Evaluation of Zygomaticosphenoidal Angle in Patients With Unilateral Zygomaticomaxillary Complex Fracture

Abstract

The anterior wall of the maxilla is a very thin bone. Thus, when isolated anterior wall fractures of the maxilla occur, it is highly likely that comminuted fractures with several small bone fragments develop. Comminuted fractures are difficult to reduce and fix using conventional methods that use plates and screws due to the thin anterior wall of the maxilla and the presence of small fragments. If the fractured anterior wall of the maxillary sinus is not properly restored, complications, such as rhinitis, sinusitis, prolapse of facial soft tissue, and mucosal irritation may occur. 6 Fixation using absorbable mesh allows for relatively accurate reduction and has the advantage of having a reduced operation time as compared to the conventional internal fixation method using plates and screws. However, complications, such as rhinitis, purulence, pain, and swelling, were reported due to the development of inflammatory reactions such as foreign body reactions when reconstruction was performed using mesh. 1 The maxillary sinus is the largest air cavity in the human body and plays a role in improving the respiratory function of the nose. The maxillary sinus plays an important role in the immune system of the nasal cavity and is involved in the production of nitrogen monoxide (NO). 7 The mucous membrane of the maxillary sinus continuously synthesizes and acts as a reservoir of NO. Therefore, it is important to preserve the mucosal layer of the maxillary sinus by minimizing dissection when reconstructing a fracture of the anterior wall of the maxillary sinus. 8 Fibrin glue is a surgical formulation used to form fibrin clots for hemostasis or wound healing. 9 A syringe containing plasma proteins, fibrinogen, and factor XIII and a syringe containing calcium chloride, thrombin, and aprotinin are packaged separately and mixed directly before use. An active form of a fibrin clot is formed upon mixing of the contents. Fibrin glue lowers the infection rate in wound healing. If fibrin glue is applied after sufficient reduction of comminuted fracture fragments, it can also promote healing of the mucosa as well as fibrocartilaginous callus formation, which is the healing process of a fractured bone. 10 As such, fibrin glue can decrease the shearing force by increasing the adhesion to the surrounding tissues and maintaining the restoration. 11 The adhesion strength of fibrin glue with human tissue is reported to be 811.1 mN/cm2. 12,13 Although this strength is inadequate to fix the facial buttress with great force, it is thought to be sufficient to fix thin, comminuted, and light fragments.The limitation of this study is its small sample size. However, fixation using only fibrin glue showed better or similar results in this study in terms of the length of hospital stay, follow-up period, and acute complication rates. Furthermore, no chronic complications were reported. Follow-up radiologic imaging tests showed a wellmaintained and adequately fused reduced site. CONCLUSIONSThe surgical method using only fibrin glue after th...

3D-Printed Zygomatic Sliding Surgical Guide: A novel surgical guide, An in vitro study.

“…9,[14][15][16] Besides, reduction at ZST and ZTT is done indirectly utilizing these local flaps. 30 The availability of computer-aided surgical techniques for diagnosis, virtual planning, and treatment of maxillofacial fractures allowed for individualized surgical fracture treatment minimizing the potential of postoperative pitfalls. 13,18,31 The 3DP-ZSSG managed to actively reduce the zygomatic bone into the virtually planned position with minimal mean deviation (ranging from zero to 0.6mm).…”