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Purpose: Although different proposals have been made to categorize isolated zygomatic arch fractures (ZAF), an investigation about fracture type and clinical outcome has not been published. In this study, we analyzed the geometric fracture morphology in isolated ZAF and provide a survey of reduction outcomes in accordance with 4 independent classifications., Materials and Methods: Geometric measurements were performed in radiologic images of 94 patients with isolated ZAF, which were consecutively treated by closed reduction over transbuccal approach. Fracture types were allocated to the classifications of Rowe and Williams, Honig and Merten, Yamamoto et al., and Ozyazgan et al. The odds of achieving a satisfactory outcome were calculated for all categories., Results: Wide preoperative dislocation angles of more than 22° presented in M-type fractures (77.1%) more frequently compared to 2 fragments without the M-shape (33.3%) and one fragment (14.8%, p < 0.001). Favorable reduction outcome was significantly higher for M-shaped fractures than for differently configured fractures (83.3% vs. 30.4%, odds ratio 11.43, confidence interval 4.27-30.61). The rate of reduction in 100%-75% was most frequent for the Honig and Merten type I as well as Ozyazgan type IBV (both 85.4%, p < 0.001) and Yamamoto type II (84.2%, p < 0.001)., Conclusion: The classifications of Honig and Merten, Yamamoto et al., and Ozyazgan were quite applicable, and subgroups showed significant increments in reduction outcome. Our analysis emphasizes that the differentiation of two clinical relevant groups, M-shaped and variable arch fractures, is feasible to manage and efficient to determine the odds of reduction outcome., (Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

This study investigates treatment outcome in zygomaticomaxillary complex (ZMC) fracture repair., Methods: The medical records and CT-images of patients that received treatment for a unilateral ZMC fracture in 2005-2011 were studied. ZMC fractures were categorised as incomplete (type A), tetrapod (type B) or comminuted (type C). The incidence of sequelae, wound infection and secondary surgical interventions was analysed per fracture category., Results: A total of 153 patients were treated in the selected period. Persisting sensory disturbances in the area innervated by the infraorbital nerve were observed in 50 cases (37%), facial asymmetry in 19 cases (14%), enophthalmos in 10 cases (7%) and persisting diplopia in 9 cases (7%). Wound infection occurred in 6 cases (4%). Secondary surgical procedures of the ZMC, orbital floor, and/or extraocular muscles were performed in 14 cases (9%). C-type fractures were associated with more secondary corrections for ZMC malreduction (12%, p = 0.03), more secondary reconstructions of the orbital floor (10%, p < 0.01), and more functional corrections of diplopia by extraocular muscle correction (5%, p = 0.02)., Conclusion: Treatment outcome in C-type ZMC fractures is less favourable than treatment outcome in A-type and B-type fractures. Intraoperative imaging, surgical navigation devices and 3D-planning software may improve treatment outcome in C-type ZMC fractures., (Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objectives: To assess the changing mid-face fracture patterns using a computed tomography scan., Methodology: Fifty patients with mid-face trauma requiring open reduction and fixation were studied using 1.6 mm axial, sagittal, coronal and 3D images. Images were evaluated clinically, intra-operatively and finally were compared with standard Le Fort lines. Results. The male population dominated the female at a ratio of 11.5:1. The majority of the mid-face fractures were seen in the age group of 21-30 years. Road traffic accident (78%) was the major etiological factor followed by work-related accidents (12%) and assaults (10%). The CT scan analysis included categorizing the patients into three groups: (1) Fracture patterns resembling Le Fort lines (24%); (2) Fracture patterns partially resembling Le Fort lines (56%); and (3) Fracture patterns that do not resemble Le Fort lines (20%)., Conclusion: With the change in the velocity of wounding object, there is a change in the mid-face fracture patterns. The majority of the cases present as a variant of classical Le Fort fractures. Computed tomography is a valuable diagnostic tool in assessing the fractures of the mid-face. 2D images are more sensitive than 3D images. However, both the images are required in delivery of an optimal treatment plan.

Determining the optimal method for zygoma fracture reduction is a common challenge. Numerous methods for treating zygomatic arch fractures have been suggested. However, a substantial gap exists between suggested treatment strategies and real-world practice. A general consensus of classification and treatment guidelines for zygomatic arch reduction has not yet been established. We reviewed our cases and propose a new classification of zygomatic arch fracture and a treatment algorithm for successful reduction based on the injury vectors.

The present study aims to elucidate the relationship between preoperative deviation patterns of fractured zygomas and treatment outcomes. Forty-five randomly selected patients with tri-pod type zygoma fractures were classified into a medial rotation group and a lateral rotation group, depending on preoperative deviation patterns. A minimum of 6 months after the operation, symmetry of the cheek was evaluated by three plastic surgeons using a VAS system. The evaluated scores were compared between the two groups. Furthermore, simulation of postoperative secondary deformity was performed by applying hypothetically defined relapse forces on CAD models produced by referring to the CT data of 20 patients. The deviation values obtained by the simulation were compared between the two groups. The results demonstrate that VAS scores were higher for the lateral rotation group than for the medial rotation group and that the deviation values were higher for the medial rotation group than for the lateral rotation group. It is concluded that treatment outcomes of zygoma fractures are affected by preoperative deviation patterns. Cases with medial rotation are likely to present poorer outcomes than those with lateral rotation.

This article presents an overview of surgical management for complex midfacial fractures for the practicing otolaryngologist-head and neck surgeon. Discussion includes the important anatomic relationships; pathophysiology; clinical features; pertinent physical examination findings; imaging; surgical approaches; and techniques for repair of zygomaticomaxillary complex, orbital, naso-orbital-ethmoid, and Le Fort fractures., (Published by Elsevier Inc.)

Ideal reconstruction of the zygoma position is essential in restoring facial width, projection, and symmetry. Reconstruction should be focused on the zygoma's 4 articulations and restoring the vertical and horizontal pillars of the facial skeleton. This article describes the applied surgical anatomy as it relates to zygomatic deformities, surgical approaches, and reconstruction. The basis for diagnosing and classifying zygoma deformities as they relate to severity of injury and associated displacement, comminution, and comorbidities is also discussed. Traditional and contemporary concepts in posttraumatic, postablative, and esthetic reconstruction are also described., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Major problems in closed reduction of isolated, minimally displaced, and depressed zygomatic arch fractures are blind nature of the technique, reliability on digital palpation, reduction click, and step deformity between fragments. The purpose of this study was to objectively confirm the adequacy of closed reduction intraoperatively and the usefulness of the "C"-arm image intensifier. A total of 12 patients with 1- to 8-day-old unilateral isolated and depressed zygomatic arch fracture underwent closed reduction under "C"-arm image intensifier. Of these patients, 9 were men and 3 were women, with age ranging from 18 to 32 years. Intraoperative prereduction and postreduction images were obtained using the "C"-arm image intensifier. Criteria for adequate reduction were the following: intrafragmentary gap less than 0.5 mm, no overriding of fragments, no depression of fragments, and no step deformity. After being clinically satisfied about the reduction, images on "C"-arm showed no intrafragmentary gap. In 3 patients, there were residual overriding and minimal rotation around the anteroposterior axis of the posterior fragment. In 1 patient, rotation and step deformity remained. In this patient, additional stabilization was provided. The "C"-arm image intensifier shows some poorly reduced or unstable isolated depressed zygomatic arch fractures that remain unidentified even after careful palpation. Thus, it plays a recognizable role to avoid the trouble of second intervention.

The purpose of this study was to evaluate the natural history of zygomatic fractures in 469 cases over 14 years. The medical records of patients seeking treatment for zygomatic fractures were reviewed. The zygomatic fractures were classified as monopod, dipod, or tripod fractures for most patients. The monopod fractures included (1) zygomaticofrontal, (2) zygomaticomaxillary, and (3) zygomatic arch fractures. The dipod fractures were subclassified into 3 types according to combination of the previously mentioned 3 sites, which were 1 and 2, 1 and 3, and 2 and 3. Tripod fracture included all 1, 2, and 3. Among 469 cases of zygomatic fractures, tripod fractures (n = 238, 50.7%), zygomaticomaxillary fracture (n = 121, 25.8%), and isolated fracture of the zygomatic arch (n = 98 20.9%) formed most of the cases (n = 457, 97.4%). About one-half cases were tripod fractures (n = 238, 50.7%), and another half cases were monopod fractures (n = 220, 46.9%). Only 11 cases (2.4%) were dipod fractures. Most of the monopod fractures were zygomaticomaxillary (n = 121, 25.8%) and zygomatic arch fractures (n = 98, 20.9%). Among the dipod fractures, no cases of zygomaticofrontal and zygomatic arch fractures were reported. An open reduction was performed in 73.8% (346 cases), closed reduction in 24.5% (115 cases), and conservative treatment in only 1.7%. In tripod fracture (n = 238), an open reduction and internal fixation was performed for most of the cases (n = 225, 94.5%), and closed reduction was performed in only 11 cases (4.6%). In monopod zygomaticomaxillary fracture (n = 121), internal fixation was performed for most of the cases (n = 108, 89.3%), and closed reduction was performed in only 9 cases (7.7%). However, in monopod fracture of the zygomatic arch (n = 98), most of the cases (n = 95, 96.9%) were treated with closed reduction; open reduction was performed in only 1 case (1.0%). At zygomaticofrontal area (n = 241), internal fixation was performed in most of the cases (n = 198, 82.2%). At the infraorbital rim (n = 364), internal fixation was carried out in most cases (n = 257, 70.6%). At the zygomaticomaxillary buttress (n = 279), internal fixation was performed in about one third of the cases (n = 91, 32.6%). At the zygomatic arch (n = 339), only 1 case (0.3%) was fixed internally. The postoperative complication rate occurred in 88 cases (19.1%) among 461 cases operated. The most common complication was hypesthesia (50 cases, 56.8%), followed by diplopia (15 cases, 17.0%), limitation of mouth opening or closure (11 cases, 12.5%), infection (6.8%), and hematoma (4.5%). Most patients with hypesthesia improved at 2 months. About 90% of the patients with diplopia improved within 2 months. Limitation of mouth opening was improved immediately after operation in most of the cases. Our findings demonstrate significant differences in the demographics and clinical presentation that will enable a more accurate diagnosis and prediction of concomitant injuries and sequelae.

The aims of this report were to analyze the cases of lateral brow incision and 1-point fixation and to introduce the criteria for application of this selective approach.Among 70 patients with tripod fractures, 14 patients (20%) underwent 1-point fixation technique through lateral brow incisions. Preoperative and postoperative displacements of the infraorbital rim were radiologically measured.Of these patients, 7 cases (50%) were type III, 6 cases (43%) were type IV, and 1 case (7%) was type V according to the Knight and North classification. Simple fracture of the infraorbital rim was seen in 10 patients (71%), and comminuted fracture was seen in 4 patients (29%). In 11 patients, zygomaticofrontal sutures were fixed with square microplates with 4 holes and 0.5 mm in thickness, and straight miniplates with 4 holes and 1.0 mm in thickness were used in 3 patients. Of 14 tripod fractures, 6 (43%) were associated with floor fractures. Seven had displacement of the infraorbital rim (range, 2.0-7.6 mm; mean, 4.6 +/- 0.8 mm), and the other 7 had no displacement of the infraorbital rim. After surgery, step deformities of the infraorbital rims were improved (range, 0.1-3.8 mm; mean, 1.4 +/- 0.5 mm). All 14 patients were satisfied with their postoperative appearance.Indications for using 1-point fixation of the tripod fracture are (1) minimal or moderate displacement of the infraorbital rim in the tripod fracture of the zygoma, (2) no ocular signs of diplopia or enophthalmos, and (3) comminuted infraorbital rim fractures where internal fixation is difficult.

These clinical studies were carried out in maxillofacial unite, 10th floor, Surgical Specialties Hospital, Medical City, Baghdad. These orbital injuries included 236 patients during 15 years of experience. Their ages ranged from 2 to 72 years (mean, 37 years); 172 were male, and 64 were female. Orbital injuries are classified into isolated orbital walls, roof, floor, lateral wall, and zygoma and medial wall and complex wall injuries, as orbital skeleton injuries, or as part of cranio-orbito-facial injuries. There were 110 cases (46.6%) with orbital floor, and 85 cases (36%) with lateral wall and zygomatic complex injuries; 6 cases (3.6%) had isolated roof injuries; there were 15 cases (6.3%) with medial wall fractures and dislocation of medial canthal ligaments; 8 cases (3.3%) were orbital skeleton injuries with superior orbital fissure syndrome in 2 cases and eyeball laceration in 1 case, and 12 cases (5.08%) were cranio-orbito-facial injuries. These cases were treated and reconstructed by chrome-cobalt mesh for orbital floor, and also, Silastic rubber silicone was used in the floor and roof. Bone graft was used for reconstruction of large defect of the floor and medial wall, and Silastic was used for secondary operation for reconstruction of the floor as additional layer in cases with slight resorption of bone graft to correct residual enophthalmos, and lyophilized dura was used for reconstruction of the roof. Follow-up of the cases was extended for 15 years. The aim of these studies was to show some interesting clinical cases and surgical challenges for the management of these cases.

Introduction: Fractures of the zygomatic complex with its accompanying functional and esthetic deficits are a fairly common phenomenon in the practice of maxillofacial and plastic surgery. The purpose of this paper is to provide a review, based on collected data, on the topic of "fractured zygoma". The review is presented under the headings of epidemiology, fracture patterns, treatment modalities and complications. Throughout the paper comparison is made with published data from around the world., Methods: A 10-year retrospective audit was undertaken of all hospitalized patients, at the department of maxillo facial and plastic surgery in Charles Nicolle Hospital (Tunisia), who had sustained a fractured zygoma from 1995 to 2004., Results: A total of 356 fractures were sustained. Patients in the third decade of life (34%) recorded the highest incidence. The sex distribution is markedly higher for males than for females (9/1). Road traffic accidents (31%) were the predominant etiology. Tetrapod fractures (43.7%) were the most frequent type of fractures followed by zygomatic arch fractures (34.53%). Cases were managed by either closed or open reduction. Percutaneous reduction was the commonest technique employed. However, in unstable fractures necessitated open reduction, transosseous wiring was the most frequently employed fixation. Patients were followed-up routinely, for an average of nine months. Inferior orbital nerve dysfunctions were seen in 8.7% of cases., Discussion: Epidemiological findings are similar to those reported in the literature. Males sustained more fractures than females and road traffic accidents were the commonest cause of zygomatic fractures. Open reduction and internal fixation is advocated for the unstable, markedly displaced or comminuted fractures.

Purpose: To evaluate possible associations between the degree of reduction, remaining dislocation (mm), fracture type, and the sequelae from which the patient may suffer postoperatively in patients with zygomaticomaxillary fracture managed by closed reduction., Material and Methods: A 3-year retrospective audit was undertaken to identify all patients who had sustained a fractured zygoma and were operated on by closed reduction at the Ear, Nose, and Throat Department, Karolinska University Hospital, Huddinge, Sweden. Patients were followed up by mail questionnaire and postoperative computed tomography (CT)., Results: The odds of having symptoms (odds ratio [OR] 4.26, confidence interval [CI] 1.09-18.44) was significantly higher in the group with a reduction less than 100% (n = 34) compared with the group with 100% reduction (n = 17) (P = .035). The odds of having symptoms (OR 9.91, CI 0.89->500) was higher in the group with remaining dislocation 6 to 10 mm compared with the group with no remaining dislocation (P = .069). The type of fracture (A, B, or C) also influenced the patients' postoperative symptoms. The odds of having symptoms was 48.40 (CI 4.60->500) times higher having fracture C compared with fracture A (P < .001)., Conclusions: The degree of reduction and remaining dislocation of zygomaticomaxillary fractures is important to achieve a good postoperative result, that is, reducing the patient's postoperative symptoms. Furthermore, the type of fracture also influences the patient's long-term sequelae.

Purpose: To evaluate the incidence of ocular injuries and clinical ocular signs in patients with orbitozygomatic fractures of varying severity, presenting to a regional oral and maxillofacial surgery service., Patients and Methods: This is a retrospective study of patients presenting to Limerick Regional Hospital (Limerick, Ireland) with orbitozygomatic fractures from January 1998 to December 2004. Patients with panfacial fractures and those with isolated zygomatic arch fractures were excluded. All patients were examined by the ophthalmology service preoperatively and reviewed postoperatively as indicated. The study population was divided into 3 subgroups based on the extent of the bony injury (confirmed by clinical, plain radiographic, and CT examination) as follows: group 1: "simple" noncomminuted orbitozygomatic complex fractures; group 2: comminuted orbitozygomatic complex fractures; group 3: "pure" orbital blowout fractures. Patient demographics, fracture etiology, and ocular findings were recorded., Results: The study population included 148 patients (130 males, 18 females). All fractures were unilateral. Ocular findings were present in 29 (20%) patients, consisting of 8 of 85 patients (9%) in group 1; 15 of 53 patients (28%) in group 2; and in 6 of 10 patients (60%) in group 3., Conclusions: Clinical ocular findings and injuries are a relatively common complication of orbitozygomatic fractures, occurring in 29 (20%) patients in this study. These injuries occur more often in patients with orbital blowout fractures compared with comminuted orbitozygomatic complex fractures or simple orbitozygomatic complex fractures. Ophthalmology consultation is recommended for all patients presenting with orbitozygomatic fractures, and is essential for patients with orbital blowout fractures, based on the high incidence of clinical ocular findings and injuries in this subgroup of patients.

This article presents a systematic approach for interpreting a craniofacial CT scan that is clinically useful to the reconstructive surgeon. By categorizing the fracture patterns and highlighting the variables that may affect fracture management, the radiologist can expand his interpretation of the fracture pattern into a clinically useful diagnosis that may affect fracture management.

A clinically applicable, comprehensive reporting system for the diagnosis of facial fractures was developed with three guiding principles: (1) preservation of classical anatomical terminology and nomenclature, (2) facilitation of uniform interpretation of radiographs between radiologists and (3) non-redundant diagnostic descriptions of complex fractures, in a manner that correlates with treatment modality. Twenty-two fracture types (17 simple fracture types and 5 complex fracture types) are included in the system. Each patient's fracture pattern is described by listing the component fractures present. A short narrative (modifying description) is provided after each fracture listed. Simple fractures that help to comprise more complex fractures are not listed separately, but are described within the modifying description of the complex fracture they help to comprise. When components of multiple complex fractures are present, a hierarchy of complex fractures dictates which fracture is described first. Additional complex fractures are only described separately when they do not share common components. In all other cases, the second (lower order) complex fracture is best described by simply listing the component (simple or complex) fractures that are not accounted for in the higher order complex fracture. Adoption of this reporting system should improve communication between emergency medicine physicians, radiologists and surgeons.

Purpose: Among facial fractures, zygomatic arch fractures occur rather frequently. Facial fractures have recently been classified in fine detail according to computed tomographic findings. Nevertheless, there exists no classification of the zygomatic arch fracture, which has a physiognomically important place, to provide guidance for treatment. We aimed to make a detailed classification of zygomatic fractures in various shapes, which does not exist in the literature, and to form an algorithm for treatment., Patients and Methods: A total of 451 patients with zygomatic arch fractures treated in our clinic from 1987 through 2004 were assessed retrospectively from the treatment viewpoint together with radiological and clinical findings., Results: At the end of this assessment, arch fractures were divided into 2 groups: 1) isolated fractures in which the zygomatic arch alone broke, and 2) combined fractures in which the zygomatic arch broke together with the other facial bones. Isolated fractures were also divided into 2 subgroups as A) 2 fractures in the arch, and B) more than 2. Isolated arch fractures with more than 2 fracture lines were also classified as V-shaped fractures where fragments are partially reduced and those where fragments are displaced. As for combined fractures, they were subgrouped as A) single fracture in the arch, and B) plural. Plural fractures were further classified within their own group, also according to whether fragments were displaced or not., Conclusion: In the 2 fractures and V-shaped fracture subgroups of isolated fractures, preservation of fragments in reduced position was satisfactory during the closed reduction and afterwards. As for those with more than 2 fractures of isolated arch fractures, they required open reduction and internal rigid fixation. The same treatment was used in combined zygomatic arch fractures where there were more than one displaced fractures. In addition to classification, we formed an algorithm to guide us in treatment based on our series.

A new classification system and algorithm of zygomatic arch fractures is described that provides the surgeon with a useful starting point from which to organize a valid treatment plan and management of zygomatic arch fractures. Hönig Merten (HM) class I is defined as an isolated tripod fracture, HM class II as an isolated stick fracture of the arch, and HM class III is a combined fracture of the malar bone and the zygomatic arch. Although reduction of the class I and II is usually closed, open reduction is mandatory in class III zygomatic arch fractures.

Objective: To investigate a new classification and treatment of zygomatic complex fractures (ZCF) by clinical and radiographic studies., Methods: Standard radiographs with Waters, submental vertex views had been obtained before and after operation in 206 patients (212 sides) with ZCF. Patients with complicated fractures underwent two and three dimensional CT. Computer-assisted measuring system was used to measure the degree of displacement., Results: ZCF were classified into 3 types and 6 subtypes according to the degree of displacement of segments and facial deformities. Treatment principles were proposed. The results were satisfied through clinical application and measurement of post-operative images., Conclusions: The treatment for ZCF should be selected according to the fracture types. The key of operation is to recover the malar prominence. Remodeling the length and radian of zygomatic arch guarantee the recovery of malar prominence. Zygomatic-sphenoid and zygomatic-maxillary fissures are very important reference marks for reduction and fixation.

Background: The purpose of this paper is to provide a review, based on collected data, on the topic of "fractured zygoma". The review is presented under the headings of epidemiology, fracture patterns, treatment modalities and complications. Throughout the paper comparison is made with published data from around the world., Methods: A 10-year retrospective audit was undertaken of all hospitalized patients, at the Royal Hobart Hospital, Tasmania, who had sustained a fractured zygoma. All Le Fort fractures involving the zygoma were excluded., Results: A total of 263 fractures was sustained, largely due to assault. Alcohol was a significant contributing factor. Tetrapod fractures were the most frequent type of fractures witnessed. Plating was the most frequently employed fixation. Inferior orbital nerve dysfunction and other complications were seen in 24.6% and 20.7% of follow-up cases, respectively. Open reductions were nearly 4 times more likely to be accompanied by complications if inferior orbital nerve dysfunction was excluded., Conclusions: Both closed and open reductions are good treatment modalities and were used in near equal numbers of patients. There is a higher incidence of postoperative facial deformity in the closed reduction group, but more complications related to the incisions in the open reduction group. Open reduction and internal fixation is advocated for the unstable, markedly displaced or comminuted fractures. Silastic sheeting is a favoured graft for repair of the associated orbital floor defects and is associated with few complications.

The aims of this non-randomized prospective study were to establish and justify minimized therapy for zygomatic complex fractures. Fifty-two consecutive patients were examined and classified with conventional routine radiographs. Preoperative symptoms were recorded. Treatment of zygomatic fractures was by percutaneous hook reduction and miniplate fixation along the frontozygomatic suture. Exploration of the orbital floor was carried out only in cases of primary diplopia or comminuted fractures. Postoperatively, patients were followed for 12 months. Clinical and radiologic assessment of reduction was symmetric and stable in all cases. Preoperative symptoms disappeared completely except for sensitivity disturbance in five patients. Patients with no post-trauma diplopia did not develop eye motility disturbances or enophthalmos. The treatment of a zygomatic fracture is possible by the described technique. Exploration of the orbital floor is indicated only in cases of preoperative diplopia. Therefore, a patient with a zygomatic fracture and diplopia should be classified as having a orbitozygomatic fracture. In cases of comminuted fractures, exploration of the orbital floor remains mandatory.

Objective: To compare the clinical effectiveness of computed tomography (CT) with conventional radiography in midfacial fractures., Methods: The conventional radiographs (CM) and CT scans of 40 consecutive patients with complex midfacial fractures were assessed independently by two examiners. The number and site of fractures of the orbit, zygoma and maxilla were compared by the Wilcoxon Matched Pairs Signed Rank test. The best method for classification of the fracture was determined., Results: Coronal CT (CCT) proved superior in the diagnosis of orbital fractures (P<0.001). There was no significant difference between any of the imaging methods for fractures of the zygoma. Axial CT (ACT) was the most effective method in imaging of maxillary fractures (ACT-CM; P<0.001, ACT-CCT; P<0.01). CCT was the most useful in classification of orbital and maxillary fracture., Conclusion: CCT is superior to CM for the assessment of complex midface fractures

Objective: To investigate an available method for quantitative diagnosis of zygomatic fractures that allow quantitative classification and diagnosis., Methods: The radiographs and 2- and 3-dimensional CT images of 57 patients with zygomatic fractures were measured and analyzed by a computer-assisted measuring system before and after treatment. This was used to diagnose the displacement and deformity of the fractures., Results: (1) Using anthropology points and a computer-assisted measuring system, a new method was established to assess the displacement of the zygomatic fractures. (2) Displacement of the zygomatic fractures was approximately diagnosed by measuring different angles of the CT images. (3) A new classification was proposed based on the deformities of the zygomatic fractures: Type A, zygomatic body was intact and not displaced; Type B, zygomatic body was intact but displaced (including comminuted zygomatic arch fractures); Type C, zygomatic body was comminuted and displaced. (4) There were 4 subtypes with characteristics in the most common Type B fractures. (5) Different images had different advantages for diagnosing zygomatic fractures., Conclusions: (1) Displacement of the zygomatic fractures can be quantitatively diagnosed by measuring 3-D CT images. (2) The computer-assisted 3-D CT measuring system is accurate, reliable, and clinically feasible for diagnosing zygomatic fractures. (3) The best image to diagnose the displacement of the fractures should be used.

Fractures of the middle portion of the facial skeleton are commonly referred to as midface or LeFort fractures. While significant progress has been made in terms of evaluation and treatment of such fractures, they remain a challenge for the maxillofacial surgeon. In this section, we will review the principles of midface fracture evaluation and repair, emphasizing the importance of understanding biomechanics and controversies that exist in respect to repair sequencing.

Background and Objectives: To achieve the optimal preoperative appearance following craniofacial fracture repair, the surgeon must be facile in the most sophisticated reconstructive techniques and able to determine their application. The purpose of this article is to describe the common deformities following such repairs, outline a strategy to avoid them, and review the surgical techniques to correct them., Methods and Materials: The deformities are categorized by the anatomic zones of the orbit, i.e., zygomatic, frontal, and nasoethmoidal, affected by low-, middle-, and high-energy impact. The common types of deformity and acute and late treatments are discussed for each category., Results And/or Conclusions: The optimal time to correct posttraumatic orbital deformities is during the acute phase. Extended open reduction and rigid fixation techniques have their own morbidity, which must not outweigh the deformity of an untreated or partially treated injury. The results of late reconstruction are always limited by scarring of the overlaying soft tissue envelope.

The pre- and postoperative symptoms of zygomatic bone fractures were examined in a follow-up study to prepare a classification proposal. A differential indication for minimally invasive therapy modes was looked for with respect to this proposal. Therapy of isolated zygomatic bone fractures consisted in repositioning with a hook and miniplate fixation across the frontozygomatic suture. The aims of this study were clinical and radiological assessment of the repositioning result in terms of aesthetics and stability and quantification of the postoperative remission of disturbances of sensitivity of the infraorbital nerve. A total of 52 patients were examined. After the operation (on average after 3.5 days following the trauma) they were followed-up postoperatively for 12 months according to a strict schedule. Preoperatively, 49 patients reported disturbances of sensitivity of the infraorbital nerve. Other symptoms, such as periorbital haematoma and flattening of the zygomatic prominence, were observed in 49 patients and 45 patients, respectively. All fractures were repositioned well as assessed clinically and radiologically. The aesthetic result was evaluated as symmetric and durable in all cases. Six months postoperatively 41 patients reported normal sensitivity in the area of the infraorbital nerve. In only five patients (10.2%) was the sensitivity loss persistent throughout the entire follow-up period. Patients with primarily lacking diplopia developed neither eye motility disturbances nor postoperative enophthalmus in the following period. It can be concluded that the treatment of an isolated zygomatic bone fracture which satisfies aesthetic and functional requirements is possible by reposition and fixation with one miniplate at the lateral orbital rim. An additional osteosynthesis at the infraorbital rim or at the zygomaticomaxillary crista is not necessary. A routine revision of the orbital floor is only indicated in cases of preoperative diplopia. A zygomatic bone fracture connected with diplopia should be classified as combined zygomatic-/orbital floor fracture.

One hundred forty-four orbital fractures treated between 1982 and 1987 were examined with special attention to the specific anatomic architecture and biomechanical aspects of the craniofacial skeleton. The following parameters were examined: lesion mechanism, the bony lesion observed at surgery, clinical signs of fracture and morphological, functional and esthetic sequellae. All operated patients had undergone an ophthalmological examination prior to surgery, with special attention on binocular vision and ocular motility. Fractures were classified into pathological groups according to the parameters studied. For each group, clinical signs and accompanying sequellae were described. Seven clinical and pathological groups of orbital fractures were described, each with its specific mechanism of trauma, bony lesions, clinical signs, sequellae and appropriate treatment.

Purpose: The goal of this study was to review experience with early and delayed repair of orbitozygomatic complex fractures and develop guidelines for repair based on timing and extent of injury., Patients and Methods: Records of patients with orbitozygomatic complex fractures over a 10-year period were reviewed for cause of injury, signs and symptoms, length of time from injury to repair, and method of repair. Results were evaluated by office examination and telephone interviews at least 6 months to 10 years after surgery., Results: Seventy-eight patients who had undergone 81 surgical procedures were analyzed. The series consisted of 49 primary repairs (1 to 22 days postinjury), 10 delayed repairs using osteotomies at 21 days to 5 months postinjury, and 22 delayed repairs requiring onlay bone grafting from 4 months to 16 years postinjury. Forty patients (43 procedures) were available for follow-up. Early surgical intervention dramatically improved esthetic and functional outcomes, whereas late repair was less satisfactory. Hypoesthesia was not improved by surgery. Osteotomy and onlay grafting techniques were necessary for delayed treatment., Conclusion: Orbitozygomatic fractures can be repaired up to 21 days postinjury using primary reduction and fixation techniques. Osteotomies are required after 21 days and can be used successfully up to 4 months postinjury. After 4 months, successful repair requires onlay bone grafting.

The treatment of zygomatic fractures varies among surgeons, and the cosmetic and functional results are frequently less than optimal. A treatment guideline based on a simple classification of zygomatic fractures is presented. The emphasis is placed on the indications for closed and open reduction, consistent methods of three-dimensional alignment and fixation, and the management of concomitant infraorbital rim and orbital floor fractures. Postoperative results with regard to infraorbital nerve and maxillary sinus dysfunction, malar asymmetry, and orbital complications in the treatment of 1,025 consecutive zygomatic fractures are presented.

The author has made clinical studies on treatment of fractures of the zygomatic bone in terms of frequency of fractures according to sex, age, fracture type, main manifestations and treatment methods from 106 patients with zygomatic bone fractures among 969 patients with maxillofacial bone fractures. The results obtained were as follow: 1. The frequency of malar bone fracture was 4 times more in male than that in female. 2. The most prevalent age of malar bone fracture was 21-30 years of age, and the nexts were followed 11-20, 31-40, 0-10, 41-50, 51-60, 61-70, and over 71 in the orders. 3. Among maxillofacial bone fractures, mandibular fracture was most prevalent as 76.3%, and the nexts were followed by the maxilla (10.8%), the molar bone (9.7%) and the nasal bone (3.3%). 4. Among 106 fractures of the malar bone, zygomatic bone fracture only was occupied 48.1%, but the rests were accomplished by another maxillofacial bone fractures. 5. In classification of molar bone fractures according to Knight and North's, group 3 fractures were most prevalent, and followed by group 2, 1, 4 and 6 in the orders. 6. Main manifestations were upper cheek flattening, lower eyelid ptosis, subconjunctival ecchymosis, epistaxis, difficulty of mouth opening, pain during mouth opening and others in the orders. 7. 93.4% of malar bone fracture has been treated surgically, but the rests treated conservatively, and [symbol: see text] shaped elastic stapler wire has been effectively used to get fixation at zygomatico-maxillary fractures.

The malar arch consists of both the temporal process of the malar bone and the zygomatic process of the temporal bone. So far, there have been various different surgical approaches to the fractured malar arch. This report deals with 16 cases of the facial bone fractures including the malar arch. The usefulness of a pre-auricular (tragus) skin incision elongated to the haired temporal region is presented.

It is well known that certain kinds of fractures of the facial skull occur repeatedly. In attempting to classify our own patients we came to the conclusion that an easy categorizing into the known schemes is rarely possible. Therefore, we propose a new classification based on 353 facial skull fractures, treated in our clinic during the last eight years. In doing so, we take into account not only the localization of the fracture, but also the degree of the injury in the form of a grading. Both of the large groups, lateral and central facial skull fractures, are further divided into isolated fractures of particular localisations (zygomatic arc, orbital floor fracture etc.) and compound fractures of varying degrees (lateral or central impression fractures of the mid-face Grade I-III). This classification, based on practical experience, allows the majority of all existing injuries to be freely categorized.

In this article, the authors relate their experience in the management of zygomatic fractures, based on 168 cases treated in the Plastic Surgery Unit of Bruges between January 1971 and August 1980. The symptomatology and treatment of those fractures are discussed according to the type of fracture. The importance of the early treatment and the necessity of osteosynthesis when the fronto-zygomatic suture is distracted are stressed. Multifragmented fractures are treated in the same way by means of osteosynthesis. The use of a silastic sheet for blow-out floor fractures is advocated.

Fifty-one patients with malar complex fractures were examined with computed tomography to analyze the pattern of displacement in an anteroposterior direction of the face. Malar complex fractures were classified into four groups according to the location and direction of the fragments. Comparisons of the fracture classification obtained by use of CT images with that obtained by conventional radiographic methods demonstrated sufficient correlations between the classification systems to confirm that it is possible to establish a complete three-dimensional pattern of displacement in malar complex fractures using CT imaging.

A system is proposed which defines the Le Fort fracture pattern more precisely and allows one to compare fractures and describe them adequately. The system involves a description of the highest level of Le Fort fracture on each side, a description of the fragment that carries the maxillary dentition, and a description of accompanying nasoethmoidal or mandibular fractures. The areas that must be considered for open reduction are thus precisely defined and represent the weak structural areas of the maxilla as defined by Le Fort in his experiments. Open reduction should progress from stable bone to stable bone, replacing with bone grafts those areas that are unsatisfactory for interfragment wiring. Aesthetic results obtained are superior and more predictable than after treatment with classical Adam's fixation.

In 1973 methods for diagnosing and treating zygomatic complex fractures were reviewed, with emphasis on the lateral eyebrow incision for access to the zygomaticofrontal region. The following clinical update reviews alternative approaches to the zygomatic complex (coronal incision, upper eyelid incision), and current concepts of treatment for acute injuries and late deformities secondary to malunion.

A prospective study involving 54 patients was undertaken to compare external pin and transnasal Kirschner wire (K-wire) fixation of the unstable, non-comminuted, tripod malar fracture. The features assessed were: (1) The aesthetic result. (2) The ease and speed of both procedures. (3) Per-operative complications. (4) Post-operative complications. (5) Patient tolerance of the procedure.

A retrospective study of zygomatic fractures is presented in order to analyse late complications and to evaluate the different radiographic classifications. The study comprises 109 patients with 111 zygomatic fractures. The aetiology was violence in 39% and traffic accidents in 28%. Associated fractures of the craniofacial skeleton occurred in 42% of the patients. Seventy-two patients were available for the follow-up study. Malar flattening was found in 16% of the patients operated on. Thirty-four per cent of the patients had sensory disturbances, 6% had enophthalmos, and 1% had diplopia. Classifications of zygomatic fractures are reviewed. The fractures in the current study were grouped in accordance with the classifications of Knight & North and Larsen & Thomsen. Neither of these classifications was found to be useful in the preoperative evaluation of the postreductive fracture stability. The most reliable method of evaluating this stability is the preoperative evaluation, but CT classification systems may in the future demonstrate their value.

The classification of orbitozygomatic fractures is presented, and, using this, a decision can be made as to when to examine the fracture with CT scans and how to decide on employing a coronal approach for exposure. Three-point fixation is advocated using wires and miniplates. All portions of the fracture should be stabilized. In this way, the complications of enophthalmos, diplopia, dystopia, and flattening of the nose and cheek may be avoided. The method of treating late deformity resulting from orbitozygomatic and orbitoethmoid fractures is presented, stressing wide exposure, good fixation of osteotomies with miniplates, and cranial bone grafting to reduce orbital volume and correct enophthalmos.

A review of classifications of zygomatic fractures demonstrates an increasing complexity in the choice of proper treatment. To facilitate the choice of treatment a proposal is made of a simplified classification with prediction of post-reductive fracture stability. The author's material, comprising 137 patients, has been accordingly divided and the proposed classification justified by the peroperative findings and by the follow-up results.