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fractures of zygomatic bone
- 1. Fractures of zygomaticbone Dr Deepak Kumar
- 2. Introduction • Zygoma :strong buttress of lateral midface Lying between Zygomatic processes of frontal bone and maxilla • High Incidence of ZMC Fracture Related to it’s prominent position within the facial skeleton.
- 3. • Role instructure,function and esthetics of facial region Protects the globe of the eye and separates the orbital contents from temporal fossa and maxillary sinus Forms the lateral part of the orbit. Origin to masseter muscle. Transmits part of the masticatory forces to cranium. Absorbs impact forces before it reaches brain.
- 4. • Sutures Zygomaticotemporalsuture Zygomaticomaxillary suture Frontozygomatic suture Zygomaticosphenoidal suture
- 5. Applied anatomy Thick,strong, quadrilateral Shape bone, with an outer convex (cheek) surface and inner concave ( temporal) surface. It forms the point of greater prominence of cheek. It resembles four sided pyramid which has Temporal,orbital ,maxillary and frontal processes Zygoma articulates 4 bones- 1. Frontal 2. Sphenoid 3. Maxillary 4. Temporal
- 6. Rowe and killeyclassification: Type 1: no significant displacement Type 2: fractures of zygomatic arch Type 3: rotation around vertical axis Inward displacement of orbital rim Outward displacement of orbital rim Type 4: rotation around the longitudinal axis Medial displacement of the frontal process Lateral displacement of frontal process
- 8. Type 5:displacement of the complex en bloc Medial Inferior Lateral (rare) Type 6: displacement of the orbitoantral partition Inferiorly Superiorly (rare)
- 9. Type 7:displacement of orbital rim segments Type 8: complex comminuted fractures.
- 10. • Rowe’s modifiedclassification : Type 1: single or double un- displaced fracture Type 2: displacement with bone contact at all fracture lines Type 3: displacement without bone contact at one fracture line
- 11. Type 4:displacement without bone contact at two fracture lines Type 5: comminuted fractures or displacement without bone contact at more than three or more fracture lines.
- 12. • Signs andsymptoms: Flattening/ loss of contour the injured cheek. Unilateral epistaxis may be present. Circumorbital ecchymosis will develop after few hours from effusion of blood into surrounding tissues. subconjunctional hemorrhage is observed at the outer canthus Depression of the ocular level / limitation of ocular movement Proptosis of eye due to retrobulbar hemorrhage
- 13. Patient maycomplain of diplopia and /or blurring of vision Anesthesia of cheek,nose ,lip may b present Step deformity of the infraorbital margin Limitation of mandibular movement Ecchymosis and tenderness in the upper buccal sulcus,change in sensation of the teeth and gums. Enophthalmos may be seen
- 14. • Treatment ofzygomatic bone fractures: Stable fractures: simple elevation will be sufficient,because of high degree of stability due to integrity of temporal fascia and interdigitation of the fracture lines. No additional fixation is required after reduction. 1. Type 1: no treatment 2. Type 2: unless vertically displaced 3. Type 3 and type 4(a): open reduction may be required and transosseous wiring is advisable
- 15. Unstable fractures:require open reduction and transosseous wiring or bone plating . Type 4(b) Type 5,6 and 7,8
- 16. • Operative technique: Temporal fossa approach Buccal sulcus approach Lateral coronoid approach Percutaneous approach Intranasal transantral approach Towel clip reduction Endoscopic management Modified gilles’s approach in the setting of bicoronal exposure Coronal/ bicoronal approach
- 17. • Gillies temporalapproach: Temporal fascia is attached to zygomatic arch and the temporal muscle passes downward medial to the fascia to be attached to the coronoid process. Between two structures a natural anatomical space exists into which an instrument can be inserted And it can be utilized to elevate the displaced zygoma or its arch into position
- 18. Technique: Hairis shaved from the temporal region of scalp. External auditory meatus is plugged with cotton to prevent any fluid or blood getting inside. Incision about 2- 2.5cm in length and inclined forward at 45° to zygomatic arch, well in temporal region.
- 20. Temporal fasciais exposed which can be identified as white glistening structure. Incision is taken into the fascia and the fibers of temporalis muscles will be seen. Then long bristow’s periosteal elevator is passed below the fascia and above the muscle And the instrument is inserted through it, downward and forward, tip of the instrument is adjusted medially to the displaced fragment.
- 21. Thick gauzepad is kept on the lateral aspect of skull to protect it from pressure of elevator while reduction. Tip of elevator is manipulated upward, forward and outward Snap sound is heard as reduction procedure is complete Wound is closed in layers
- 22. Shave Temporalregion Incision and dissection Incision of temporal Fascia Pass elevator blade Outward and forward force And closed wound
- 23. • Intraoral procedure: Keen’s approach: buccal vestibular incision is taken in first and second molar region behind zygomatic buttress Pointed curved elevator is passed supraperiosteally up beneath the zygomatic bone. Depressed bone is then elevated with an upward, forward and outward movement
- 25. Approaches toinfraorbital rim for direct fixation by bone plates: Existing skin laceration Infraorbital rim incision Subtarsal incision Subciliary incision Transconjuctival incision
- 26.