Pdf on jan 22, 2015, gerhard s mundinger and others published zygomatic arch fracture with coronoid impingement find, read and cite all the research. Patients with single zygomatic arch fracture were excluded. Clinically, the depressed arch fracture has impinged on the coronoid process producing the limitation in mouth opening. Optimizing closed reduction of nasal and zygomatic arch fractures with a mobile fluoroscan. But when there is an associated depressed zygomatic arch fracture, the support is necessary from mediolateral or posterolateral aspect. Pdf zygomatic arch fracture with coronoid impingement. Lateral wall fractures are therefore more commonly seen following significant maxillofacial trauma involving the malar complex too. A zmc fracture that follows this pattern usually has one additional fracture line through the zygomatic arch. Orthopantogram xray clearly showed an additional fracture of the coronoid process. C, caldwells projection showing the density superimposed on the petrous portion of the temporal bone. Simple zygomatic arch orbitozygomatic fractures are usually the result of a blow to the lateral face, for example, during a fist fight or from an object such as a baseball. Isolated arch fractures are often the result of a direct lateral force to the arch that drives the fragments of the zygomatic arch medially surgery of the eyelid, orbit, and lacrimal system, oxford, 212217, 220222, 1995. Fractures of the zygomatic complex and arch pocket. This video documents the steps typically followed during open reduction of isolated, depressed zygomatic arch fractures.
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 1751, dupuytren detailed an intraoral and external technique to reduce a medial displaced zygomatic arch. In patients with two process fracture, the infra orbital rim and zygomatic buttress were the most common sites of fracture accounting 27. Also described was an approach to the zygomatic arch by way of a plane between. Diagnosis and management of common maxillofacial injuries. Epistaxis can occur when the turbinate bones are fractured, and nasolacrimal duct obstruction can result from a. This article focuses on the zygomatic arch fracture.
Because the point of least resistance to fracture is not at the zygomaticotemporal suture, but approximately 1. Management of isolated zygomatic arch fractures and a. Stabilization of the isolated zygomatic arch fracture using foleys. Related pathology le fort type 3 fracture zygomaticomaxillary complex fra. Management of zygomatic fractures pocket dentistry. Zygomatic arch fracture with coronoid impingement ncbi. A malar fracture should be suspected if periorbital oedema, ecchymosis of the lower lid, andor a lateral sub conjunctival haemorrhage bloodshot eye is present. The fixture at the infraorbital site is a 1 mm localising plate. According to the site of fracture, the patients were divided into three groups. Any patient who did not undergo a preoperative ct scan with 0. Interesting case series zygomatic arch fracture with coronoid impingement gerhard s.
These fractures are caused chiefly by automobile accidents, fist blows, and accidental falls. The malarzygomatic compound is formed by the zygoma, its frontal and maxillary processes and the zygomatic arch. Must distinguish zygomatic arch fracture from zygomaticomaxillary tripod fracture. This flatness may be concealed partially by soft tissue swelling for the first days to 2 weeks. Patient perspective in the management of zygomatic fractures. The rowes zygomatic elevator is then passed beneath the periosteal elevator, as it. Treatment for zygomatic arch fractures really depends on the specific fracture. Tripod fracture fracture of zygomatic arch, lateral and inferior orbital rims, and lateral wall of maxillary sinus. A flat malar arch is best assessed from behind the patients head. Isolated fractures of the zygomatic arch are a relatively common injury, and reduction of the fracture is usually accomplished via a closed or indirect technique. Zygomatic arch projections questions and study guide.
Zygomaticomaxillary complex fracture radiology reference. The patients hair was shaven for clarity and for proper marking of key anatomic landmarks. For the occasional unstable zygomatic arch fracture several methods of fixation have. The proposed surgical access was through infraorbital access figure 7 and left zygomatic frontal figure 8 for exposure, reduction and. Lateral orbital wall and zygomatic arch fracture an isolated lateral wall fracture of the orbit is rare, as this is the strongest of the orbital walls.
Temporal gillies approach to a zygomatic arch fracture. A general consensus of classification and treatment guidelines for zygomatic arch reduction has not yet been established. Fracture sites at the zygomatic arch and the zygomaticofrontal suture were exposed and fixed with miniplates under endoscopic control. The zygomaticomaxillary complex fracture, also known as a quadripod fracture, quadramalar fracture, and formerly referred to as a tripod fracture or trimalar fracture, has four components. In medially displaced fracture, it may be difficult to pass the instrument medial to the zygomatic arch. Zygoma arch fracture an overview sciencedirect topics. I have a zygomatic arch fracture with no deformities. Zygomatic arch definition of zygomatic arch by the free. The need for 7 screws at the fz region was due to the gross comminution at that site. The ages of the patients ranged from 10 to 76 years old, mean age was 32. Zygomatic bone is situated at the lateral part of the facial triangle, and is frequently exposed to maxillofacial traumas, since it forms the most prominent region of. Signs of zygomatic fracture are periorbital or maxillary vestibular ecchymosis, periorbital edema, flattened arch or malar prominence, deformity or displacement, trismus, displacement of palpebral fissure, enophthalmos, exophthalmos, chemosis, and conjunctival hemorrhage figures 122 and 123.
Sacks, md department of plastic and reconstructive surgery, johns hopkins hospital, baltimore, md correspondence. These fractures have the potential to result in either a cosmetic deformity andor a functional issue. The temporal process, which forms zygomatic arch a1frontal process, which forms lateral orbital wall a2maxillary process, which forms infraorbital rim a3category bfracture of all three processes, detaching zygomatic bone from facial skeleton i. Surgical methods of zygomaticomaxillary complex fracture. A new proposal of classification of zygomatic arch fractures. Such landmarks are shown and discussed in sequence with the key surgical steps. Zygomatic arch reduction gillies approach springerlink. The fracture of the zygomatic arch is a traumatic solution of continuity of the lateral structure of the middle third of the face, formed by the zygomatic processes of the temporal bone and the temporal process of the zygomatic bone. Zygomatic arch definition of zygomatic arch by merriam. Stabilization of the isolated zygomatic arch fracture using foleys balloon catheter. Loss of the prominence of the malar eminence is a frequent sequela of zygomatic fracture.
A deformity may be palpable along the orbital margins, the zygomatic arch, or. The zygomatic bone forms the lateral aspect of the midface and comprises the lateral and the inferior orbital rim and malar eminence, thus creating facial width and projection. A 26yearold male was struck on the left side of his face while playing baseball. Management of the unstable isolated zygomatic arch fracture. The zygoma forms a significant portion of the floor and lateral wall of the orbit and forms a portion of the zygomatic arch, otherwise known as the malar eminence, which plays a key role in the determination of facial morphology. The identified 694 patients who were admitted for zygomatic fractures from which 192. The zygomatic arch is formed by the union of the temporal process of the zygomatic bone and the zygomatic process of the temporal bone at the zygomaticotemporal suture. Many zygomatic fractures which have good bony alignment despite the fracture do not require any treatment at. The zygomatic process of the frontal bone and the zygomatic arch, which form the dorsal orbital rim, are prone to fracture and resultant opening into the frontal and caudal maxillary sinuses. A new classification of zygomatic fracture featuring.
Reduction of fractures of the zygomatic arch using a finger. It articulates posteriorly byits temporal process with the zygomatic process of the tem. Evaluation of treatment of zygomatic bone and zygomatic. The arch is prone to fracture due to its long and thin structural framework which projects outside the facial skeleton. Other fracture patterns, include isolated zygomatic arch fractures, or zmc fractures with associated panfacial fractures, such as le fort ii and iii. Radiographic positioning of the zygomatic arch ce4rt. Zygomatic arch definition is the arch of bone that extends along the front or side of the skull beneath the orbit. A method of zygomatic arch stabilization british journal of oral and. After maxillofacial injuries, the possibility of fractures of the zygoma and zygomatic arch should always be considered and adequately investigated.
Management of zygomatic arch fractures by intraoral open. Pdf reduction of fractures of the zygomatic arch using a. The zygomatic bone occupies a prominent and important position in the facial skeleton. We propose an innovative inhouse rapid prototyping rp protocol for the 3dzygoma mask manufacture of a patientspecific protective device to apply after zygomatic arch fracture reduction. In this instance, the tip of the instrument must be placed medially until the medial aspect of the zygomatic arch is reduced. Additionally, the fracture components may result in impingement of the. Zygomatic arch fractures in isolation or associated with fractures of other bones are common. Our study includes 16 consecutive patients who underwent. Postoperative radiographs of a complex zygomatic fracture. They are the second most common facial bone fracture after nasal bone fractures pathology. Ipsilateral eye may appear to tilt due to pulling of lateral canthus. This technique was used in 15 consecutive patients including 2. Introduction the zygoma has four projections, which create a quadrangular shape. Most often, they are managed by closed reduction without any.
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