Aim: To analyse the epidemiology, aetiology, and surgical management of zygomatic complex (ZMC) fractures in our major trauma centre, and to compare the number and location of fixation points and surgical access in our patient cohort with the literature. Methods: Retrospective analysis of all operative cases (Open Reduction and Internal Fixation) of zygomatic complex fractures over a one year period (2016). Results: A greater proportion of patients in our cohort (54%) were treated with one-point fixation compared to the literature, with the zygomaticomaxillary (ZM) buttress being the most popular fixation point (90%). ZM buttress and frontozygomatic (FZ) suture were the commonest choices for two-point fixations (70%). Buccal sulcus incision was used for ZM access in all cases. For FZ access, upper blepharoplasty incision was the most common (56%). For infra-orbital margin access, transconjunctival incision was the most common (75%). There was no significant association between number of fixation points and presence of associated injuries, impact of injury, or time to operation. There were no post-operative complications. Conclusion: A greater proportion of patients in our cohort were successfully treated with one point fixation compared to the literature, and fewer patients underwent orbital floor exploration and repair in our cohort compared to the literature. This study highlights the ongoing variation in the surgical management of ZMC fractures.

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Mini-implants or mini-screws also known as Temporary anchorage devices (TADs) have become widely accepted component of everyday orthodontic practice as chief anchorage source. The proximity of the implant to the root surface, placement in the alveolar mucosa and improper angulations are the most important reasons for failure of mini-implants. So we have designed a modified implant placement grid which does not need to be attached separately to a section of wire; as it can be fixed easily to the Final archwire with the help of Guerin lock. This guide can be used in buccal as well as lingual cases. The grid is approximately 2.5 cm in height and the overall structure is rectangular in shape with 10mm in length and 5mm in width and also has an extending long arm which is approximately 1.5mm in length. With the use of the custom made modified grid, the implant can be precisely and dependably placed in areas of reduced space and near to important anatomical structures. The versatility of the grid lies in the fact that it can be fabricated chair side and suits in different anatomic location and clinical situation.

Anchorage refers to the resistance against displacement by anatomical structures and the control of anchorage is one of the main factors for determining the success of orthodontic treatment. Conventional means of anchorage system were extra-oral and intra-oral anchorage. Evolution of intra-oral skeletal anchorage provided “Absolute Anchorage” using dental implants, miniplates and mini implant for fixed appliances which demanded stationary type of anchorage. Success of orthodontic mini implant depends on root proximity of the screw, cortical bone thickness and placement angle. In this article, we have described a grid for site selection and a well designed standard placement guide to prevent the root proximity while insertion, and reduce the chance of implant failure.

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