Surgical Methods of Zygomaticomaxillary Complex Fracture

Abstract

Background: Zygoma is a major buttress of the midfacial skeleton, which is frequently injured because of its prominent location. Zygoma fractures are classified according to Knight and North based on the direction of anatomic displacement and the pattern created by the fracture. In zygomaticomaxillary complex (ZMC) fracture many incisions (lateral eyebrow, lateral upper blepharoplasty, transconjunctival, subciliary, subtarsal, intraoral, direct percutaneous approach) are useful. We reviewed various approaches for the treatment of ZMC fractures and discussed about incisions and fixation methods.

Methods: A retrospective review was conducted of patients with ZMC fracture at a single institution from January 2005 to December 2014. Patients with single zygomatic arch fracture were excluded.

Results: The identified 694 patients who were admitted for zygomatic fractures from which 192 patients with simple arch fractures were excluded. The remaining 502 patients consisted of 439 males and 63 females, and total 532 zygomatic bone was operated. Orbital fracture was the most common associated fracture. According to the Knight and North classification the most frequent fracture was Group IV. Most fractures were fixated at two points (73%).

Conclusion: We reviewed our cases over 10 years according to fracture type and fixation methods. In conclusion, minimal incision, familiar approach and fixation methods of the surgeon are recommended.

Keywords: Maxillary fractures; Maxillofacial injuries; Zygomatic fractures.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1. Reduction with plate and screw. A 1.5 mm plate with a 4.0 mm screw fixed on the lateral fracture segment of the inferior orbital rim, and the fracture is reduced by pulling the plate anterior-laterally with a small bone hook. After the reduction screw is fixed on the medial segment of the inferior orbital rim.

Fig. 2. Group IV zygomaticomaxillary complex fracture. (A) Preoperative computed tomography. (B) Postoperative computed tomography. The displaced and medially rotated fracture segment reduced and fixated with plates and screws.

Fig. 3. Reduction with plate and screw. A 1.5 mm plate with a 4.0 mm screw fixed with the lateral fracture segment of the inferior orbital rim, and pulling the plate antero-medially with a small bone hook. After the reduction screw is fixed on the medial segment of the inferior orbital rim.

Fig. 4. Group V zygomaticomaxillary complex fracture. (A) Preoperative computed tomography. (B) Postoperative computed tomography. The displaced and laterally rotated fracture segment reduced and fixated with plates and screws.