Efficacy of two-point fixation in the management of zygomatic complex fractures – A prospective clinical study

Mittal, Gaurav; Garg, Ritesh; Sharma, Siddharth; Rathi, Vidhi Chhabra; Ranjan, Rakesh; Khare, Gagan

doi:10.4103/njms.njms_49_18

Cited by 6 publications

(5 citation statements)

References 10 publications

(8 reference statements)

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“…Another study on the stability of two-point fixation was conducted on 20 patients by Mittal et al by comparing the values of the malar height and vertical dystopia disparity in the water's view radiograph before and after the operation. The study demonstrated that radiographic and clinical indices significantly improved after surgery, demonstrating that two-point fixation successfully stabilizes the fragmented pieces [21] . The results of the present study agree with the conducted results above as clinically and aesthetically sufficient results were obtained after fixation of ZMC by the 2-point technique providing the reliability of using the 2-point technique for management of ZMC fractures.…”

Section: Discussionmentioning

confidence: 81%

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Facial Asymmetry After Management of Unilateral Zygomaticomaxillary Complex Fractures Using Two-Point Fixation Technique

2024

The Egyptian Journal of Hospital Medicine

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Background: It is crucial to correctly identify and treat zygomatic bone injuries because of the zygoma's functional and aesthetic importance in the face contour. Zygomatic fractures can cause disfigurement, which necessitates operation to restore face symmetry. Objective: To evaluate the facial asymmetry after management of unilateral zygomaticomaxillary complex fracture using a two-point fixation technique. Patients and Methods: This study was conducted on 20 patients with unilateral zygomaticomaxillary complex (ZMC) fractures managed by a two-point fixation technique. The zygomaticomaxillary (ZM) buttress was used as a key point of fixation through an intra-oral approach for all patients and either the infraorbital rim (IOR) or the frontozygomatic (FZ) suture area was used as a second point of fixation. Radiographic assessment of the computed tomography (CT) scans was done by measuring the malar width, malar projection, and malar height on the fracture side and the normal side both preoperatively and postoperatively after 1 week and after 1 month. The asymmetry index comparing the normal side with the fracture side was measured both preoperatively and postoperatively. Results: The difference between preoperative and 1-week, 1-month postoperative malar width and malar projection was highly significant, while the malar height difference wasn't significant. The asymmetry index decreased significantly postoperatively by 1 week and 1 month by using the 2-point fixation technique. Conclusions: Stable fixation results and adequate aesthetic outcomes can be obtained by using the 2-point fixation technique in the management of ZMC fractures.

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Section: Discussionmentioning

confidence: 81%

“…The identification, evaluation, and surgical treatment of ZMC fractures have been the subject of a great deal of research. Nevertheless, quantitative measurement of postoperative malar asymmetry has not been the basis of many studies [21][22][23] . Using paired landmarks, the asymmetry index may measure the three-dimensional face symmetry.…”

Section: Discussionmentioning

confidence: 99%

Facial Asymmetry After Management of Unilateral Zygomaticomaxillary Complex Fractures Using Two-Point Fixation Technique

2024

The Egyptian Journal of Hospital Medicine

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“…A total of 20 patients with established ZMC fractures were operated with a two-point fixation method and followed up for up to 3 months. 2-point fixation revealed satisfactory functional and aesthetic results, offering an efficient result compared to other modalities of management of ZMC [24].…”

Section: Major Clinical Outcomesmentioning

confidence: 84%

Major clinical and surgical approaches to treating orbitozygomatic and zygomatic maxillary complex fractures: a systematic review

Baraúna,

Gomes,

Beneti

2024

MedNEXT

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Introduction: In the scenario of orbitozygomatic fractures, facial and head injuries account for half of deaths due to trauma, and thousands are left with long-term or permanent injuries. Fractures of the zygomatic-maxillary complex (ZMC) and zygomatic arch are common athletic injuries. Operative treatment is indicated in cases of significant displacement or functional disturbance. Technology such as virtual surgical planning, intraoperative navigation, and intraoperative imaging has the potential to improve the accuracy of treatment of challenging fractures. Objective: It was to develop a systematic review of the main clinical and surgical approaches to the treatment of orbitozygomatic and zygomatic maxillary complex fractures. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from October 2023 to January 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 102 articles were found, 26 articles were evaluated in full and 25 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 14 studies with a high risk of bias and 12 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=57.9%>50%. A single-piece fracture of the fronto-orbito-zygomatic-maxillary bone connected to a temporoparietal bone may require additional osteotomy to achieve successful results in an acute setting. Orbital volume analysis offers a valid modality for objectively evaluating the efficiency of the management of orbitozygomatic complex fractures. The success rate of the fixation procedure at 1 point of the zygomaticomaxillary complex is high, with minimal complications. Intraoperative CT/three-dimensional imaging should be used in the treatment of ZMC fractures requiring orbital floor reconstruction, where adjacent fractures require fixation and/or when ≥ 2 axes are displaced ≥ 5 mm.

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“…Mittal et al in their study on pre and post operative values on vertical dystopia and malar height discrepancy showed a statistically significant increase in clinical parameters post operatively and concludes that 2-point fixation provides a stable fixation. 18 In our trauma center 2-point fixation was maximally used in 3 years. Acquiring an informed consent for performing infraorbital approach for reducing and fixing was bit tiresome as they were not prepared for scar below the eye as most of the patients were in young age group.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of Management of Zygomatic Complex Fractures

Kambalimath,

M.V.V.

et al. 2023

The Traumaxilla

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Introduction Zygomatic bone and its surrounding bony anatomy are essential for maintaining facial contour—cheek prominence and orbital integrity. Management of the zygomatic complex (ZMC) fractures are important in the maintenance of function and facial integrity. Aim and Objectives To analyze the incidence, aetiology, surgical management, and complications encountered in the treatment of ZMC fractures in our super-specialty hospital, and to compare the number and location of fixation points and surgical access in our patient cohort with the literature. Materials and Method Retrospective analysis of all operative cases (Open Reduction and Internal Fixation) of ZMC fractures over a 3-year period (2017-2021) were reviewed. Craniofacial maxillofacial trauma patient’s medical records were collected and out which only the ZMC fracture cases were reviewed. Only the medical records from the period from 2017 to 2021 were included. The parameters such as etiology, site of the ZMC fracture, type of fracture, associated injuries, clinical findings, treated with conservative or surgical intervention, type of incisions used, number of fixation used, and any complications encountered were reviewed and analyzed. Results Out of 428 cases of craniofacial injury, 96 cases were ZMC fractures, isolated ZMC fractures accounted for 43%, 33% with associated injuries, 13% isolated arch, while 11% accounted isolated infraorbital rim fracture. Most common clinical findings were subconjunctival ecchymosis (71%), flattening of cheek (39%), malocclusion (22%), and so on. Buccal sulcus incision (66%) was mainly used, followed by upper blepharoplasty incision (59%). Depending on degree of displacement of fracture 1-point fixation (8%), 2-point fixation (30%), or 3-point fixation (27%) was performed. About 33% of cases were conservatively managed and followed up on regular intervals. Lymph edema, infra orbital paresthesia, temporary blindness, diplopia, hemianopsia were some of the complications encountered which were managed successfully and followed up. Conclusion ZMC fractures are most commonly occurring midface fractures with variable etiologies. The most common ZMC fracture pattern was tripod type of fracture. Greater portion of the patient were treated with 2-point fixation. Most of the complications were due to the impact and velocity of trauma.

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Efficacy of two-point fixation in the management of zygomatic complex fractures – A prospective clinical study

Cited by 6 publications

References 10 publications

Facial Asymmetry After Management of Unilateral Zygomaticomaxillary Complex Fractures Using Two-Point Fixation Technique

Facial Asymmetry After Management of Unilateral Zygomaticomaxillary Complex Fractures Using Two-Point Fixation Technique

Major clinical and surgical approaches to treating orbitozygomatic and zygomatic maxillary complex fractures: a systematic review

Retrospective Analysis of Management of Zygomatic Complex Fractures

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