Zygomatic fractures are common facial injuries, representing the most common facial fracture 214 or the second in frequency after nasal fractures. Musculoskeletal injuries are common and vary greatly in mechanism, severity, and treatment. The classic description of the fracture pattern is that of a tetrapod although they are sometimes confusingly referred to as tripod fractures. The main goal of the analysis should be to determine whether internal orbital reconstruction will be required. Trauma to the zmc represents 45% of all midface fractures. The atlas mimics a radiological workstation pacs and includes anatomy as it presents itself on plain film as well as on crosssectional studies with multiplanar reconstruction mpr and threedimensional.
However the variability of these fractures is great, owing to the difference in magnitude and direction of force, the amount of soft tissue. A study on assessing the etiology and different treatment. They are the second most common facial bone fracture after nasal bone injuries. A previous study has performed 3d analyses of the parallel and rotational displacements that occur in a fractured zmc. Few studies have reported on using craniometry for comminuted zygomaticomaxillary complex zmc fracture management. Stable fracture other types of zygomatic fractures, which requires reduction, but no fixation. Fracture by dan pyne revisions by tom pabst glenn gers e.
Unstable fracture with great displacement and distruption at the frontozygomatic suture and comminuted fracture. Management of tripod fractures zygomaticomaxillary. The aim of this study was to investigate the biomechanics of the facial skeletal for understanding the buttress after fixation with standard and modified anatomical thin titanium mesh attm plates by finite element fe analysis. Open fractures are often the result of highenergy trauma and can lead to significant longterm morbidity and disability. A number of studies had shown zmc fractures to be the second most.
In this article, we shall look at the different parts of the temporal bone, their articulations, and any. This term fails to recognize the posterior relationship of the zygoma with the sphenoid bone of the skull base and its extension inferiorly down the lateral wall of the maxillary sinus. The fracture line extends backwards from the lateral margin of the anterior nasal aperture below the zygomatic buttress to cross the lower third of the pterygoid laminae. Pdf surgical methods of zygomaticomaxillary complex fracture. Find, read and cite all the research you need on researchgate. Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients.
This is a horizontal fracture above the level of the nasal floor. The term zygomaticomaxillary zygomaticomalar complex zmc fractures refers to the osseous disruption of the malar eminence at 4 buttresses. Lalitha, bds, mds1 krishnappa ranganath, bds, mds1 parimala sagar, bds, mds1 1department of oral and maxillofacial surgery, faculty of dental. Unfortunately, the incidence of maxillofacial trauma is increasing at an alarming rate. Discuss the evaluation of open fractures including physical exam and radiographic studies. Fracture of the zygomaticomaxillary complex zmc is one of the most common facial injuries. Additionally, the fracture components may result in impingement of the. Fractures and dislocations university of cincinnati. Case report threepoint fixation of displaced tripod. Displaced fracture of the zygomatic bone as evidenced on radiography waters and caldwell view. Many authors have devised classification schemes for zygomaticomaxillary complex zmc fractures.
The eye socket, or orbit, is a bony cavity that houses the eye, the muscles that move the eye, the surrounding blood vessels, nerves, and fat. Surgical management of zygomatic complex fractures in a major. The precise location of cracks are unpredictable the load level are more precisely estimated. It contains the middle and inner portions of the ear, and is crossed by the majority of the cranial nerves. The feet or pods in this description refer to the main sites of fracture displacement, which can be identified either clinically or radiographically. How should i code anesthesia for a malar tripod procedure. Zmc fractures is a frequent challenge in plastic surgery.
Fracture mechanics in fracture mechanics attention is basically focused on a single crack. Analysis of the changing patterns of midface fractures. Reduction of zygomatic complex fracture using combination. A new classification of zygomatic fracture featuring zygomaticofrontal suture. Repair of a facial zygomaticomaxillary complex fracture. Surgical methods of zygomaticomaxillary complex fracture. Standard attm sattm plate designed as the lshape anticipated to be fixed in the zmc anterior maxilla and lateral buttress to increase the. 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. Location on bone describe the location shaft, metaphysis, epiphysis proximal, distal neck, head, dome. An ebook reader can be a software application for use on a computer such as microsofts free reader application, or a booksized computer this is used. Pdf on aug 21, 2014, srinivas m susarla and others published zygomaticomaxillary complex fracture find, read and cite all the research. A fracture through the orbital roof can result in a dural tear, with resultant csf leakage or brain herniation. Zmc fractures have a high incidence of ocular injury 10% and a higher incidence of visual sequelae 41% than most other forms of midfacial injury 15%.
Girard screw provides excellent three dimensions control over the fractured zmc and aids in the manipulation and reduction of the zmc fractures. Repair of a facial zygomaticomaxillary complex fracture mordechai hoschander department of oral and maxillofacial surgery, ny presbyterian lower manhattan hospital, new york, ny, usa. Oral and maxillofacial surgeons are trained, skilled and uniquely qualified to manage and treat many aspects of facial trauma. Here, we assessed whether specific approaches and fixation methods for. Obeng clinical history 29yearold male involved in a motor vehicle accident. 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. Orbital trauma and facial fracture repair what is the orbit. This code description may also have includes, excludes, notes, guidelines, examples and other information. Many publications have appeared on intraoperative imaging for trauma surgery, but in most hospitals intraoperative imaging is not routinely performed for zmc fracture repair. The patient does not recall striking his head, but complains of tenderness over the right zygomatic arch and maxilla. Bennett fracturedislocation fractures of the hand intraarticular fracture of the proximal end of the first metacarpal, with dorsal and lateral dislocation of the distal. Orbital trauma and facial fracture repair denver eye. However, few studies have investigated adequate fixation methods according to these displacements. Most fractures result from a single, significant force applied to normal bone.
The temporal bone contributes to the lower lateral walls of the skull. Isolated zygoma and zygomaticomaxillary complex zmc. Classification of mandible, midface, zmc and noe fractures. Analysis of the changing patterns of midface fractures using 3d computed tomography. Hawes, md orthopedic traumogologist, intermountain medical center, intermountain healthcare. A zmc fracture is also known as a tripod, tetrapod or quadripod fracture, trimalar fracture or malar fracture. Women who have been domestically abused are more likely to suffer zmc fractures and orbital blowout fractures, 2 while mandible fractures are more common when the. Treatment of zygomatic complex fractures using two point. A new classification of zygomatic fracture featuring. Max frye howard franklin jeffrey fiskin current revisions by glenn gers weinstock productions castle rock entertainment january 6, 2005. The trapdoor fracture is an inferior orbital blowout fracture in which the inferior rectus muscle herniates into the underlying maxillary sinus before the fractured fragment returns to its original position, entrapping the muscle. Fractures of the zygomatic complex are among the most frequent in maxillofacial trauma. 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.
The fracture also passes along the lateral wall of the nose and the lower third of the nasal septum to join. Displaced zmc fractures are typically plated in the following sequence. These goals are accomplished more easily several days after the injury, when much of the tissue edema has resolved and any residual deformity can be appreciated more readily. Numerous techniques have been described for the reduction of zmc fracture. They are the second most common facial bone fracture after nasal bone fractures pathology. 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 extremities, spine, and pelvis can all be affected. Advantages of intraoral and transconjunctival approaches. In the absence of comminution of the zygoma or the lateral orbital rim with or without minimal displacement, platforms. The lower portion of the bone articulates with the mandible, forming the temporomandibular joint of the jaw. Humphrey, md, department of otolaryngologyhead and neck surgery, the university of kansas medical center, ms 3010, 3901 rainbow blvd, kansas city, ks 66160.
A section of tibia illustrates a fracture of cortical bone with displacement of the distal tibia and associated hemorrhage and fibrin deposition. Signs of zmc fracture are periorbital ecchymosis, subconjunctival hemorrhage, hypoesthesia in the region of infraorbital nerve, palpable stepoffs of the orbital rim and upper buccal surfaces, orbital subcutaneous emphysema, enophthalmos, other malpositions of the globe, and diplopia. Although early approaches have striven to predict fracture by analyzing the behavior of atomic bonds, gri. The incidence, cause, age, and gender predilection of zygomatic. Fracture mechanics examples fracture mechanics can be applied in a large number of fields. Zygomaticomaxillary complex zmc fracture is the second most common facial bone fractures after nasal bone and has been extensively described in the literature. An algorithm for the treatment of isolated zygomatico. Shaped like an empty ice cream cone it is composed of 7 facial bones. They can account for approximately 40% of midface fractures. The treatment of the zygomatic complex fractures is controversial, as. Radiographic examination proper treatment of fractures of the mandible is dependent on proper diagnosis of the in. Fractures of the zygomatic arch alone minimum or no. Overview of fractures merck manuals professional edition. The first algorithm will likely be the one used most commonly for the next several years until intraoperative ct scanning has become universally available.
Not only does this result in a disgruntled patient, it may affect their ability to continue to perform their occupation. Intraoperative imaging seems to be the next step to improve surgical outcome in the treatment of zygomaticomaxillary complex zmc fractures. From march 2014 to december 2014, 34 patients with zmc fractures were treated by onepoint fixation in the zm buttress using unsintered hydroxyapatite uhapolyllactide plla plates. The fracture complex results from a direct blow to the malar eminence and. A zmc fracture which follows this pattern usually has one additional fracture line through the zygomatic arch. Fractures typically occur across these three buttressrelated sutures, leading to the term tripod fracture. A much higher percentage of zygomaticomaxillary complex zmc fractures occur in males 80% than in females 20%. Zygomaticomaxillary complex, bone fracture, sphenozygomatic suture, internal.
An observational study preeti satish, bds, mds1 kavitha prasad, bds, mds1 r. The zygomaticomaxillary complex zmc plays a key role in the structure, function, and esthetic appearance of the facial skeleton. Start by basing your coding on surgical codes 255 percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulation. Choose the procedure code based on whether the surgeon uses an open or percutaneous approach and how complicated the repair was. Figure 21a figure 21b figure 21c figure 21d findings figures 21a and 21b. Incidence of zmc fractures peaks in persons aged 2030 years.
Algorithm 1 relies heavily on a careful analysis of the preoperative ct scans. The degree of immobilization created with titanium plates and screws also allows fixation at fewer anatomic points. This case report presents a 21yearold man who was involved in a traffic accident and who subsequently presented with a zmc fracture. Overlooking a fracture may not have immediate consequences, but can result in disfigurement and permanent disability. Jefferson fracture both bone forearm fracture tibfib fracture jones fracture bennetts fracture straddle fracture. The ultimate goal in treating zygomaticomaxillary complex zmc fractures is to obtain an accurate stable reduction while minimizing external scars and functional deformity. Zmc fracture, 7 or zygomaticoorbital fracture, 8 because the zygomatic bone is nearly never involved alone, as it is in intimate contact with the temporal. Pdf zygomaticomaxillary complex fracture researchgate. Spectrum of critical imaging findings in complex facial. Zygomaticomaxillary complex fracture radiology reference. From september 2011 to october 2018, 43 patients with comminuted zmc fracture receiving open reduction internal fixation under coronal incision were enrolled. In 1909, keen was the first to depression and patients with paresthesia of the infra describe an intra oral upper buccal sulcus incision to orbital nerve with fractured zygomatic complex were.
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