INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
Pre-op

Post-op
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
• Applied surgical anatomy
• Clinical features
• Radiological features
...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Anatomy:
• central support to cheek
• buttress of lateral mid 3rd face
...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
ANATOMY
Processes
Maxillary
Temporal
Frontal
Orbital
Lateral wall and f...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
ANATOMY

Arch

Temporal
Zygoma
Maxilla

Muscle attachments:
Zygomaticus...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Mechanism of Injury
Direct & Indirect
In-bending at area of impact
Out-...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
• Applied surgical anatomy
• Clinical features
• Radiological features
...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features
Flattening of cheek
Periorbital edema / Ecchymosis
Su...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features
ENOPHTHALMOS
• Inferior & posterior
displacement
• Ex...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features
Paresthesia (V2) / Pain !!!
Trismus
Tenderness / Step...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical examination
Palpation:
• Step / tenderness / mobility
• Supra-...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
• Applied surgical anatomy
• Clinical features
• Radiology
• Management...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Radiographic examination
Occipito-mental view
(PNS view,
Waters positio...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Radiographic examination

Submento-vertex view
(jug handle view)
Zygoma...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Radiographic examination

C.T. Scans:

GK / MAXFAC
SDM DHARWAD
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
• Applied surgical anatomy
• Clinical features
• Radiology
• Management...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
Immediate – primary care:
• ABC
• Nasal packs
Anterior / Pos...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
• Restoration of form & function
• Anatomic reduction
• Trea...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
Closed Reduction
Arch fractures
Minimal disruption
(at 2 sut...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
Closed Reduction
• Temporal approach
(Gillies 1927)

GK / MA...
Gillies Temporal Approach

GK / MAXFAC
SDM DHARWAD
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
Closed Reduction

• Transcutaneous
approach

GK / MAXFAC
SDM...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
Open Reduction & fixation
F-Z Suture
Infra-orbital rim & orb...
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management :

Open Reduction

F-Z Suture
GK / MAXFAC
SDM DHARWAD
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management :

Open Reduction

Zygomatico-maxillary suture
Infra-orbital...
MAXILLOFACIAL INJURIES
Orbital floor Fractures
(blow out #s)
Shape: Pyramidal Apex
Optic foramen
Roof, Lateral wall,
floor...
MAXILLOFACIAL INJURIES
Orbital floor Fractures
(blow out #s)
• Applied anatomy
• Clinical features
• Radiographic features...
MAXILLOFACIAL INJURIES
Orbital floor Fractures
(blow out #s)
Applied anatomy
Floor : Zygoma & Maxilla
Entrapment
“Trap doo...
MAXILLOFACIAL INJURIES
Orbital floor Fractures
(blow out #s)
Clinical features
Pain
Edema
Ecchymosis
Proptosis
Paraesthesi...
MAXILLOFACIAL INJURIES
Orbital floor Fractures
(blow out #s)
Radiographic features
Occipito-mental view
( PNS, Water’s Vie...
MAXILLOFACIAL INJURIES
Orbital floor Fractures
(blow out #s)
Management
Diplopia & Enophthalmos
Surgical & surgical only
C...
MAXILLOFACIAL INJURIES
Orbital floor Fractures
(blow out #s)
Management
Incidence – 2 / 62
Reconstruct floor to prevent
en...
MAXILLOFACIAL INJURIES
If you cannot convince people…
confuse them
Thank You
Zygoma /certified fixed orthodontic courses by Indian dental academy
Zygoma /certified fixed orthodontic courses by Indian dental academy
Zygoma /certified fixed orthodontic courses by Indian dental academy
Zygoma /certified fixed orthodontic courses by Indian dental academy
Zygoma /certified fixed orthodontic courses by Indian dental academy
Zygoma /certified fixed orthodontic courses by Indian dental academy
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Zygoma /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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  • This should be the first slide
  • Prominent position – frequently fractured
    Either alone or in combination with other bones of midface
    Fractures include disruption of any of 5 articulations
  • Articulates with
    zygomatic process of maxillary bone: infraorbital rim
    Zygomatic process of temporal bone :in front of the glenoid fossa
    External angular process of frontal bone:to form fz suture
    With in orbit articulates with medially orbital floor & laterally G.W.sphenoid
    By virtue of its attachments
    Forms floor & lateral wall of orbit & roof and lateral wall of maxillary sinus
  • Arch: contributions from three bones temporal, zygomatic & maxillary
    Muscle attachments
    Nerves
    Z facial br of zygomatic nerve enters orbit through inferior orbital fissure divides into
    Z temporal which supplies area around zf suture & z facial which passes along inferior and lateral surface of the orbit exciting through a foramen on malar eminence to supply that area
    Infraorbital nerve through posterior margin of inferior orbital fissure, travels through a in its first 2/3rds of its course obliquely and medially across orbital floor and then through a canal in the infraorbital rim to exit the zygoma @ 1cm below the infraorbital rim grove
  • Direct violent forces to cotralateral side can cause disruption of zygoma due to reciprocal transfer of forces but not common, bilateral zygoma fracutres are usually in association with other facial bones involved as in lefort 3 and is because of higher energy involvemnt.
    Fractures are dislocated posteriorly,inferiorly & medialy are most frequent. Orbital #s are compressed with overlapping # fragments & while reducing, orbital fractures become more severe. These are impacted fractures
    More extensive injuries are dislocated posteriorly inferiorly and laterally. The arch and soft tissue attachments must be disrupted to permit this.
    Any zygomatic complex fracture should include a discontinuity along the floor of the orbit.
    The direction of dislocation involves the rotation of the bone in several planes this has resulted in several classifications
  • This should be the first slide
  • Loss of prominence of malar eminence may partially conceled by soft tissue swelling
    Proptosis due to swelling with in muscular planes and tissue planes
    Echymosis and hematoma usually confined to distribution of orbital septum spectacle hematoma
    Epistaxis on ipsilateral nostril secondary to hemorrhage into maxillary sinus
  • Clinical pictures to be added.
  • Paresthesia V2 contusion or compression of nrve by bone fragments within the area of infraorbital foramen specially medially displaced fractures and will resolve only after elevation of fracture.
    Limitation in mouth opening due to swelling with in muscular and soft tissue planes, medially displaced arch, and posteriorly displaced body
  • Difference betwqeen proptosis & exopthalmos
  • This should be the first slide
  • Tetanus immunization schedule microbiology of tetanus check with dinesh
    Fully immunised : last dose with in 10yrs .5ml toxoid
    Partially immunised: more than 10yrs .5ml toxoid
  • Immediate intervention nessasary
    Prevent
    Enopthalmos
    diplopia
    Approach through blepharoplasty incision for floor medial and lateral wall
    Sub conjunctival approach with lateral canthplexy alternative
    Aim to reconstruct the floor / medial wall
    Choice of graft : calvarium
  • Transcript of "Zygoma /certified fixed orthodontic courses by Indian dental academy "

    1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
    2. 2. Pre-op Post-op
    3. 3. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiological features • Management
    4. 4. MAXILLOFACIAL INJURIES Zygomatic complex fractures Anatomy: • central support to cheek • buttress of lateral mid 3rd face Articulations: • Zygomatico-frontal •Zygomatico-maxillary • Zygomatico-temporal (arch) • Zygomatico-sphenoid(orbital floor) GK / MAXFAC SDM DHARWAD
    5. 5. MAXILLOFACIAL INJURIES Zygomatic complex fractures ANATOMY Processes Maxillary Temporal Frontal Orbital Lateral wall and floor orbit Roof and lateral wall maxillary sinus GK / MAXFAC SDM DHARWAD
    6. 6. MAXILLOFACIAL INJURIES Zygomatic complex fractures ANATOMY Arch Temporal Zygoma Maxilla Muscle attachments: Zygomaticus major / minor: malar eminence GK MAXFAC Levator labii superioris: infraorbital rim /DHARWAD SDM
    7. 7. MAXILLOFACIAL INJURIES Zygomatic complex fractures Mechanism of Injury Direct & Indirect In-bending at area of impact Out-bending of weak areas (distant) Dislocation posterior inferior medial lateral GK / MAXFAC SDM DHARWAD
    8. 8. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiological features • Management GK / MAXFAC SDM DHARWAD
    9. 9. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical Features Flattening of cheek Periorbital edema / Ecchymosis Subconjunctival haemorrhage Epistaxis / Surgical emphysema Proptosis / Enophthalmos GK / MAXFAC SDM DHARWAD
    10. 10. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical Features ENOPHTHALMOS • Inferior & posterior displacement • Expansion of orbit EXOPHTHALMOS • Medial dislocations GK / MAXFAC SDM DHARWAD
    11. 11. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical Features Paresthesia (V2) / Pain !!! Trismus Tenderness / Step deformity Facial nerve weakness Drooping of upper lip DIPLOPIA GK / MAXFAC SDM DHARWAD
    12. 12. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical examination Palpation: • Step / tenderness / mobility • Supra-orbital rim • F-Z suture • Infra-orbital rim • Paresthesia (lip, nose 14-11 + gingiva) GK / MAXFAC SDM DHARWAD
    13. 13. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiology • Management GK / MAXFAC SDM DHARWAD
    14. 14. MAXILLOFACIAL INJURIES Zygomatic complex fractures Radiographic examination Occipito-mental view (PNS view, Waters position) Fronto-zygomatic suture Zygomatico-maxillary buttress Inferior orbital rim GK / MAXFAC SDM DHARWAD
    15. 15. MAXILLOFACIAL INJURIES Zygomatic complex fractures Radiographic examination Submento-vertex view (jug handle view) Zygomatic arch Posterior displacement GK / MAXFAC SDM DHARWAD
    16. 16. MAXILLOFACIAL INJURIES Zygomatic complex fractures Radiographic examination C.T. Scans: GK / MAXFAC SDM DHARWAD
    17. 17. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiology • Management GK / MAXFAC SDM DHARWAD
    18. 18. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Immediate – primary care: • ABC • Nasal packs Anterior / Posterior • Control of pain • Control of infection - Tetanus!! • Prevent surgical emphysema GK / MAXFAC SDM DHARWAD
    19. 19. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management • Restoration of form & function • Anatomic reduction • Treatment: “Surgical intervention” Closed v/s Open • Displacement & comminution • Exposure of fracture site • Fixation GK / MAXFAC SDM DHARWAD
    20. 20. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Closed Reduction Arch fractures Minimal disruption (at 2 sutures) Intra-oral approach (Keen 1909) GK / MAXFAC SDM DHARWAD
    21. 21. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Closed Reduction • Temporal approach (Gillies 1927) GK / MAXFAC SDM DHARWAD
    22. 22. Gillies Temporal Approach GK / MAXFAC SDM DHARWAD
    23. 23. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Closed Reduction • Transcutaneous approach GK / MAXFAC SDM DHARWAD
    24. 24. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Open Reduction & fixation F-Z Suture Infra-orbital rim & orbital floor Zygomatico-maxillary buttress (Intra-oral) GK / MAXFAC SDM DHARWAD
    25. 25. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management : Open Reduction F-Z Suture GK / MAXFAC SDM DHARWAD
    26. 26. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management : Open Reduction Zygomatico-maxillary suture Infra-orbital rim GK / MAXFAC SDM DHARWAD
    27. 27. MAXILLOFACIAL INJURIES Orbital floor Fractures (blow out #s) Shape: Pyramidal Apex Optic foramen Roof, Lateral wall, floor & medial wall Direct injury to globe  intraoccular pressure GK / MAXFAC SDM DHARWAD Fracture floor/medial wall
    28. 28. MAXILLOFACIAL INJURIES Orbital floor Fractures (blow out #s) • Applied anatomy • Clinical features • Radiographic features • Management GK / MAXFAC SDM DHARWAD
    29. 29. MAXILLOFACIAL INJURIES Orbital floor Fractures (blow out #s) Applied anatomy Floor : Zygoma & Maxilla Entrapment “Trap door effect” Diplopia , Enophthalmos GK / MAXFAC SDM DHARWAD
    30. 30. MAXILLOFACIAL INJURIES Orbital floor Fractures (blow out #s) Clinical features Pain Edema Ecchymosis Proptosis Paraesthesia Emphysema Diplopia GK / MAXFAC SDM DHARWAD
    31. 31. MAXILLOFACIAL INJURIES Orbital floor Fractures (blow out #s) Radiographic features Occipito-mental view ( PNS, Water’s View) “Hanging Drop” CT Scan: Coronal cuts: Floor Axial cuts: Medial wall GK / MAXFAC SDM DHARWAD
    32. 32. MAXILLOFACIAL INJURIES Orbital floor Fractures (blow out #s) Management Diplopia & Enophthalmos Surgical & surgical only Create a new floor Bone Cartilage Metal: titanium GK / MAXFAC SDM DHARWAD
    33. 33. MAXILLOFACIAL INJURIES Orbital floor Fractures (blow out #s) Management Incidence – 2 / 62 Reconstruct floor to prevent enophthalmos & diplopia SDM DHARWAD
    34. 34. MAXILLOFACIAL INJURIES
    35. 35. If you cannot convince people… confuse them
    36. 36. Thank You

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