Zygomatic dental implant induced orbital fracture and inferior oblique trauma

Abstract

A 51-year-old female underwent four upper zygomatic dental implants (ZI) and one upper and four lower conventional implants. Immediately postoperatively, the patient had pain and diplopia upon manual elevation of the edematous eyelid. Panoramic x-ray showed a malpositioned right upper ZI, requiring removal of the right upper ZI the following day. The patient had delayed referral to ophthalmology one month later for persistent diplopia. Computed tomography scan and magnetic resonance imaging demonstrated a right inferolateral fracture with fibrosis surrounding the inferior oblique muscle. Clinical exam showed right lower eyelid retraction, right hypotropia, and inability to elevate in adduction, consistent with a right inferior oblique paresis. Surgical exploration revealed incarceration of lid and orbital tissue into the fracture. After repositioning of the prolapsed tissue, a high-density porous polyethylene implant was placed for fracture repair. The inferior fornix was reconstructed with amniotic membrane and 5-fluorouracil was injected into the scar tissue. Six months later, the patient underwent strabismus surgery with resolution of symptoms.

Reabilitação Com Ancoragem Zigomática

“…No trans-operatório, lesões provenientes de acidentes com brocas, lesões hemorrágicas, hematoma suborbital, sangramento nasal e perfuração da órbita, são condições muito citadas na literatura. Nesse sentido, é importante que o profissional informe ao paciente, para que o mesmo não seja pegue de surpresa e tenha convicção que essas manifestações podem acontecer (TRAN et al, 2018).…”

Complicaciones y satisfacción de pacientes rehabilitados con implantes cigomáticos en una clínica privada de Quito – Ecuador

“…2 Aunque las complicaciones antes mencionadas son las más frecuentes, otras complicaciones menos frecuentes descritas tienen que ver con la formación de fistulas oroantrales, formación de hematomas faciales y periorbitarios, epistaxis, defectos nerviosos sensoriales, enfisema subcutáneo, fistulas cutáneas y en casos raros penetración en la cavidad orbitaria o perforaciones intracerebrales. 19,20 La pobre higiene oral de los pacientes y la contaminación de los tejidos blandos que rodean los abutments pueden estar implicadas en complicaciones con los implantes cigomáticos con pérdida de osteointegración y periimplantitis. Las bacterias principalmente implicadas son los gram negativos anaerobios y las bacterias facultativas anaerobias como Prevotella spp, porphyromonas gingivalis, fusobacterium spp y actinomices spp.…”

“…Otros autores incluso advierten del riesgo de perforación ocular, indicando que es sorprendente que esta complicación aún no ha sido reportada en la literatura. 19,20 Topilow et al recomendó el uso de un calzador de acero inoxidable dentro del fórnix conjuntival inferior para proteger las estructuras orbitarias al momento de la perforación, este aparato puede ser colocado también en pacientes sedados luego de la aplicación de anestésico tópico. El feedback de contacto de metal con metal puede advertir al cirujano de parar el fresado y revisar la dirección de la perforación.…”

Reliability and accuracy of dynamic navigation for zygomatic implant placement

“…Due to the limited intraoperative visibility and anatomical intricacies of zygoma processes, zygomatic implant (ZI) surgery is considered a “semi‐blinded” surgery, and the difficulty and the rate of surgical complications sometimes increased (Block et al, 2009 ), such as orbital cavity penetration accompanied by extraocular injury (Krauthammer et al, 2017 ; Tran et al, 2019 ), intracranial placement (Reychler et al, 2010 ), infraorbital nerve and zygomaticofacial nerve paresthesia (Bedrossian & Bedrossian, 2018 ), and globe penetration (Topilow et al, 2020 ). To avoid these complications, Wu et al proposed eyelid incision to expose inferolateral orbital rim to avoid orbital cavity penetration complication (Wu et al, 2015 ).…”