Zygomaticomaxillary complex fractures: diagnosis and treatment

Peretti, Nicholas; MacLeod, Stephen

doi:10.1097/moo.0000000000000372

Cited by 34 publications

(39 citation statements)

References 26 publications

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“… 18 In general, the decision to operate is focused on aesthetic and functional improvement. 19 If ZMC trauma is viewed on a spectrum based on severity, the extremes (no displacement and severe displacement/comminution) may be managed nonoperatively and operatively, respectively. However, evaluating the need for surgical intervention for the ZMC fractures that fall in the middle of the spectrum can be subjective and inconsistent.…”

Section: Discussionmentioning

confidence: 99%

Automated 3D Analysis of Zygomaticomaxillary Fracture Rotation and Displacement

Prabhu

Chung

Rudolph

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: The zygomaticomaxillary complex (ZMC) can experience a multitude of deforming forces. There is limited understanding on which deformities alter patient outcomes. This study utilized an automated, three-dimensional analysis to elucidate which fracture patterns and rotational deformities are most prevalent and associated with postoperative complications. Methods: This study was a 7-year retrospective review of patients with unilateral ZMC fractures who underwent surgical intervention. Patient demographics, injury mechanisms, presenting symptoms, and postoperative outcomes were collected. Segmentation was completed using Mimics software. The lateral-medial, superior-inferior, and anterior-posterior axes were manually identified on the zygoma and then displacement, rotational direction, and rotational degrees were automatically calculated using Geomagic software. Total displacement score was generated by summation of individual displacement scores at each of the five sutures. Results: Eighty-one patients satisfied inclusion criteria. The most prevalent rotational pattern of the zygoma was medially-superiorly-posteriorly ( P < 0.001). When comparing rotation along the three axes, the zygoma had the greatest rotation along the lateral-medial axis compared with the superior-inferior ( P = 0.003) and anterior-posterior ( P < 0.001) axes. Within each axis, the zygoma was more likely to rotate medially than laterally ( P = 0.003) and posteriorly than anteriorly ( P = 0.01). Multivariate analysis identified total displacement scores and degrees rotated along the lateral-medial axis as significant predictors of facial complications and reoperation. Conclusions: This study suggests that patients with unilateral ZMC fractures who undergo surgical intervention are at an increased risk for adverse outcomes with greater rotation along the lateral-medial axis and higher total displacement scores. Additionally, the automated analysis method described can provide objective data to better characterize ZMC fractures.

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Section: Discussionmentioning

confidence: 99%

Automated 3D Analysis of Zygomaticomaxillary Fracture Rotation and Displacement

Prabhu

Chung

Rudolph

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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“…11 There have been numerous studies analyzing how mechanism of injuries, approaches, fixation points, and implant materials affect ZMC reconstruction. 3,8,[12][13][14][15][16][17] Our study builds upon the prior studies by extensively analyzing multiple variables and presenting a novel classification system in order to elicit potential relationships between fracture patterns and patient outcomes. We sought to test the clinical application of a comminution-based scoring method against what many consider to be the gold standard in the Zingg classification schematic.…”

Section: Discussionmentioning

confidence: 99%

A Novel Classification Method of Zygomaticomaxillary Complex Fractures by Suture Comminution to Better Predict Clinical Outcomes

Prabhu

Rudolph

Hemal

et al. 2020

FACE

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Purpose: To assess a novel technique for classifying zygomaticomaxillary complex (ZMC) fractures by its ability to predict clinical outcomes and reoperations when compared to a well-established classification method. Methods: The investigators conducted a retrospective cohort study over a 7-year period composed of patients with unilateral and bilateral fractures of the ZMC. Fractures were graded according to the Zingg method and a CT-based comminution method. Outcomes were classified into 3 groups: orbital complications, facial complications, and reoperation. Orbital complications consisted of enophthalmos and diplopia. Facial complications consisted of lagophthalmos, ectropion, ptosis, facial motor weakness, trismus, and malar depression. Other variables included demographics, mechanism of injury, and preoperative symptoms. Results: A total of 159 patients were identified producing a total of 204 ZMC fractures. The mean age was 40.2 ± 16.5 years and the most common mechanism of injury was motor vehicle accidents in 49.7% of patients. By the Zingg classification, B-type fractures were the most common in 46% of patients. The average total comminution score was 2.9 ± 2.4. Univariate analysis showed an association between increased age and reoperation ( P = .01). After adjusting for demographic and clinical variables on multivariate analysis, total comminution score was a significant predictor of facial complications and reoperation. The Zingg method did not demonstrate significance as a predictor for facial complications or reoperation. Neither classification method was predictive of orbital complications. Conclusion: The results of this study suggest that total comminution scoring is a viable method for categorizing ZMC fractures to better predict clinical outcomes.

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“…18 This tool consists of 12 domains: a clearly stated aim, inclusion of patients, collection of data, appropriate endpoints, unbiassed assessment, follow-up period, loss to follow-up, calculation of the sample size, adequate control group, contemporary groups, baseline equivalence and statistical analysis. The twelve domains were scored as: not reported (0), reported but inadequate (1), reported and adequate (2).…”

Section: Evaluation Of Study Quality and Risk Of Biasmentioning

confidence: 99%

“…The zygomaticomaxillary complex (ZMC) is an integral part of the facial structure and plays an important functional, structural and aesthetic role in the mid-facial contour and in protecting the orbital contents. 1,2,3 Fractures involving the ZMC are among one of the most common maxillofacial traumas. 1,4,5,6,7,8 Most ZMC fractures are caused by violent assaults, road traffic accidents, falls and sport-related injuries.…”

Section: Introductionmentioning

confidence: 99%

“…1,5,9 Although ZMC fractures predominate in young adult males, there is geographic and sociodemographic variation in the incidence and aetiology of ZMC fractures, due to socioeconomic, cultural and environmental factors. 1,2,9 Clinical decision making in the treatment of ZMC fractures can be challenging. Various treatment algorithms have been introduced; however, uniform consensus is still lacking.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical treatment of fractures of the zygomaticomaxillary complex: effect of fixation on repositioning and stability. A systematic review

Raghoebar

Rozema

Lange

et al. 2022

British Journal of Oral and Maxillofacial Surgery

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Zygomaticomaxillary complex fractures: diagnosis and treatment

Cited by 34 publications

References 26 publications

Automated 3D Analysis of Zygomaticomaxillary Fracture Rotation and Displacement

Automated 3D Analysis of Zygomaticomaxillary Fracture Rotation and Displacement

A Novel Classification Method of Zygomaticomaxillary Complex Fractures by Suture Comminution to Better Predict Clinical Outcomes

Surgical treatment of fractures of the zygomaticomaxillary complex: effect of fixation on repositioning and stability. A systematic review

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