Zygomatico-Maxillary Complex Fracture Fixation: How Much Is Enough?

Abstract

The prominence of the zygomatic region predisposes it to bearing the brunt of facial injuries. Due to the architectural pattern of the mid-face, the zygoma generally fractures at four of its articulations (tetrapod fracture) making displacement possible in multiple planes and directions. Ocular injuries, occlusal disharmony and cosmetic deformities are sequelae of zygomatic complex fractures.Due to multiple fracture points, the number of fixation points for adequate reduction and optimal fixation is a point of discussion in the literature. As on date, there is no specific protocol or any common consensus on the fixation pattern in a tetrapod zygomaticomaxillary complex fracture. Several studies claim that one or two-point fixation is enough but these studies are not backed by long term follow-ups, nor do any of these follow a specific treatment protocol. We follow a combined approach by Ed Ellis., et al. and the AOCMF guidelines and generally prefer a three or four-point fixation depending on the comminution and displacement for tetrapod zygomatico-maxillary complex fractures. The case reported is a typical tetrapod fracture and was planned for a three-point fixation along with closed reduction of the zygomatic arch using the Keens approach. The graduated meticulous approach of alignment of the zygoma with the greater wing of sphenoid, adequate reduction and fixation at the fractured points with reconstruction of the buttresses will give optimal results which in turn will help in maintaining facial height, facial width and restore form, function and esthetics.The zygoma is an enigmatic facial bone with its confluence influencing a large portion of the facial functional and cosmetic features. It's prominence makes it vulnerable to bearing the brunt of facial injuries [1] and so it represents 13% of all maxillofacial injuries and is the second most common bone fractured following 19. Ellis E. "Perez D An algorithm for the treatment of isolated zygomatico-orbital fractures".