Search

Background: Insufficient height and width of the alveolar ridge at the implant site remains with inadequate bone volume following extraction in older age people especially in postmenopausal women. Postmenopausal women are susceptible to primary osteoporosis where more bone resorption than formation is seen resulting in decreased bone mass. Hence the present study aims to evaluate the zygomatic bone region for placement of quad zygomatic implants using CBCT. Materials and Methods : A total of 120 CBCT images of female patients who were between the age group of 45 yrs to 65 yrs were taken. The zygomatic bone was evaluated for pneumatisation zones and thickness of zygomatic bone at three different regions i.e., superior, middle and inferior at nine points on zygoma bone along with bone to implant contact (BIC) region using virtual software. Results: The largest thickness in the superior, middle and inferior regions were at Point A2(8.01+/-2.10 mm), Point B2 (7.01+/-1.62 mm), and Point C1 (6.65+/-1.64 mm), respectively. The virtually placed implants at Point A3 (15.92+/-4.16 mm) and Point B2 (12.02+/-3.62 mm) had the highest BICs. Conclusions : To obtain the largest BICs, results suggested that the posterosuperior region (Point A3) and the centre of zygoma (Point B1) were the optimal places for the placement of quad zygomatic implants. Keywords: Postmenopause, Zygomatic implants, Zygomatic thickness, Bone-to-implant contact.

This cross-sectional study aimed to identify and characterize the pathway for appropriate placement of four zygomatic implants in the severely atrophic maxilla and to group the anatomical variations of the osteotomy trajectory for anterior zygomatic implants. Materials and methods: CBCT images of patients presenting indications for the use of four zygomatic implants to withstand a maxillary rehabilitation were reviewed. Cross-sectional planes corresponding to the implant trajectories, designed according to a zygoma anatomy-guided approach for implants placed in the anterior and posterior maxilla, were assessed separately. The relationship of the implant osteotomy trajectory with the correlated residual alveolar bone, nasal and sinus cavities, maxillary wall, and zygomatic bone anatomies was established. Results: The study population included 122 globally recruited patients, with 488 zygomatic implants, 244 of which had their starting point on the anterior incisor-canine area and 244 on the posterior premolar-molar area. The anatomy of the osteotomy path designed for the anterior implants ("A") was named and grouped into five assemblies from zygomatic anatomy-guided ZAGA A-0 to A-4, representing 2.9%, 4.5%, 19.7%, 55.7%, and 17.2% of the studied sites. Percentages for posterior implant ("P") trajectories of the osteotomy were grouped and named as ZAGA P-0 to P-4, representing 5.7%, 10.2%, 8.2%, 18.4%, and 57.4% of the sites, respectively. Approximately 70% of the population presented anatomical intra-individual differences. Conclusion: The trajectory of the zygomatic implant followed different anatomical pathways depending on its coronal point being anteriorly or posteriorly located, which justifies a new zygoma anatomy-guided approach classification for anteriorly placed zygomatic implants. Topographic characteristics of the anatomical structures that are cut by an anterior oblique plane joining the lateral incisor-canine area to the zygomatic bone, representing the planned anterior osteotomy path in a quadruple-zygoma indication, have not been previously reported. Adaptation of surgical procedures and implant sections/designs to individual patients' anatomical characteristics is essential to reduce early and long-term complications.

BACKGROUND To date, plastic surgeons do not have an objective method of measuring facial symmetry for zygomatic bone fracture management. Based on clinical practice, the authors utilized a 3-dimensional (3D) model to propose the symmetry index from the anterior view (SIAV) and the symmetry index from inferior view (SIIV). This study aimed to assess the application of these 2 indices. METHODS The SIAV is defined as the distance between the superior and lower orbital rims (DSLOR) of the defective side divided by that of the healthy side in the anterior view. The SIIV is defined as the area within the region of interest (AROI) of the defective side divided by that of the healthy side in the inferior view. We retrospectively reviewed 95 patients who underwent zygomatic fracture surgery at our medical center from January 2017 to September 2020. The Patients who had bilateral zygomatic fractures and did not have both pre- and postoperative computed tomography (CT) images were excluded. RESULTS Five out of the 95 patients were enrolled in this study. The difference between pre- and postoperative mean AROI and DSLOR on the healthy side was not significant. The insignificant difference indicates the repeatability of the measurement of the 3D skull model and different CT machines would not affect the calculation of AROI and DSLOR. The mean values of postoperative SIAV (1.06 ± 0.07) and SIIV (1.02 ± 0.08) were closer to 1 than the preoperative values (0.97 ± 0.09 and 1.10 ± 0.12). Although the difference was not statistically significant, the SIIV and SIAV would numerically present the changes in malar bone fracture postoperatively. CONCLUSION The SIAV and SIIV based on clinical practice could numerically assess the symmetry of the malar mound.

Trismus is a disturbing condition with varied etiology, one of them is Extra articular ankylosis. The extra articular ankylosis has been reported in the literature as a fusion of the coronoid process to the zygomatic bone or to the skull base. However, there are a very few cases reported in the literature that highlights a pathologic tumor of mandible leading to extra-articular ankylosis and subsequently resulting in trismus. We hereby present a unique case of young adult having restricted mouth opening due to the bony fusion of the mandibular ramus to the zygomatic bone and zygomaticomaxillary buttress region due to a pathologic tumor diagnosed as Ossifying Fibroma.

Purpose In the context of the ongoing development and expanding availability of 3-dimensional (3D) printing, there is increasing interest in designing simplified workflows that would encourage more medical practitioners to include 3D printing in their current practice. The purpose of this study is to present our experience regarding the use of 3D printing in the preoperative planning and management of acute midface trauma, an area less explored by existing studies. Methods We performed a retrospective case series study including admitted patients who underwent surgical repair of midface fractures, in which 3D-printed stereolithic models were used preoperatively for shaping the osteosynthesis material. We recorded standard information about the patients, imaging method used, and type of midface fracture. We also logged the details and durations of each main step in the preoperative 3D printing workflow and documented the durations and outcomes of each surgical procedure. Results We identified 29 cases of midface fractures that benefited of a preoperative stereolithic model. From the 2 main methods of obtaining the virtual model, mirroring and virtual fracture reduction, the longest duration was recorded in a case in which the later method was used. The longest stereolithic model printing time was found in a complex midface fracture case. All the prebent osteosynthesis material was used intraoperatively and fitted the reduced fracture sites, also serving as an intraoperative guide for correct fracture reduction. The particularities, benefits, as well as the possible challenges associated with the application of 3D printing in acute trauma cases are discussed. Conclusions Our 3D printing protocol was applicable and rendered favorable outcomes in the acute midface trauma setting. Proper understanding of the steps involved in achieving the stereolithic model is key for the adaptation of 3D printing to the current management of acute midface trauma.

Objective To analyze the value of simulated surgery in predicting the outcome of individualized surgical reduction of a prominent zygomatic arch. Methods Computed tomography data were obtained from the electronic records of 15 patients who underwent surgery at Tianjin Stomatological Hospital for prominent zygoma. The data were imported into Mimics 23.0. Left and right three-dimensional (3D) zygoma models were created through standard procedures. In the 3D models, a wedge-shaped cut of the zygomatic bone was pushed inward, and the osteotomy position of the zygomatic arch was taken as a variable to simulate the reduction malarplasty. The reduction effect was calculated from the simulated movement of the fracture end of the zygomatic arch from internal pushing forces. Stable versus high-efficiency internal pushing areas were defined based on the amount of movement. Mean values with 95% confidence intervals (CI) were calculated for the areas data. Results The anterior edge of the stable internal pushing osteotomy area was located in front of the articular tubercle point (95% CI: 10.64-11.89 mm). The posterior edge of the stable internal pushing area was located in front of the articular tubercle point (95% CI: 7.8-9.13 mm). The posterior edge of the high-efficiency internal pushing area was located in front of the articular tubercle point (95% CI: 4.7-5.73 mm). Conclusion Stable and high-efficiency internal pushing areas were detected above the zygomatic arch. The simulation showed that osteotomy in these areas can provide different degrees of zygomatic arch reduction.

A 1.5-year-old MC Cardigan Welsh Corgi was presented for a right oral fistula associated with left tonsil enlargement that responded to medical treatment. A first computed tomography scan was performed and showed no signs of a foreign body. Medical treatment was continued for 2 additional weeks and the dog was free of clinical signs for 3 months. The dog was presented again for a 3-day history of anorexia and marked pain when opening the jaw. The repeat computed tomography scan revealed a migrating foreign body near the optic canal of the right eye, and surgical exploration confirmed that it was trapped within the intraconal part of the retrobulbar space, abutting the optic nerve. The foreign body was surgically removed through an osteotomy of the zygomatic bone. The dog fully recovered with no vision loss. Based on the literature search, this is the first published report describing a migrating grass awn located in the intraconal part of the retrobulbar space, abutting the optic nerve.

OBJECTIVES: The aim of this study was to compare the maxillary dentoskeletal outcomes of the expander with differential opening (EDO) and the fan-type expander (FE). MATERIAL AND METHODS: Forty-eight patients with maxillary arch constriction in the mixed dentition were randomly allocated into EDO and FE groups. Cone-beam computed tomography scans were acquired before and after expansion. Linear and angular three-dimensional changes were assessed after cranial base superimposition using the ITK-SNAP and the 3D Slicer software. T or Mann-Whitney U tests were used for intergroup comparisons (P

Summary Objective Thezygomaticus major is a principal muscle of facial expression which is engaged when smiling. The zygomaticus major origin of the zygomatic bone is often discussed relevant to its importance in the field of plastic surgery. In addition, the zygomaticus major attachment site is also significant for forensic craniofacial reconstruction, separating the cheek into frontal and lateral surfaces. However, there are discrepancies amongst published articles regarding the precise origin of the zygomaticus major muscle. The aim of this study is to investigate more distinctive and palpable landmarks as the bony attachment of the zygomaticus major. Methods This project is the first zygomaticus major dissection study utilising Thiel embalmed cadavers. Fifty-two facial dissections were investigated in 26 Thiel embalmed bodies, bequeathed to the Centre for Anatomy and Human Identification at The University of Dundee between 2013 and 2015. Results This study found that the origin of zygomaticus major muscle was located at the superior margin of the temporal process on the lateral surface of zygomatic bone. Moreover, the zygomaticus major muscle overlapped the anterosuperior border of the masseter muscle. One out of 52 zygomaticus major muscles presented bifurcation. Conclusion The origin site of zygomaticus major is considered important to increase resemblance in forensic craniofacial reconstruction. Furthermore, since zygomaticus major is a salient muscle involved in facial expression, the potential effects for cosmetic/surgical procedures are also relevant to the medical field and successful surgical outcomes. The current study provided easily palpable landmarks of zygomaticus major origin site which is beneficial for both surgeons and forensic craniofacial reconstruction practitioners.

Prosthetic rehabilitation in maxillectomy patients aims to separate the oral and nasal cavities to provide adequate articulation, restore the contour of the midface, and provide acceptable aesthetic results. This clinical case report describes prosthetic rehabilitation via placement of dental implants in the zygomatic bone in a patient who underwent partial maxillectomy because of osteosarcoma. The success of obturator placement after maxillectomy requires retention by the surrounding dental tissue or dental implants. When zygomatic implants cannot be used, dental implants placed in the zygomatic bone and attachments fastened to these implants can easily provide the retention and stability required by the obturator.

Introduction: The zygomatic complex is integral to the facial contour, protection of the eye and other facial structures, and dental occlusion. Its importance in facial function and aesthetics requires high quality outcomes of the treatment. Case presentation: This paper reports the case of a 46-year-old man who had an occupational accident resulting in extensive facial trauma and zygomatic fractures. The patient presented with hyposphagma, palpable step in the area of the infraorbital rim, paresthesia of the right infraorbital nerve, flattening of zygomatic prominence, abrasion of the chin and nose, a 7-cm laceration in the midface region, ecchymosis in the palate, and alteration in the dental occlusion without limitation of mouth opening. Computed tomography (CT) confirmed the zygomatic complex fractures. The treatment was reduction and fixation with plates and screws. CT was used throughout the treatment period as an essential diagnostic tool for accurate fracture assessment and classification, formulation of the surgical plan, and postoperative evaluation. Conclusion: This case study illustrated the correct use of CT for improved and efficient treatment of traumatic injury of the zygoma, an anatomical area where restoration of function and aesthetics is challenging. The patient signed a written informed consent statement for publication.

INTRODUCTION: Zygomatic bone osteomyelitis is a rare condition having an incidence of 1.42%. Zygomatic osteomyelitis can be due to haematogenous infection with tubercle bacillus, facial bone fractures or very rarely due to an unknown aetiology like in our case. If surgically managed alone, it would lead to complete loss of zygomatic bone, causing high morbidity to the patient in terms of function and aesthetics like loss of globe support causing dystopia, loss of facial projection causing facial asymmetry. Restoration of facial symmetry and globe support would require extensive procedures such as non-vascular bone grafting or patient-specific implant placement or microvascular bone flap transfer. MATERIALS AND METHODS: Hyperbaric oxygen therapy (HBOT) was used to try and preserve the zygoma by promoting revascularisation. The patient received 100% oxygen at 2.5 absolute atmospheric pressure for 90 min, one session per day for 5 days in a week using a mask system in a multiplace chamber. The patient was reviewed clinically and radiologically after each 5 dives of HBOT sessions. After a total of 30 dives of HBOT, CT examination was repeated. There was partial reconstitution of cortical bone without any additional residual bone lesion. Minimal residual sequestra were noted. At this stage, the patient underwent conservative sequestrectomy in contrast to extensive surgery if HBOT was not contemplated. CONCLUSION: HBOT has the potential to be a very useful adjunct in the treatment of osteomyelitis in head and neck surgery; however, there is a need for carefully designed trials, avoiding methodological bias due to the great variability of patients, infectious agents, antibiotic resistance, host factors, to broaden the evidence of this therapeutic modality.

Introduction Giant cell reparative granuloma is a rare, locally benign tumor with an aggressive behavior resembling malignant neoplasm, originating mainly from the mandible and maxilla; however, it can originate from other sites, such as zygomatic and temporal bones, with a young adult female predilection. Case presentation A 28-year-old female presented to the Department of Otolaryngology and Head and Neck Surgery with a history of a slowly enlarging swelling over the left parotid region for four months. Physical examination revealed a non-erythematous, non-tender, firm mass with no overlying skin changes. Fine needle aspiration cytology of the lesion revealed a multinucleated giant cell-rich tumor and the histopathological examination of an incisional biopsy from the mass confirmed giant cell reparative granuloma. Therefore, a total surgical excision of the mass with curating of the zygomatic and temporal bones was performed with uneventful postoperative course and regular follow ups for one year. Conclusion A growing mass in the parotid region in a young adult female with no history of trauma should raise the suspicion of giant cell reparative granuloma. Histopathological examination is the definitive tool for diagnosis, and surgical excision is the treatment modality of choice in such cases., Highlights • Similar GCRG case has been only reported once in the literature. • This is the second case reporting a GCRG. • Young females with no history of trauma should raise suspicion of GCRG. • We must give more thoughts into etiologies causing such reported cases.

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. 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. 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. 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.

Introduction This study aimed to evaluate and compare the skeletal effects of monocortical and bicortical mini-implant anchorage on maxillary skeletal expansion (MSE) using cone-beam computed tomography in young adults. Methods The sample comprised 48 patients (aged 19.4 ± 3.3 years; 19 male, 29 female) treated with maxillary skeletal expander and was divided into 3 groups according to insertion pattern of mini-implants used. G1, 4-all-bicortical penetration (n = 17); G2, 2-rear-bicortical penetration (n = 17); G3, non-4-bicortical penetration (n = 14). Cone-beam computed tomography scans were taken before treatment and 3 months after activation. Results The transverse width of maxilla, nasal bone, lateral pterygoid plate, zygomatic bone, and temporal bone increased similarly in G1 and G2. Contrarily, G3 produced less skeletal expansion, having no effects on the temporal bone. Significant increases in width were seen in all 3 groups regarding transverse dentolinear measurements. A triangular expansion pattern was also observed, but G1 and G2 showed more parallel expansion than G3. In addition, G1 and G2 showed less inclination of anchorage teeth compared with G3. The loss of vertical alveolar bone, although only in a small amount, was observed in all groups. Conclusions MSE with non-4-bicortical penetration produced fewer orthopedic effects and more unwanted dentoalveolar side effects, whereas MSE with 2-rear-bicortical and 4-all-bicortical penetration showed similar skeletal effects, which means that 2-rear-bicortical penetrating mini-implants were critical to skeletal expansion.

Anatomical knowledge of the zygomatic region is important, because the zygomatic nerve and its branches may suffer lesions during surgical procedures in the periorbital region. The position and frequency of zygomaticofacial foramina (ZFF) may vary between individuals, and between one side and the other in the same individual. In the present study, we analysed the presence and location of ZFF, as well as the distance between them and the orbital cavity, in macerated skulls of adult individuals. We examined 287 macerated skulls, of individuals of both sexes, analysing the frequency and location of ZFF and the distance from the ZFF to the margin of the orbital cavity (OC). Zygomaticofacial foramina are very frequent structures which tend to appear singly. They are generally located in the temporal process of the zygomatic bone, but in many cases, they may be located in the mid portion of the bone. They also tend to appear at the same distance from the OC when left and right sides are compared. Sex was an important factor in determining differences in ZFF; the distance from the ZFF to the margin of the OC was greater in males than in females. Sex, age, side and skin colour did not affect the frequency and location of the ZFF. We consider that the mid portion of the zygomatic bone is the safest place to anchor zygomatic implants (ZI), since ZFF are less frequently located there than in the temporal process of the zygomatic bone.

Objective The use of standing electronic scooters associated with micromobility applications (e-scooters) has risen nationally. The aim of this study was to obtain a detailed view of soft tissue and bony craniofacial injury associated with e-scooter-related trauma. Methods Single-institution retrospective case series of patients presenting to a level 1 trauma center emergency department or trauma unit with documented e-scooter-related craniofacial injury. Results Of 203 included patients, 188 (92.6%) patients sustained craniofacial injury. One hundred thirty-one (64.5%) had exclusively soft tissue injury, 3 (1.5%) exclusively bony injury, 51 (25.1%) both soft and bony injuries, and twenty-five (12.3%) patients sustained dental injury. Aesthetic units most frequently sustaining acute soft tissue injury were the forehead (n = 106, 34.6%), scalp (n = 36, 11.8%), chin (n = 34, 11.1%), upper lip (n = 32, 10.5%), and cheek (n = 31, 10.1%). Aesthetic subunits most often sustaining acute soft tissue injury included the brow (42, 13.7%), central forehead (39, 12.7%), lateral forehead (n = 25, 8.2%), and upper lip vermillion (n = 23, 7.5%). Craniofacial osseous fracture most often occurred in the orbit (n = 42, 24.6%) and maxilla (n = 40, 23.4%). Individual osseous segments most frequently sustaining acute fracture included the anterior maxillary sinus wall (n = 22, 12.9%), nasal bone (n = 20, 11.7%), lateral orbital wall (n = 16, 9.4%), orbital floor (n = 15, 8.8%), and zygomatic bone (13, 7.6%). Conclusions Our analysis demonstrates that most patients presenting to our center with craniofacial trauma sustained acute bony fracture, most often to the midface. Our data of common injuries associated with e-scooter trauma could inform implementation in the form of facial safety equipment or safety skills training for e-scooter riders. Level of evidence 4.

Introdução: O implante zigomático (IC) é uma alternativa para pacientes desdentados ou parcialmente dentados que não possuem osso maxilar suficiente para reter o implante dentário convencional e para casos em que o enxerto ósseo não é adequado, apresentando uma taxa de sucesso superior a 90%. Objetivos: O objetivo deste estudo foi analisar as estruturas ósseas envolvidas na instalação do IC, considerando gênero e etnia. Material e método: Foram incluídos 96 crânios de indivíduos adultos, desdentados, de ambos os sexos, leucoderma e melanoderma. Um paquímetro digital foi utilizado para realizar as seguintes medidas: 1) RA-CPS: distância da crista alveolar no nível do segundo pré-molar superior até a margem superior posterior do osso zigomático; 2) ECPS: Espessura do osso zigomático ao nível da margem superior posterior; 3) EQM: espessura do osso zigomático em sua porção média. Resultados: Os valores médios obtidos para RA-CPS, ECPS e ECM em milímetros foram, respectivamente: leucoderma feminino 52,09, 2,04 e 4,30; mulheres com melanoderma 53,47, 1,99 e 4,93; machos leucoderma 55, 49, 2,28 e 5,33; Homens Melanoderma 57.01, 2.22 e 6.01. Conclusões: Concluímos que indivíduos leucoderma apresentam valores médios mais baixos do que indivíduos melanoderma. Além disso, as mulheres apresentam valores médios mais baixos que os homens em todas as medidas. Os valores encontrados neste estudo podem ser utilizados como parâmetro para o planejamento da técnica cirúrgica para instalação do CI, evitando riscos de complicações.

Objectives: The purpose of the present study was to assess the outcome of two-point fixation in isolated zygomatic bone fracture. Study Design: Descriptive study. Setting: Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, LUMHS, Jamshoro/Hyderabad. Period: From 1/3/2018 to 31/8/2018. Material & Methods: Consisted of 46 patients with displaced isolated zygomatic bone fractures. All fractures were treated by reduction with transoral (Keen’s) approach & fixation was done by two point fixation with titanium miniplates. Patient was discharged from the hospital next day & advised follow-up after two weeks. Mean ± St & ard deviation was computed for qualitative variables. Diplopia was described in frequencies. Mouth opening was measured on 7th day or 1 month & measured in 1mm by metallic ruler. T-test was applied to find the P Value. Results: There were 34 male & 12 female patients. 56.5% injuries were caused by road traffic accident. Mean mouth opening at 1st week was 25.23±5.15mm & at 2nd week was 38.75±2.00 mm. At 1st week diplopia was found in 26.1% subjects while at 2nd week, diplopia was found in 10.9% subjects. There was significant difference in mean mouth opening at 1st week with 2nd week. The results also showed significant association of diplopia at 1st week with 2nd week. Conclusion: isolated zygomatic fractures can be reduced & immobilized by two-point fixation with screws & titanium mini bone plates at frontozygomatic & the zygomatic buttress area. Post-operative complications i.e. opening of mouth & diplopia were suggestively decreased afterward 15 days of treatment.

Purpose Several approaches are available for managing zygomatic fractures; however, each approach has its complications. Use of the Carroll-Girard T-bar screw (CGTS) can reduce complications because it reduces the number of approaches needed for reduction. This study aimed to analyze the efficiency of the CGTS compared with the 3-point approach. Methods A retrospective study was conducted by reviewing the computed tomography scans of 204 patients who underwent reduction surgery of Knight and North type 3, 4, or 5 zygomatic fractures from March 2009 to August 2017. Facial asymmetry, operative time, and complications were evaluated to compare 2 groups of patients: those who underwent CGTS and those who did not. Bilateral differences in the distance from the reference plane to the malar eminence in 3 dimensions based on computed tomography scans were used to calculate facial asymmetry. Results Among 204 patients, 91 were treated with CGTS whereas 113 patients underwent a 3-point approach. Bilateral differences in the position of the malar eminence and facial asymmetry were not statistically different in both groups. Operative time was not different in both groups. However, when patients with type 4 fracture were independently compared, the mean operative time was significantly shorter for the CGTS group. Wound dehiscence occurred in 11 patients (9.7%) in the 3-point approach group, compared with none in the CGTS group. None of the patients in the CGTS group complained of postoperative cheek scars over their incision sites. Conclusions This study revealed that CGTS is a useful and feasible instrument that can reduce the number of approaches for zygomatic bone reduction and help clinicians achieve satisfactory outcomes.

The prosthetic rehabilitation of maxillary defect can be achieved successfully by using an implant-supported prosthesis. The use of remote bony areas such as the zygomatic bone in cases of large defects provides an innovative substitute for free vascularized osteocutaneous flaps and the solution to flap failures. This report describes the rehabilitation of a 22-year-old female with a subtotal maxillectomy using an immediately loaded basal implant-supported prosthesis. Four basal cortical screw implants (BCS®) are inserted; 1 on the contralateral nasal floor, 2 implants in the pterygoid plates, and the last in the zygomatic bone using cone beam computed tomography scans. The prosthesis was constructed and cemented in 3 days. The surgical and prosthetic procedures were performed without any obstacles. After 4 years in function, the patient was highly satisfied with the treatment as it improved her mastication, speech, aesthetic and returned her self-esteem. To our knowledge, this is the first clinical report detailing the use of basal implant-retained obturator in a subtotal maxillectomy patient.

Objective The aim: To study the peculiarities of the structure and to see the development of maxillary sinuses in infants, during the early and first childhood periods of human ontogenesis. Patients and methods Materials and methods: The study of the peculiarities of the development and formation of the maxillary sinuses' wall was carried out on 50 species of the upper jaws, turtles and sections of the head of the human corpses during different periods of ontogenesis (in infants, during early and first childhood) with the help of histological examination, preparation, CT scan, radiography and morphometry. Results Results and conclussions: In infants and during the early and first childhood periods of human ontogenesis in the MS there are changes in both quantitative and qualitative nature. In infants (10 days - 1 year), maxillary sinuse is located more lateral to the basis of the lower nasal concha. In this period, it begins to form its lower wall, which in the form of a narrow strip invaginates into the alveolar process. The growth of the sinus is due to the protrusion of the external wall in the direction of the zygomatic bone. The wall of the maxillary sinuse is covered with mucosa (respiratory mucous membrane), which is lined by pseudostratified columnar ciliated epithelium, which is located on the basement membrane. X-ray examination of maxillary sinuse in infants shows that it is a pear-shaped in the anterior projection. Clearly the following walls of the sinuses are visible: the upper, the lower, one, which is arched-shaped, the front and the median, which in lower part are crossed as arch to each other. Investigation of biological specimens of the maxillofacial area of the early childhood period (1-3 years) showed that maxillary sinuses in all specimens are determined more laterally to the basis of the lower nasal concha. Its vertical dimension is 7.5-8.0 mm, transverse - 5.7-6.0 mm, anterior-posterior - 13.9-14.5 mm. X-ray examination of maxillary sinuse in early childhood in the front projection shows that it has an oval shape. There are the following walls of the sinus: upper, lower, front and middle. The study of biological specimens of the facial area in the period of the first childhood (4-7 years) has been established that the configuration of maxillary sinuse is changing. All walls are determined, but the upper wall is rather short, and the front wall is narrow. The median wall has the most prominent development. On X-rays in the anterior projection, a slight extension of the maxillary sinuse is noted laterally. Therefore, one should thoroughly study the peculiarities of the development and structure of the walls of the maxillary sinuses in order to prevent the development of complications and to achieve the treatment of inflammatory diseases of the MS in an optimal term.

Highlights • Intramuscular hemangioma is a relatively rare benign vascular tumor of the skeletal muscles. • The initial diagnosis of Intramuscular hemangioma is complicated due to low incidence and variation of symptoms. • Intramuscular hemangioma in the zygomaticus major muscle is extremely rare., Introduction intramuscular hemangioma (IMH) is a relatively rare benign vascular tumor of the skeletal muscles. It shows less than 1 % of all soft tissue hemangiomas. In the head and neck area, it occurs usually in the masseter muscle followed by temporalis and sternocleidomastoid muscles. Presentation of case we present a case of 25-year-old male patient with a chief complaint of slowly growing facial swelling in the left zygomatic area. Clinical, imaging and histopathological evaluation lead to the diagnosis of intramuscular hemangioma in the zygomaticus major muscle. Discussion IMH in the zygomaticus muscle is very rare; hence, the clinical diagnosis of IMH is challenging. Different diagnostic procedures can be used such as CT and MRI. In addition, the ideal therapy for esthetic disfiguring IMH in the head are is the complete surgical excision of the lesion. Through the review of literature and to our knowledge this case is the first report of intramuscular hemangioma in the zygomaticus muscle. Conclusion IMHs are rare in the head and neck area and must be considered in differential diagnosis of isolated muscle mass in this region.

Purpose: The aim of the study was to evaluate and apply a minimal invasive approach for reconstruction of atrophic maxilla using computer-guided implant surgery by zygomatic implants combined with conventional implants. Material and methods: 10 patients with severely atrophic edentulous upper arch were included in this study, each patient had 2 conventional implants placed in the anterior maxilla, and 2 zygomatic implants on either sides placed in the zygomatic bone. In all patients a computer guided approach using a computer guided stent was used for drilling the conventional and zygomatic implants. All patients followed a clinical and radiographic follow up Result: Zygomatic Implants success was 90.0% while conventional implants success was 80.0%. The mean ± standard deviation values of coronal deviation were 3.24 ± 1.9 mm for Zygomatic implants and 2.9 ± 2.5 mm for conventional implant. The mean ± standard deviation values of apical deviation for were 4.2 ± 2.5 mm for zygomatic implants and 2.6 ± 2.5 mm for conventional implants. The mean ± standard deviation values of bone implant contact for zygomatic implant were 19.5 ± 5.3 mm, the bone covering the zygomatic implant laterally were 6 ± 2.3 mm, the minimum distance from the orbit were 5.6 ± 3.2 mm. General satisfactions for the treatment was 8.6. Conclusion: The use of zygomatic implants combined with conventional implants using virtual computer guided planning and surgery was useful for reconstruction of atrophic maxilla allowing an accurate, safe, graft less, less invasive surgery and provided a high patient satisfaction.

Introduction: Restricted mouth opening (MO) is associated with the problems in intra/extra-articular components such as trauma to the articular bone component especially at the early ages, chronic displacement of the articular disk, tumors, condylar anomalies, coronoid hyperplasia and hyperactivity of jaw muscles. A pseudo-joint can form between the zygoma and the hyperplastic coronoid process (Jacob’s disease). Pseudo-joint restricts MO, it causes multiple problems for patients, and finally it decreases the quality of their or patients’ lives. Therefore, early diagnosis and treatment are very important. Case Report: Described here is a 28-year-old man that due to trauma in childhood, his coronoid process became hyperplastic. The pseudo-joint formed between coronoid process and zygomatic bone interfere with MO. Discussion: The intraoral approach offers direct access without the risk of facial nerve injury or scars on the face

Purpose: In survivors of orbital embryonal rhabdomyosarcoma (ERMS), late effects include facial deformation and asymmetry. We sought to quantify orbital asymmetry in ERMS survivors and characterize the dose effect of radiation to the orbital bones. Methods and Materials: We evaluated the most recent follow-up magnetic resonance imaging (MRI) in 17 children (≤21 years old) with stage 1 group III orbital ERMS treated with proton therapy between 2007 and 2018. For all patients, the orbital socket volumes were calculated and compared with the contralateral, unirradiated orbital socket. Patient age, orbital tumor quadrant, and the radiation dose delivered to the major orbital bones (maxillary, frontal, and zygomatic bones) were recorded and correlated with the orbital socket volume difference. Results: The mean age at diagnosis was 5.4 years old (range, 1.1-9.7 years). All patients received a prescription dose of 45 GyRBE. The mean time interval between radiation and MRI was 2.9 years (range, 0.8-3.2 years). The mean age at most recent MRI was 8.4 years (range, 2.3-12.9 years). In 16 of 17 patients, the volume of the ipsilateral orbit was significantly smaller than the contralateral orbit on follow-up MRI (P ≤ .0001). In one patient with nonviable tumor in situ, the irradiated orbit was larger. The volume difference increased with follow-up time and did not correlate with age at treatment or age at MRI. A dose >40 GyRBE to all bones of the orbital rim was associated with a significant decrease in orbital volume (P < .05), but an isolated dose of >40 GyRBE to either the frontal, maxillary, or zygomatic bone was not. Conclusions: Despite the dosimetric precision of proton therapy, orbital asymmetry will develop after >40 GyRBE to multiple bones of the orbital rim. These data may be used to guide treatment planning and counsel patients on expected cosmesis.

Relevance. The method of setting the implant in the zygomatic bone often is conjugated errors and severe complications, as well as the need for anatomical justification, is still not widely used. their application. Purpose. Purpose. Study of the anatomical and topometric features of the zygomatic bone of an adult taking into account the age, sex and loss of natural teeth in the framework of the practical implementation of the clinical problem of maxillofacial surgery on the topic «Zygomatic implants». Materials and methods. The object of the study was the material of the modern craniological collection. For a collection of studying the anatomical and topometric features of the zygomatic bone and assessing the impact of tooth loss on its size, more than 200 skulls of people who died aged 18 to 79 years were studied. Results. In the study the linear dimensions and thickness of the adult zygomatic bones of an adult person have not been identified age-related features, as well as changes in the studied parameters, taking into account the side of the skull and the loss of natural teeth. Conclusion. Regardless of the side of the skull, age, sex and degree of tooth loss, the size of the zygomatic bone of men and women is determined by the size of the skull. Digital bata obtained, taking into account the size of the patients skull (very small, small, small, medium, large and very large) showed that the structure of the zygomatic bone is characterized by the presence of a thick layer of compact substance and a small-cell spongy substance, and the direction of the bone plates of the compact substance of the zygomatic buttress, as a rule, coincides with the direction of chewing stresses.

Highlights • Intraosseous zygomatic hemangioma is highly prevalent in females compared to males (2.28:1), with mean age of 44.1 ± 1.8 years. • The main patient concern in intraosseous zygomatic hemangioma is swelling and facial deformity. • Partial resection and curettage are associated with high recurrence rate. • Total tumor resection can assure no recurrence proved for over 10 years of follow-up, with minimal intraoperative bleeding occurred in most of the cases. • Computer guided surgery for resection and reconstruction of intraosseous zygomatic hemangioma facilitates the surgical procedures., Objectives to systemically integrate the available data on various published treatment strategies for intraosseous hemangioma of the zygoma in an updated comprehensive systematic review, and to present a new case of treated resection and immediate reconstruction using computer guided patient specific composite graft. Case presentation A 29 years old female patient with intraosseos zygomatic hemangioma treated using computer guided resection and immediate reconstruction. The resection was performed using a resection template constructed based on preoperative 3D planning. The reconstruction was performed using ramus bone graft and titanium mesh. The patient was followed up for 3 years with no complications. Methods An electronic search was performed on 3 data bases; additional hand search of bibliographies of selected articles was performed. Eligibility criteria include human studies presenting intraosseous zygomatico-orbital hemangioma with clearly reported therapeutic strategies. Results 53 articles with 73 cases were included. The lesion was highly prevalent in females compared to males (2.28:1). Fifth decade represents the highest prevalence with mean age of 44.1 ± 1.8 years. The main patient concern was swelling and facial deformity. Total tumor resection can assure no recurrence, while partial resection and curettage are associated with high recurrence rate.

Krokodil is a cheap and effective home-made substitute for heroin. It is widely used over the territory of the former USSR (Russia, Ukraine, Armenia and others). Krokodil drug-related midface ON often occurs as a complication of maxillary ON. Treatment of Krokodil drug-related ON of the midface is challenging. It is difficult to determine the ON zone preoperatively and intraoperatively, due to the complex anatomy of the midface and the different periods of the disease onset in different areas. The aim of this study is to show variations of the clinical course and treatment options of Krokodil drug-related ON of the midface. In this study, 3 cases of Krokodil drug-related midface ON are reported. The main clinical feature of midface ON is extraoral fistula in the midfacial zone with purulent discharge or extraoral exposure of zygomatic bone. Surgery is the main treatment method for Krokodil drug-related midface osteonecrosis. Surgery includes necrotic bone removal and defect closure. Usually an extraoral approach is used to expose necrotic bone. Intraoral maxillary sinus floor defect is closed with the use of a buccal fat pad to prevent formation of oroantral communication. Drug withdrawal, radical necrectomy, and proper closure of formed defects are the main factors that lead to successful treatment of Krokodil drug-related midface ON patients.

Odontogenic keratocyst is a benign locally aggressive odontogenic cyst with a high recurrence rate. This report presents an unusual case of a recurrent odontogenic keratocyst with zygomatic bone involvement and orbital and temporal extension resulting in globe compression. Odontogenic keratocyst is reviewed, and surgical management of the cyst is discussed.The authors present a case of a recurrent odontogenic keratocyst involving the zygoma with orbital and temporal invasion; aggressive surgical resection and reconstruction was required.

Facial paralysis can severely impact functionality and mental health. Facial reanimation surgery can improve facial symmetry and movement. Zygomaticus minor (Zmin) and zygomaticus major (Zmaj) are 2 important perioral muscles, that function to elevate the upper lip, contributing to the formation of a smile. The objective of this study was to analyze the morphology in three-dimensional (3D) and quantify architectural parameters of Zmin and Zmaj. In ten formalin-embalmed specimens, Zmin and Zmaj were serially dissected and digitized at the fiber bundle level. The 2 muscles were modeled in 3D to construct high fidelity models. The 3D models were used to assess muscle morphology and quantify architectural parameters including mean fiber bundle length, physiological cross-sectional area, and line of action. Zygomaticus minor fiber bundles were oriented horizontally or slightly obliquely and had a muscular attachment to the medial modiolus. Zygomaticus minor was found to either have no partitions or medial and lateral partitions. Specimens with partitions were divided into type 1 and type 2. Type 1 consisted of a medial partition with fiber bundles attaching to the zygomatic bone at the inferior margin of the orbit. The type 2 medial partition attached to the lateral margin of the orbit to attach to the zygomatic bone. Zygomaticus major had obliquely oriented fiber bundles with most specimens having inferior and superior partitions attaching to the inferior aspect of the zygomatic bone. Zygomaticus major was found to have a greater mean fiber bundle length and physiological cross-sectional area than Zmin. The direction of the line of action of Zmin and Zmaj was closely related to fiber bundle arrangement. Detailed 3D anatomical understanding of Zmin and Zmaj, at the fiber bundle level, is critical for reconstructive surgeons performing dynamic facial reanimation. This data can be used to assist with selecting the ideal donor site for reconstruction.

ObjectivesTo perform an adequate orbito-zygomatic craniotomy, it is very important that the bone cut which passes through the body of the zygoma reaches the inferior orbital fissure (IOF). To reach the IOF, two surface landmarks on the body of the zygoma are described: a point located directly superior to the malar eminence and the zygomaticofacial foramen. The article explores the reliability of these landmarks and three other alternative points to reach the IOF.Method Eighty-three adult skulls were used in this study. The IOF dimensions and the relationship with the malar eminence, the point superior to the malar eminence, the zygomaticofacial foramen and 3 alternative points (E, C, F) were analyzed.Results. The malar eminence was unacceptable for use as a guide to the IOF. The point superior to the malar eminence was also unacceptable as a guide as only 9.4% and 10.9% were in the projection of the IOF on the right and left, respectively. 59.7% of the total zygomaticofacial foramina fell in the IOF projection. The point F fell in the projection of the IOF in 98.8% and 100.0% on the right and left, respectively. Conclusion. The use of the malar eminence as a guide to reach the IOF is unreliable in one third of cases as it is not easily identified intraoperatively in these cases. The zygomaticofacial foramen cannot be considered a reliable surgical landmark to reach the IOF. The authors recommend using the point “F” which is reliable in 98.8-100% of cases.

The aim of this study was to evaluate the anatomical structures of the skulls of peccaries to establish the basis for their clinical study and future preclinical research. Ten skulls of adult peccaries were subjected to tomographic examination. The data obtained were processed via three-dimensional image reconstruction software (3D images). The reconstructions obtained from the neurocranium of the studied specimens allowed the identification and description of the following structures: nasal bone, frontal bone, parietal bones, incisor bone, maxillary bone, zygomatic bone, temporal bone, palatal bone, occipital bone, vomer bone, pterygoid bone, sphenoid bone, paranasal sinuses and orbit. Computed tomography proved to be an important diagnostic tool in the investigation of the skull of this species, allowing the acquisition of anatomical values not yet documented for the species in the literature.