Management of tripod fractures (zygomaticomaxillary complex) 1 point and 2 point fixations: A 5-year review

Abstract

The zygomaticomaxillary complex (ZMC) plays a key role in the structure, function, and esthetic appearance of the facial skeleton. They can account for approximately 40% of mid-face fractures. They are the second most common facial bone fracture after nasal bone injuries. The fracture complex results from a direct blow to the malar eminence and results in three distinct fracture components that disrupt the anchoring of the zygoma. In addition, the fracture components may result in impingement of the temporalis muscle, trismus (difficulty with mastication) and may compromise the infraorbital foramen/nerve resulting in hypesthesia within its sensory distribution. A 4-year retrospective review of all patients treated with ZMC fractures at oral and maxillofacial surgery department, sree balaji dental college and hospital was performed. Computed tomography scans were reviewed. Demographics, treatment protocols, outcomes, complications, reoperations, and length of follow-up were identified. A total of 245 patients was identified by the Current Procedural Terminology codes for ZMC fractures. Closed or open reduction methods were performed with the goal of treatment being preservation of normal facial structure, sensory function, globe position, and mastication functionality. Unacceptably poor surgical outcomes are uncommon. Significant facial asymmetry requiring surgical revision occurs in 3-4% of patients. Postoperative infection rates are extremely low, and these infections nearly always resolve with oral antibiotics. In general, the long-term prognosis after repair of ZMC fractures is very good.

Frequency of infra-orbital nerve injury after a Zygomaticomaxillary complex fracture and its functional recovery after open reduction and internal fixation

“…18 Balakrishnan from India also reported age group 20 to 40 being more prone to RTAs which was also concordant with our results. 19 Nerve injury following fracture may present with various pathophysiology involving traction, pressure, ischemia, inflammation and physical damage of the infra-orbital nerve resulting in sensory neuropathy and motor functions in the area of innervation of infra-orbital nerve both as presenting symptom and as a postoperative complication. 7 A study from Iran assessed the sensorimotor nerve damage in patients with maxillofacial trauma and found that infra-orbital nerve damage was the second most common nerve damaged after trigeminal.…”

Review of In Vivo Bone Strain Studies and Finite Element Models of the Zygomatic Complex in Humans and Nonhuman Primates: Implications for Clinical Research and Practice

“…Resorbable plates offer one possible solution, but the ideal combination of resorbable and titanium plates in adults is still being evaluated (Hanemann et al, ) and to our knowledge there are no randomized controlled studies of their long term sequelae in children (Boyette, ). Decreasing the number of plates provides another route to decreased morbidity, and the early agreement on the advisability of using at least two mini‐plates in zygomatic fracture repair (Rinehart et al, ; Davidson et al, ) is being questioned by advocates of single plate implants (Balakrishnan et al, ).…”

Does Training Background Influence Decision-Making in the Management of Zygomaticomaxillary Complex Fractures?

“…[1][2][3][4] Despite the relative frequency of these injuries, there remains debate regarding management, including number of approaches and points of fixation and the decision to explore the orbital floor. [5][6][7][8][9][10][11][12][13][14] Recent studies have attempted to resolve these controversies using large cohorts to derive algorithms for management. 2,3 At many institutions, facial trauma management is divided across several services, such as oral and maxillofacial surgery, plastic and reconstructive surgery, and otolaryngology (ORL).…”