An Evidence-Based Approach to Zygomatic Fractures

Evans, Gregory R. D.; Daniels, Mark; Hewell, Lauren

doi:10.1097/prs.0b013e31820456e5

Cited by 17 publications

(13 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…24,41,42 This can be well seen in cases of improper management of naso-orbito-ethmoid fractures with serious secondary deformities. [43][44][45][46][47] This may make all secondary reparative trials quite difficult to restore aesthetic results and normal functions as lacrimal patency. Thus, the complexity of the injury and the time of intervention can be considered major factors in surgical outcome.…”

Section: Discussionmentioning

confidence: 99%

Periorbital Trauma: A New Classification

Sadek

Elbarbary

Safe

2019

Craniomaxillofacial Trauma & Reconstruction

View full text Add to dashboard Cite

Overlooked injured structures in periorbital trauma could lead to aesthetic and functional deficits. As trauma may affect superficial, middle, and deep components, meticulous survey guided by a structured periorbital trauma classification is needed for proper management. Thus, a new classification for periorbital trauma is proposed to serve this purpose. Periorbital region was defined anatomically by anthropometric landmarks. The periorbital injuries were categorized according to anatomical and clinical basis. The new classification was used to study periorbital trauma cases received at Ain Shams University Hospitals between July 2013 and July 2016 retrospectively. The study included 260 patients: 196 (75.38%) males and 64 (24.62%) females. The type and severity of injury, time of primary intervention, type of surgery performed, and patients’ visits to the outpatient clinic were evaluated. The status of the postinjury and postoperative (primary surgery) aesthetic status and functional status were evaluated. The periorbital region was identified. Anatomical categorization of periorbital injuries included periocular, frontal, temporal, and malar regions. Injuries/deficits were categorized into simple, composite, complex, and isolated bony injuries according to the depth and involved tissues. Subsequently, the classification was formulated. In the retrospective study, the incidence of extended simple injuries was the highest, while the least was the extended complex injuries. Functional deficits occurred in 24 patients (9.23%) and aesthetic deficits occurred in 55 patients (21.15%). Required secondary operations for this group included redo of fixation, correction of medial canthal ligament, repair of canalicular system, scar revisions, fat grafting, and creation of natural creases. The results of this study demonstrated that unsatisfactory aesthetic and functional results occurred when injuries of important structures were overlooked, aesthetic units were not respected, and when management was delayed. A three-dimensional, oriented, new classification of periorbital trauma based on anatomical and clinical categorization is proposed to help in identifying injured structures, stimulate the search for other injuries, structure preoperative evaluation, and recommend a surgical plan that would ultimately achieve precise primary repair with best aesthetic and functional outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

Periorbital Trauma: A New Classification

Sadek

Elbarbary

Safe

2019

Craniomaxillofacial Trauma & Reconstruction

View full text Add to dashboard Cite

show abstract

“…15,17,26Y28 Some have extended this time frame to 21 days with successful outcomes, obviating the need for additional surgery. 8,23,30 Dingman and Harding 5 described this concept that ''once fibrous malunion is established, zygoma mobilization requires refracturing, removal of the callous sequestrum, and freshening of the fracture lines before proper realignment of the fragments.'' When fibrous malunion has developed, bone manipulation becomes more complex and renders established diplopia and enophthalmos particularly difficult to revert.…”

Section: Discussionmentioning

confidence: 99%

Delayed Repair of Lateral Orbital Wall and Orbital Floor Fracture

Lee

Tahiri²,

Roy³

et al. 2013

Journal of Craniofacial Surgery

View full text Add to dashboard Cite

Timing of surgical management of facial fractures may differ from the current standard when an associated severe ophthalmologic injury exists; this may necessitate a delay in repair to protect the patient's vision. We set out to demonstrate that good functional and aesthetic outcomes can be achieved in cases where zygoma bone fracture repair had to be delayed for more than 21 days after injury with a specific surgical plan.Using the electronic database from Montreal General Hospital, a level I trauma center, a retrospective review of all facial fractures occurring from 1994 to 2009 was performed. Our review returned a total of 22,727 trauma patients admitted to Montreal General Hospital. Of these, 2672 sustained 1 or more facial fractures. Among the facial trauma patients, 945 patients' injuries included a zygoma fracture, 324 (35.3%) of which were managed operatively. Seven cases had their surgery delayed for more than 21 days after injury, 2 of which were managed using simple osteotomies and plate fixations, without the need for bone grafts. Both patients demonstrated a satisfactory outcome with improvement relative to their preoperative status. We provide a detailed description of our most recent case of a 73-year-old woman in whom the surgical repair of the lateral orbital rim and orbital floor was delayed for 10 weeks to allow healing of her associated traumatic retinal detachment.For patients with associated ocular injuries who cannot undergo orbital fracture repair within 21 days of the trauma, delayed surgery may still result in an acceptable aesthetic result.

show abstract

“…The type of fragmentation and the degree of comminution and displacement in the suture regions dictate how many topographical points (1-5 points) need to be explored for surgical realignment. 19 Reduction and fixation will be targeted in the simplest way through limited transfacial incisions in the lower and upper eyelid, the lateral brow area or via a transconjunctival approach in combination with an upper vestibular incision. Depending on stability requirements, mini and micro-osteosynthesis plates are applied for a 1-to 5-point fixation.…”

Section: Zygomatic Fracturesmentioning

confidence: 99%

Maxillofacial Fractures: Midface and Internal Orbit—Part II: Principles and Surgical Treatment

et al. 2015

View full text Add to dashboard Cite

Current clinical assessment and imaging techniques were described in part 1, and this article presents a systematic review of the surgical treatment principles in the management of midface and internal orbit fractures from initial care to definitive treatment, including illustrative case examples. New developments enabled limited surgical approaches by standardization of osteosynthesis principles regarding three-dimensional buttress reconstruction, by newly developed individualized implants such as titanium meshes and, especially for complex fracture patterns, by critical assessment of anatomical reconstruction through intraoperative endoscopy, as well as intra- and postoperative imaging. Resorbable soft tissue anchors can be used both for ligament and soft tissue resuspension to reduce ptosis effects in the cheeks and nasolabial area and to achieve facial aesthetics similar to those prior to the injury.

show abstract

An Evidence-Based Approach to Zygomatic Fractures

Cited by 17 publications

References 31 publications

Periorbital Trauma: A New Classification

Periorbital Trauma: A New Classification

Delayed Repair of Lateral Orbital Wall and Orbital Floor Fracture

Maxillofacial Fractures: Midface and Internal Orbit—Part II: Principles and Surgical Treatment

Contact Info

Product

Resources

About