Surgical Approaches and Fixation Patterns in Zygomatic Complex Fractures

Abstract

The aim of this research was to analyze the surgical approaches and methods of rigid fixation used to treat zygomatic complex (ZC) fractures over a 10-year period. One hundred fifty-three patients who underwent surgery to treat ZC fractures between 1999 and 2008 were retrospectively evaluated. Demographic information, signs, and symptoms of the fractures, classification, surgical approaches, and methods of internal fixation were obtained from the medical records. The data were analyzed using statistical descriptive analysis and chi test (P < 0.05). The mean age of the sample was 31 years, and males were predominant (82.3%). In 60.1% of the patients, one surgical approach was used to treat the ZC fractures, whereas 2 surgical approaches were used in 24.8% of the patients. The zygomaticomaxillary buttress was fixed in 86.9% of the patients, followed by infraorbital rim fixation and zygomaticofrontal. There was a statistical significance between fracture displacement and surgical approach for the infraorbital rim (P < 0.0001) and zygomaticofrontal suture (P < 0.0001). Considering that adequate reduction and fixation should be performed and that we try to minimize the amount of scarring, the intraoral zygomaticomaxillary buttress approach is the first choice to treat ZC fractures. In cases of displacement bigger than 5 mm, approaches to 3 of 4 points of the ZC are mandatory to reduce the fractures. The infraorbital rim and zygomaticofrontal suture approaches are indicated to treat displaced fractures.

Correlation between clinical findings and CT-measured displacement in patients with fractures of the zygomaticomaxillary complex

“…Mean age at the time of fracture was 42.7 years in our study. In a retrospective 10-year study involving 153 patients, Olate et al reported on a mean age of 31 years (Olate et al, 2010). In a study conducted in Brazil Calderoni et al (2011) reported on a predominance of patients aged between 21 and 30 years.…”

“…In cases of minimal displacement the zygomaticomaxillary buttress is exposed by an intraoral approach and stabilized by a 2.0 mm miniplate. However, in most cases additional exposure of the infraorbital rim via a subtarsal, subciliary or transconjuctival incision as well as exposure of the zygomaticofrontal buttress via an eyebrow margin incision or an upper blepharoplasty incision followed by microplate stabilization is necessary (Olate et al, 2010). In cases of involvement of the orbital floor reconstruction might be necessary.…”

Estudio Morfométrico de la Región Orbitaria para la Instalación de Implantes Craneofaciales

“…Por otra parte, en la región lateral de la órbita existe la posibilidad de instalar implantes sin complicaciones anatómicas relevantes; de hecho, esta área es frecuentemente abordada para el manejo del trauma facial con éxito en los tratamientos (Olate et al 2010).…”

Two point fixation in zygomatic compex fractures

“…Infra orbital and zygomatico frontal suture approach was used to treat the displaced zygomatic complex fractures. [8] Six mm screws can be safely placed above the frontozygomatic suture. Infra orbital rim incision provided adequate exposure of the fracture site; compressed infra orbital nerve was released from the fractured fragments.…”