Skip to main content
Erschienen in: Oral and Maxillofacial Surgery 1/2021

25.07.2020 | Original Article

Zygomaticomaxillary fracture fixation: a prospective comparative evaluation of two-point versus three-point fixation

verfasst von: Saikrishna Degala, Sathish Radhakrishna, Shweta Dharmarajan

Erschienen in: Oral and Maxillofacial Surgery | Ausgabe 1/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Zygomatic bone has a higher risk of sustaining injuries in the maxillofacial skeleton. On fracturing, zygomatic bone separates from the four neighbouring bones at its articulations. Treatment for zygomaticomaxillary fractures has evolved a long way since 3000 BC. With the advent of miniplates for midface fracture, controversies still exist regarding the stability of zygoma following 1, 2, and 3 points for fixation. The study aims to compare and determine the most effective technique for the reduction of zygomaticomaxillary fractures and the ability to retain the fractured zygoma in a stable position. Hence, a study was conducted in our institute to compare 2 and 3-point fixation of zygomaticomaxillary fractures taking into account the clinical and radiographic parameters.

Methods

Twenty-four patients were divided into 2 equal groups A and B, receiving 2- and 3-point fixation respectively. Fracture displacement and stability were assessed using coronal and axial CT scan tracings at preoperatively, immediate, and 5-week postoperatively.

Results

Group B showed a significant reduction in postoperative mean displacement at sphenozygomatic and infraorbital region when compared with group A. Patients in group A had an increase incidence in vertical dystopia and enophthalmos. There was no postoperative displacement at any site in both the groups.

Conclusion

The fractured segment was held in place by both the fixation methods but 3-point fixation gave better stability in maintaining the fractured segment in desired reduced position.
Literatur
1.
Zurück zum Zitat Rana M, Warraich R, Tahir S, Iqbal A, Von See C, Eckardt AM, Gellrich NC (2012) Surgical treatment of zygomatic bone fracture using two points fixation versus three-point fixation-a randomized prospective clinical trial. Trials. 13(1):36CrossRef Rana M, Warraich R, Tahir S, Iqbal A, Von See C, Eckardt AM, Gellrich NC (2012) Surgical treatment of zygomatic bone fracture using two points fixation versus three-point fixation-a randomized prospective clinical trial. Trials. 13(1):36CrossRef
2.
Zurück zum Zitat Kovacs AF, Ghahremani M (2001) Minimization of zygomatic complex fracture treatment. Int J Oral Maxillofac Surg 30(5):380–383CrossRef Kovacs AF, Ghahremani M (2001) Minimization of zygomatic complex fracture treatment. Int J Oral Maxillofac Surg 30(5):380–383CrossRef
4.
Zurück zum Zitat Kelley P, Hopper R, Gruss J (2007) Evaluation and treatment of zygomatic fractures. Plast Reconstr Surg 120(7):5S–15SCrossRef Kelley P, Hopper R, Gruss J (2007) Evaluation and treatment of zygomatic fractures. Plast Reconstr Surg 120(7):5S–15SCrossRef
5.
Zurück zum Zitat Bluebond-Langner R, Rodriguez E (2009) Application of skeletal buttress analogy in composite facial reconstruction. Craniomaxillofac Trauma Reconstr 2(01):019–025CrossRef Bluebond-Langner R, Rodriguez E (2009) Application of skeletal buttress analogy in composite facial reconstruction. Craniomaxillofac Trauma Reconstr 2(01):019–025CrossRef
6.
Zurück zum Zitat Pappachan B, Alexander M (2012) Biomechanics of cranio-maxillofacial trauma. J Maxillofac Oral Surg 11(2):224–230CrossRef Pappachan B, Alexander M (2012) Biomechanics of cranio-maxillofacial trauma. J Maxillofac Oral Surg 11(2):224–230CrossRef
7.
Zurück zum Zitat Rudderman RH, Mullen RL (1992) Biomechanics of the facial skeleton. Clin Plast Surg 19(1):11–29CrossRef Rudderman RH, Mullen RL (1992) Biomechanics of the facial skeleton. Clin Plast Surg 19(1):11–29CrossRef
8.
Zurück zum Zitat Dal Santo F, Ellis E III, Throckmorton GS (1992) The effects of zygomatic complex fracture on masseteric muscle force. J Oral Maxillofac Surg 50(8):791–799CrossRef Dal Santo F, Ellis E III, Throckmorton GS (1992) The effects of zygomatic complex fracture on masseteric muscle force. J Oral Maxillofac Surg 50(8):791–799CrossRef
9.
Zurück zum Zitat Agasao M, Nagasao T, Imanishi Y, Tomita T, Tamaki T, Ogawa K (2009) Experimental evaluation of relapse-risks in operated zygoma fractures. Auris Nasus Larynx 36(2):168–175CrossRef Agasao M, Nagasao T, Imanishi Y, Tomita T, Tamaki T, Ogawa K (2009) Experimental evaluation of relapse-risks in operated zygoma fractures. Auris Nasus Larynx 36(2):168–175CrossRef
10.
Zurück zum Zitat Hwang K (2010) One-point fixation of tripod fractures of zygoma through a lateral brow incision. J Craniofac Surg 21(4):1042–1044CrossRef Hwang K (2010) One-point fixation of tripod fractures of zygoma through a lateral brow incision. J Craniofac Surg 21(4):1042–1044CrossRef
11.
Zurück zum Zitat Zingg M, Chowdhury K, Lädrach K, Vuillemin T, Sutter F, Raveh J (1991) Treatment of 813 zygoma-lateral orbital complex fractures: new aspects. Arch Otolaryngol Head Neck Surg 117(6):611–620CrossRef Zingg M, Chowdhury K, Lädrach K, Vuillemin T, Sutter F, Raveh J (1991) Treatment of 813 zygoma-lateral orbital complex fractures: new aspects. Arch Otolaryngol Head Neck Surg 117(6):611–620CrossRef
12.
Zurück zum Zitat Chakranarayan A, Thapliyal GK, Sinha R, Suresh MP (2009) Efficacy of two point rigid internal fixation in the management of zygomatic complex fracture. J Maxillofac Oral Surg 8(3):265–269CrossRef Chakranarayan A, Thapliyal GK, Sinha R, Suresh MP (2009) Efficacy of two point rigid internal fixation in the management of zygomatic complex fracture. J Maxillofac Oral Surg 8(3):265–269CrossRef
13.
Zurück zum Zitat Karlan MS, Cassisi NJ (1979) Fractures of the zygoma: a geometric, biomechanical, and surgical analysis. Arch Otolaryngol 105(6):320–327CrossRef Karlan MS, Cassisi NJ (1979) Fractures of the zygoma: a geometric, biomechanical, and surgical analysis. Arch Otolaryngol 105(6):320–327CrossRef
14.
Zurück zum Zitat Punjabi SK, Rehman H, Ali Z, Ahmed S (2011) Causes and management of zygomatic bone fractures at Abbasi Shaheed Hospital Karachi (analysis of 82 patients). JPMA J Pak Med Assoc 61(1):36PubMed Punjabi SK, Rehman H, Ali Z, Ahmed S (2011) Causes and management of zygomatic bone fractures at Abbasi Shaheed Hospital Karachi (analysis of 82 patients). JPMA J Pak Med Assoc 61(1):36PubMed
15.
Zurück zum Zitat Parashar A, Sharma RK, Makkar S (2007) Rigid internal fixation of zygoma fractures: a comparison of two-point and three-point fixation. Indian J Plast Surg 40(1):18 Parashar A, Sharma RK, Makkar S (2007) Rigid internal fixation of zygoma fractures: a comparison of two-point and three-point fixation. Indian J Plast Surg 40(1):18
16.
Zurück zum Zitat Rana M, Warraich R, Tahir S, Iqbal A, Von See C, Eckardt AM, Gellrich NC (2012) Surgical treatment of zygomatic bone fracture using two points fixation versus three point fixation-a randomised prospective clinical trial. Trials. 13(1):36CrossRef Rana M, Warraich R, Tahir S, Iqbal A, Von See C, Eckardt AM, Gellrich NC (2012) Surgical treatment of zygomatic bone fracture using two points fixation versus three point fixation-a randomised prospective clinical trial. Trials. 13(1):36CrossRef
17.
Zurück zum Zitat Ellis E, Kittidumkerng W (1996) Analysis of treatment for isolated zygomaticomaxillary complex fractures. J Oral Maxillofac Surg 54(4):386–400CrossRef Ellis E, Kittidumkerng W (1996) Analysis of treatment for isolated zygomaticomaxillary complex fractures. J Oral Maxillofac Surg 54(4):386–400CrossRef
18.
Zurück zum Zitat Strong EB, Sykes JM (1998) Zygoma complex fractures. Facial Plast Surg 14(01):105–115CrossRef Strong EB, Sykes JM (1998) Zygoma complex fractures. Facial Plast Surg 14(01):105–115CrossRef
19.
Zurück zum Zitat De Ruiter BJ, Levin A, Nash DW, Kamel GN, Mostafa E, Baghdasarian D, Davidson EH (2019) The zygomaticosphenoidal angle: a reference for surgical navigation in zygomaticomaxillary complex fracture repair. Plast Reconstr Surg Glob Open 7(8S-1):71–72CrossRef De Ruiter BJ, Levin A, Nash DW, Kamel GN, Mostafa E, Baghdasarian D, Davidson EH (2019) The zygomaticosphenoidal angle: a reference for surgical navigation in zygomaticomaxillary complex fracture repair. Plast Reconstr Surg Glob Open 7(8S-1):71–72CrossRef
20.
Zurück zum Zitat Candamourty R, Narayanan V, Baig MF, Muthusekar MR, Jain MK, Babu RM (2013) Treatment modalities in zygomatic complex fractures: a prospective short clinical study. Dent Med Res 1(1):13 Candamourty R, Narayanan V, Baig MF, Muthusekar MR, Jain MK, Babu RM (2013) Treatment modalities in zygomatic complex fractures: a prospective short clinical study. Dent Med Res 1(1):13
21.
Zurück zum Zitat Ridgway EB, Chen C, Colakoglu S, Gautam S, Lee BT (2009) The incidence of lower eyelid malposition after facial fracture repair: a retrospective study and meta-analysis comparing subtarsal, subciliary, and transconjunctival incisions. Plast Reconstr Surg 124(5):1578–1586CrossRef Ridgway EB, Chen C, Colakoglu S, Gautam S, Lee BT (2009) The incidence of lower eyelid malposition after facial fracture repair: a retrospective study and meta-analysis comparing subtarsal, subciliary, and transconjunctival incisions. Plast Reconstr Surg 124(5):1578–1586CrossRef
22.
Zurück zum Zitat Benoliel R, Birenboim R, Regev E, Eliav E (2005) Neurosensory changes in the infraorbital nerve following zygomatic fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 99(6):657–665CrossRef Benoliel R, Birenboim R, Regev E, Eliav E (2005) Neurosensory changes in the infraorbital nerve following zygomatic fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 99(6):657–665CrossRef
Metadaten
Titel
Zygomaticomaxillary fracture fixation: a prospective comparative evaluation of two-point versus three-point fixation
verfasst von
Saikrishna Degala
Sathish Radhakrishna
Shweta Dharmarajan
Publikationsdatum
25.07.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
Oral and Maxillofacial Surgery / Ausgabe 1/2021
Print ISSN: 1865-1550
Elektronische ISSN: 1865-1569
DOI
https://doi.org/10.1007/s10006-020-00881-4

Weitere Artikel der Ausgabe 1/2021

Oral and Maxillofacial Surgery 1/2021 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.