex zmc fractures with closedreduction steinmann pin fixation and to compare it to the reduction and aesthetic outcomes of openreduction techniques orif. The zygomatic bone has a prominent and im portant position in the facial. A study protocol for a randomised controlled trial. Basilar skull fracture blowout fracture mandibular omnteggia nasal fracture le fort fracture of skull zygomaticomaxillary complex fracture zygoma fracture. Nerve injury following fracture may involve traction, pressure, ischemia, damage.
Case report threepoint fixation of displaced tripod. Zygomaticomaxillary complex fracture tripod fracture return to. Basilar skull fracture blowout fracture mandibular fracture nasal fracture le fort fracture of skull zygomaticomaxillary complex fracture zygoma fracture. Next, a 2mm lplate is placed along the zygomaticomaxillary buttress laterally. Zygomaticomaxillary complex fractures springerlink. Moreover the importance of zygomatic complex in facial skeleton lies inprotecting globe of eye and absorbing and redistributing masticatory andexternal load. Type b involves a fracture where all three processes of zygoma. Optimizing the surgical management of zygomaticomaxillary. In most cases, there is loss of sensation in the cheek and upper lip due to infraorbital nerve injury. A zygomaticomaxillary complex fracture extends through these four sutures figs 8, 9. Jul 03, 2019 zygomaticomaxillary complex zmc fractures, also known as a tripod, tetrapod, quadripod, malar or thoracolumbar spinal fracture classification systems. Like other facial fractures, the optimal management of operative zmc fractures requires anatomic reduction of all fractures followed by rigid internal fixation.
This plays a key role in the structure and function of. As zygomaticomaxillary complex fracture is the second most common fracture of the. Failure to correct can result in rotational deformity and increase the volume of. Therefore for cosmetic and functional reasons it is imperative to diagnoseand treat zygomatic fractures adequately. Once reduction was established, fixation was accomplished using an lshaped plate at the zygomaticomaxillary buttress and. Definitions zygoma is a very crucial component which maintains facial contour.
Postoperative followup ranged from three to 61 mon ths. The most common zygomaticomaxillary complex zmc fracture pattern involves fracture of the frontozygomatic suture lateral orbital rim, the zygomatic arch, the lateral buttress zygomaticomaxillary buttress, and the inferior orbital rim. Pdf zygomaticomaxillary complex fracture researchgate. A total of 1,330 zmc fracture patients and 5,320 nonzmc fracture participants were included and newly developed ear.
Pdf surgical methods of zygomaticomaxillary complex fracture. Zygomaticomaxillary complex fractures orthopedics jama. Investigate the risk of earassociated diseases after zygomaticomaxillary complex zmc fracture in a populationbased retrospective cohort study. Zygomaticomaxillary complex fractures by dara liotta, md. 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. The treatment of the zygomatic complex fractures is. You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. This is a retrospective cohort study using taiwans national health insurance research database of reimbursement claims. Zygomaticomaxillary complex zmc fractures are a group of fractures that can significantly alter the structure, function, and appearance of the midface, including the globe. Fractures of the zygomaticomaxillary complex and their. Maxillofacial computed tomographic scan, demonstrating a depressed zygomaticomaxillary complex fracture with loss of projection top left, displacement at the. A study on assessing the etiology and different treatment. Zygomaticomaxillary complex fracture deepak k gupta 2.
Case example zygomatic complex fracture tripod fracture. Consideration 1 indications second most common mid face fracture nasal fracture is first, usually from lateral blunt force like a blow. Zygomaticomaxillary complex, zygomaticomaxillary compound, 31 zygomaticoorbital, 26 zygomatic complex, 32,33 malar, trimalar, and tripod fractures are terms that have been used to describe the clinical entity of fractures involving the zygoma and adjacent bones. The etiology of zygomaticomaxillary complex fractures is shown in table i. The zygomaticomaxillary complex zmc plays a key role in the structure, function, and aesthetic appearance of the facial skeleton. The zygomaticomaxillary complex fracturealso known as a quadripod fracturequadramalar fractureand formerly referred to as a tripod fracture or trimalar fracturehas four components. Zygomaticomaxillary complex zmc fractures involve the malar eminence at 4 buttresses. The zygomaticomaxillary complex fracture known as a quadripod fracture, quadramalar fracture, referred to as a tripod fracture or trimalar fracture, has four components. Fractures of the zygomatic complex and arch pocket. Pdf objective evaluate the 1year treatment outcome of zygomatic complex fractures with surgical or nonsurgical intervention. Apr 04, 2020 proximal supracondylar holsteinlewis fracture.
Risk of earassociated diseases after zygomaticomaxillary. Failure to correct can result in rotational deformity and increase the volume of the orbit, causing the eye ztgomatic sink inwards. Zygomatic complex fracture tripod fracture iowa head and. Multiple fixation methods have been used over the years, including wire osteosynthesis, lag screw fixation, transfacial kirschner wire fixation, titanium plate and screw fixation, and more recently, resorbable plating systems. Few studies have reported on using craniometry for comminuted zygomaticomaxillary complex zmc fracture management. Maxillofacial computed tomographic scan, demonstrating a depressed zygomaticomaxillary complex fracture with loss of projection top left, displacement at the sphenozygomatic suture top right. Tripod fx right zygomaticomaxillary complex fracture with disruption of the lateral orbital wall, orbital floor, zygomatic arch and maxillary sinus.
This patient was diagnosed with a left zygomaticomaxillary complex fracture and underwent open reduction and internal fixation via a gingivobuccal sulcus approach. Concomitant noe fractures predict a higher incidence of. Zygomaticomaxillary complex how is zygomaticomaxillary. This fracture pattern was previously known as a tripod fracture because only three disrupted sutures the zygomaticofrontal, zygomaticomaxillary, and zygomaticotemporal sutures could be discerned at screenfilm radiography. Once the fracture was aligned, the infraorbital rim was typically plated with a 1. Fracture of these zygomafractures can be managed by different methods. On physical exam, the fracture appears as a loss of cheek. Other fracture patterns, include isolated zygomatic arch fractures, or zmc fractures with associated panfacial fractures, such as le fort ii and iii. Reconstructive procedures protocols general considerations. Zygomatic complex fracture tripod fracture iowa head. To code a diagnosis of this type, you must use one of the three child codes of s02. The zygomaticomaxillary complex zmc is comprised of zygoma and its articulations to the zygomatic arch and maxilla. A zygoma fracture zygomatic fracture is a form of facial fracture caused by a fracture of the zygomatic bone.
Sep 06, 2015 zygomaticomaxillary complex fracture 1. Zygomaticomaxillary complex zmc fractures are almost always associated with fractures of the internal orbit. The upper and transverse maxillary bone has the zygomaticomaxillary and zygomaticotemporal sutures, while the lateral and vertical maxillary fraitur. The present study was conducted to evaluate the prevalence of posttraumatic as well as portoperative diplopia, and the improvement of diplopia over time before and after surgery. Symptoms include flattening of the face, trismus reduced opening of the jaw and lateral subconjunctival hemorrhage. The inadequate reduction of zmc fracture leads to asymmetrical facial contouring, diplopia, enophthalmos, facial numbness, and limited mouth opening. Morbidity of the infraorbital nerve following orbitozygomatic complex fractures. The patients ranged in age from 16 to 68 years, with a mean age of 29 years. Fracture in the zygomaticosphenoidsuture is difficult to visualize clinically. Zygomatic complex fractures and its management acta scientific. Treatment of the oz fractures seeks to restore the function of the orbital complex as well as the facial esthetics of the patient. 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. The term zygomaticomaxillary zygomaticomalar complex zmc fractures refers to the quiz ref idosseous disruption of the malar eminence at 4 buttresses. Sep 28, 2019 basilar skull fracture blowout fracture mandibular fracture nasal fracture le fort fracture of skull zygomaticomaxillary complex fracture zygoma fracture.
Zygoma or cheek bone fracture of zygoma is not usually present alone, its find mostly in the conjunction with adjacent structure i. Zmc fractures is a frequent challenge in plastic surgery. Zygomaticomaxillary complex zmc and zygomatic arch za fractures are a relatively common injury in australia, with the royal brisbane and womens hospital managing approximately 160 patients per year. Jun 07, 20 zygoma plays an imp role in facial contour.
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