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Purpose: This study aimed to determine the presence and incidence of accessory sutures and bipartite zygomatic bone types, and their effects on population affinity and clinical significance. Methods: We examined 120 dry skulls and 50 zygomatic bones to evaluate the presence, frequency, and location of accessory zygomatic sutures as well as subtypes of bipartite zygomatic bones. Morphometric analysis included measuring the total width and length of the zygomatic bone with accessory sutures (ASs), the total length of the AS, and the shortest distance between the AS and various anatomical landmarks. Results: Bipartite zygomatic bone was observed in 14 of 120 dry skulls (11.6%) and 1 of 50 zygomatic bones (2%), indicating an overall incidence of 16 occurrences (8.82%). The ASs were predominantly located posterolaterally in 11 cases (six males, five females), anteromedially in two cases (one male, one female), superiorly in one case (male), and superolaterally in one case (male). Significant differences were noted in the distribution of the ASs (p < 0.001). Notably, a vertical inferior bipartite zygomatic type, which has not been reported in the literature, was identified. Correlations were observed between the various anatomical landmarks. Among females, the length of AS was significantly different (p = 0.038). Significant differences were also noted in the shortest distance between the AS and the zygomaticofacial foramen (ZFF) based on the body side (p = 0.034). Conclusions: Our study suggests that the bipartite zygomatic bone is not a common occurrence, indicating its significance as a morphological variation present in certain individuals. The type VII bipartite zygomatic bone exhibited the highest incidence rate, suggesting potential ethnic-specific differences in the prevalence of certain subtypes. The consistent pattern of suture distribution, along with the asymmetry and variability in suture patterns, emphasizes its potential clinical relevance. [ABSTRACT FROM AUTHOR]

Zygomatic bone contributes to the orbital walls, and therefore associated injuries carry a high risk of severe dysfunction of the visual apparatus. The aim of our study was to retrospectively assess the spectrum and frequency of ophthalmic involvement in patients presenting with malar fracture, and the need for referral to an ophthalmologist for evaluation. In total, 102 patients presenting with malar fracture between January 2008 and August 2017 at Bapuji Dental College and Hospital, Davangere, Karnataka were enrolled in this study. Patients with confirmed malar fracture were categorized according to Henderson's classification, and associated ocular injuries were recorded. Assessment of the spectrum and frequency of ophthalmic involvement in patients presenting with different types of malar fracture was then carried out, followed by categorization of the need for referral to the ophthalmologist with regard to the associated ocular injury, as per the Al-Qurainy et al. (1991) scoring system, allocating the patients to early, routine, and non-referral categories. Statistically significant differences in proportions of various types of ophthalmic involvement were found between categories of malar fracture, and in degrees of ophthalmic involvement within each category of malar fracture, except in the Type II group of patients. The most severe ocular injuries were noted in Type VII followed by Type V, with the least severe injuries noted in Type II patients. According to the Al-Qurainy et al. (1991) scoring system, eight patients required early referral, 10 patients needed routine referral, and 84 patients were in the non-referral category. Categorization of referral of patients to an ophthalmologist in hospitals lacking ophthalmology departments can be based on the Al-Qurainy et al. classification of referral for Henderson's Type III, IV, and VI. Henderson's Type I and II patients need to be referred only in medicolegal cases. Henderson's Type VII and V patients require mandatory referral. [ABSTRACT FROM AUTHOR]

Variant foramina of the skull can lead to misdiagnosis on medical imaging and potentially, intraoperative complications if not appreciated. Here, we report an unusual foramen found superior to the frontozygomatic suture. The foramen was located on the left side at the superolateral rim of the orbit, 2.36 cm inferolateral to the supraorbital foramen. It was positioned 2.5 mm superior to the frontozygomatic suture. The foramen had a length of 3.1 mm and a width of 1.3 mm. The internal opening of the foramen was located 1.45 cm superolateral to the zygomaticotemporal foramen. We suggest that this foramen is a pathway for either a branch of the zygomatic nerve or lacrimal nerve and/or their vascular bundles. Although the prevalence of such a finding cannot be confirmed, such a case is of archival value as a comparison for future similar cases. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to reveal the location of the zygomaticofacial foramina, the variations of their numbers, and their connections between the zygomatico-orbital and zygomaticotemporal foramina. Methods: Ethics committee approval of our study was received by the Istanbul Medical Faculty Clinical Research Ethics Committee (date:30.07.2021, number:358356). 171 zygomatic bones of unknown gender from the Department of Anatomy, Istanbul University, were included in this study. The number of zygomaticofacial foramina and their connections with the zygomatico-orbital foramen and the zygomaticotemporal foramina were examined. Also, the morphometric distances between the zygomaticofacial foramen were calculated. Evaluation of the data was done with SPPS v.21. Results: The number of zygomaticofacial foramina was found as 299. It was found single, double, three, four, five and six foramina, in 52 (30.4%), 52 (30.4%), 24 (14.03%), 10 (5.85%), 5 (2.93%), 1 (0.58%) zygomatic bone, respectively. Zygomaticofacial foramen was absent in 27 (15.8%) bones. Of these 299 foramina, 129 were found to be connected with zygomatico-orbital foramen and 23 with zygomaticotemporal foramen. It was noted that 147 zygomaticofacial foramina had no connection with any foramina. The distances between the zygomaticofacial foramen and the frontozygomatic suture, temporal process, maxillary process, the lowest point of the zygomatic bone, and orbital rim were found as 25.30 ± 2.81mm, 18.74 ± 3.56mm, 21.56 ± 4.16mm, 18.72 ± 2.57mm, 6.67 ± 3.27mm, respectively. Conclusion: Consequently, the location and variations of ZFF are of great importance for maxillofacial surgery and regional block anesthesia. Knowing its location and variations will help prevent complications during any surgical intervention in this region. [ABSTRACT FROM AUTHOR]

Fibrous dysplasia (FD) is a benign bone disease characterized by the replacement of normal bone with fibro-osseous connective tissue. Although FD may occur in the facial bones, it rarely occurs in both the zygomatic bone and mandible simultaneously. We herein describe a 59-year-old woman who developed FD in the zygomatic bone and mandibular coronoid process. She was referred to our hospital because of the presence of a radiopaque area around the maxillary tuberosity. Computed tomography showed a bell-shaped, radiopaque mass in the right zygomatic bone and upward extension of the right coronoid process. Although we biopsied the lesion of the zygomatic bone, we could not precisely diagnose the lesion. The lesion was excised intraorally under general anesthesia. Histological examination revealed FD in the zygomatic bone and coronoid process. Postoperative computed tomography showed a residual lesion in the zygomatic bone, but there was no enlargement even 1 year postoperatively. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical features, diagnosis and treatment of osteomyelitis of the jaw caused by an actinomycotic infection and to provide a reference for clinical diagnosis and treatment. Methods A case of osteomyelitis in the bilateral maxilla and the left zygomatic bone and arch caused by a mixed bacterial infection dominated by Actinomycetes was reviewed and analyzed in combination with the literature. Results The patient had left upper posterior tooth pain with repeated left facial swelling for 7 months. The patient's left face was swollen before surgery, the left maxillary alveolar bone was necrotic, and the upper palate showed fistula discharge. A maxillofacial magnetic resonance imaging scan excluded tumors and other space-occupying lesions. According to CBCT images, the initial diagnoses were left infraorbital space infection and osteomyelitis of the bilateral maxillary, the left zygomatic bone, the left zygomatic arch and the lateral orbital wall. Necrosis of the left maxilla and the zygomatic bone was excised, the focus was cleared and the focal tooth was extracted under general anesthesia. Histopathological results confirmed osteomyelitis and actinomycotic infection. Anti-inflammatory therapy with penicillin sodium was given before surgery, and piperacillin sodium and tazobactam sodium, dexamethasone sodium phosphate, tranexamic acid and mecobalamine were given after surgery. The patients' 6-month follow-up results showed that the maxillofacial shape was basically symmetrical; no ulceration, pus or abnormal secretion was found in the skin or intraoral mucosa; and the surgical area showed good recovery. A review of the relevant literature showed that Actinomyces is an opportunistic pathogen, and factors such as trauma and dental infection have been implicated in the pathogenesis of osteomyelitis. In addition to surgery, antibiotics are used to treat the disease and multidisciplinary symptomatic treatment combined with supportive treatment is required to achieve a better prognostic effect. Conclusion Actinomycotic osteomyelitis occurring in the maxilla and the zygomatic bone is an extremely rare disease that can be diagnosed by clinical manifestations, bacteriological examination and biopsy. Appropriate and effective penicillin drugs should be given at the initial stage of treatment, more sensitive antibiotics should be selected according to the results of the drug sensitivity test, and the lesions should be surgically removed when the patient's condition improves. Active symptomatic and supportive treatment should be performed during the treatment period.

Background: Divided zygoma (DZ) is an important structure in the midfacial region. The anatomy of DZ is poorly researched, but knowledge about this entity could be useful during posttraumatic facial reconstructions. The aim of this study was to estimate the prevalence and anatomy of DZ in different regions around the world. Therefore, the authors performed a meta-analysis, including all studies that report extractable data on the DZ. Materials and methods: The main online medical databases such as PubMed, EBSCO, ScienceDirect, Web of Science, SciELO, BIOSIS, Current Content Connect, Korean Journal Database and Russian Citation Index, were utilised to gather all studies on anatomical characteristics, prevalence, symmetry, and a number of divisions of zygomatic bone. Results: A total of 20 studies were included in this meta-analysis. Data were grouped and analysed in five categories: (1) prevalence of DZ bone, (2) prevalence of DZ skulls, (3) gender prevalence of DZ with sides, (4) divisions of zygomatic bone, (5) symmetry of DZ. Conclusions: In conclusion, the authors of the present study believe that this study can be considered an up-to-date meta-analysis regarding the prevalence, divisions, and symmetricity of the DZ. The data provided by the present study may be useful information for physicians in recognizing the DZ of the fracture and may be important information during zygomatic bone osteotomy. Detailed anatomical knowledge of the midfacial region can prevent surgical complications when operating in this area. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Functional and aesthetic rehabilitation of maxilla or posterior maxillary defects is challenging and zygomatic implants have been an effective option in the management of atrophic edentulous maxilla and maxillectomy defects. Zygomatic implants were introduced by Branemark. Bone grafting and augmentation procedures involve two step procedures and lead to economic and financial loss for the patient, thus zygomatic implants have proved to be a good non-grafting option for the rehabilitation procedures for treating posterior maxillary and atrophic maxillary cases. Aim: This study aims to assess the awareness of zygomatic implants among undergraduate students. Materials And Method: A online questionnaire based survey was circulated among the students of Saveetha Dental college and the answers were compiled in excel sheet and tabulated and analysed using the statistical software IBM SPSS version 20.0 and the results of the survey were represented using tabulations and graphical illustrations. Results: Totally 100 participants took part in the the survey and out of which 90% of them were aware of zygomatic implants. 80% of the participants who took part in the survey were aware of the indications of zygomatic implants. 80% of the participants were aware of the most common complication being sinusitis. And the rest of the participants were aware of the other complications that can occur due to zygomatic implants. Conclusion: This survey was done to create an awareness on zygomatic implants. From the study most of them were aware of zygomatic implants, their indication, surgical procedure, contraindication and treatment protocol. [ABSTRACT FROM AUTHOR]

Background: A wide range of medical procedures in the zygomatic region in maxillofacial surgery, implantology, and aesthetic medicine requires a detailed study of the zygomaticofacial foramen (ZFF) due to the high risk of damage to its contents during manipulation.This study aimed to estimate the shape, diameter, and location of ZFF and their relationships with anatomical landmarks., Materials and Methods: A studywas conductedon 53 dry adult human skulls. Standard morphometric measurementswere takenusing sliding calipers.The number, diameter, shape, and location of ZFF were notedon both sides, andthe distances between the ZFF and surrounding anatomical landmarks were measured.Conventional statistical methods were usedto evaluate the data., Results: Out of 106 sides, no ZFFwas noticedin 2.8%, one foramen was found in 40.6%, two foramina were found in 39.6%, threein 10.4%, four in 4.7%, andfive in 1.9%. The vertical diameter was 0.98 ± 0.35 mm, while the transverse diameter was 0.87 ± 0.31 mm. The shape of the ZFF was oval in 67%, round in 26.2%, semilunar in 4.9%, and irregular in 1.9%. The distance from the ZFF to the infraorbital margin was 6.63 ± 2.09 mm, tothe frontozygomatic suture was 26.24 ± 3.49 mm, tothe zygomaticomaxillarysuture,was 19.75 ± 3.55 mm, tothe zygomaticotemporal suture was 22.31 ± 3.98 mm and, to the most prominent point of the zygomatic bone was 8.03 ± 2.64 mm., Conclusions: The variations in the number and location of ZFF mustbe consideredwhile performing regional blockanesthesia,and surgical or aesthetic procedures in the zygomatic region.

Objective: In literature that may be many variations for zygomaticofaciale foramen (FZF) located, there are studies examining incidence. FZF, where nerve exits, is important such as anesthesia in this region, zygomatic implant procedures, zygoma osteotomies. This study aimed examine localization and number of FZF in cone beam computed tomography (CBCT) images. Methods: CBCT images of 157 individuals between ages of 13-96, taken by PlanmecaProMax 3D Mid, were retrospectively examined with RadiAnt DICOMVIEWER program. The presence of any bony malformation of skull skeleton was determined exclusion criterion for study. The number of FZFs, location FZF, distances between FZF and the most lateral edge of orbit (OL), between FZF and zygomaticotemporal suture, and between FZF and the lowest point of zygomatic arch were measured on images. The analysis of data included was carried out with SPSS25. Results: Right and left side images of a total of 157 patients (45.27±18.09 years, male: 103, female: 54) were analyzed. The number of FZF was found to be 30.5%-41.9%-12.8%-2.9% in Type 0-I-II-III, respectively. There was no statistically significant difference FZF between the right and left sides (p>0.05). Type I is mostly located in region c, Type II and Type III are located in region a. In measurements, statistically significant difference was found between right and left sides in the first hole FZF-OL measurement (p=0.001). Conclusion: During surgical procedures, it is important know locations of neurovascular structures on zygomatic bone. For this reason, knowing number and localization of FZF in this region can give an idea in determining a safe area. [ABSTRACT FROM AUTHOR]

Copyright of China Journal of Oral & Maxillofacial Surgery is the property of Shanghai Jiao Tong University, College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Disseminated cryptococcosis is a well-characterized complication in immunocompromised patients with cryptococcal pneumonia or meningitis; however, isolated cryptococcal osteomyelitis is a rare entity that occurs in approximately 5% of patients with cryptococcosis. Cryptococcal osteomyelitis in the head and neck region is extremely rare. To the best of our knowledge, no cases of cryptococcal osteomyelitis affecting only the zygomatic bone have been reported to date. Case presentation A 78-year-old man without other comorbidities presented with progressive swelling of the right cheek along with pain and trismus. Clinical examination revealed a tender swelling in the right zygomatic region; the maximal mandibular opening was about 2 cm. Laboratory data showed mildly elevated inflammatory indices (C-reactive protein: 0.45 mg/dL; erythrocyte sedimentation rate: 35 mm/h). Computed tomography showed a 30-mm-diameter lesion at the right zygomatic arch. A part of the lesion has extended to the subcutaneous area of the cheeks with signs of bone destruction and surrounding contrast effects. Histopathological examination of fine-needle aspirate and needle biopsy showed cryptococcus. Furthermore, culture of the aspirate showed growth of Cryptococcus neoformans. No evidence of any other site involvement was observed. Therefore, the patient was diagnosed with isolated cryptococcal osteomyelitis and was initiated on fluconazole therapy. The treatment was effective, and all symptoms were resolved in 4 weeks. Fluconazole therapy was stopped after 6 months. There are no signs of recurrence as of 15-month follow-up. The patient has no cosmetic abnormalities or sequelae. Conclusions Fine-needle aspiration cytology, needle biopsy, and fungal culture were useful for definitive diagnosis. Immunocompetent patients with isolated osteomyelitis may be cured with oral fluconazole alone.

Introduction: Zygoma is one of the facial bones that are impacted in the accidents. Hence, we aim to evaluate the patient's profiles in the fracture associated with zygomatic bone. Materials and Methods: We conducted a prospective clinical study with 60 subjects who were divided equally into cases (30) and controls (30); controls were general population and the cases underwent surgery of zygomatic complex fracture. Health-related quality of life (HRQoL) was assessed by the means of the questionnaire. The values were compared for the significance keeping P < 0.05 as significant. Results: The preoperative 15D score was lesser for cases than controls. Soon after surgery, it was statistically least and after a month, the mean score surpassed the controls. Infraorbital sensory loss was seen even after 6 months. Conclusions: As expected, the HRQoL decreases only to improve after the surgery. However, the infra-orbital nerve sensory loss may continue for over 6 months after the zygomatic complex fracture. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: First arch syndromes are congenital defects caused by failure of neural crest cells to migrate into the first branchial arch. First arch syndrome is classified into 2 main clinical manifestations: Treacher Collins syndrome, characterized by bilateral underdevelopment of the zygomatic bones; and Pierre Robin sequence. The aim of this study was to describe the feasibility of visualization of the fetal zygomatic bone and assess its application in cases referred for features suggestive of first arch syndrome. Methods: A prospective cohort study was conducted. The feasibility of visualization of the zygomatic bone was performed in 50 sequential fetuses with a normal anatomic scan between 12 and 24 weeks' gestation using 3‐dimensional sonography. Following this, cases referred for targeted scans for suspected first branchial arch syndrome were assessed for the presence or absence of the zygomatic bones. Results: Visualization of the fetal zygomatic bone was feasible in all low‐risk cases. Cases referred for targeted scans included 11 isolated cases of micrognathia or retrognathia, 3 cases of microtia, and 3 cases of auricular or facial vestiges. Within this group, the zygomatic bones were visualized in all but 2 cases. No associated extrafacial malformations were detected; therefore, this phenotype was consistent with Treacher Collins syndrome. Conclusions: Prenatal imaging of the zygomatic bones offers a clinically based sonographic approach to cases referred for features suggestive of first arch syndrome and enables differentiation between the 2 main clinical manifestations: Treacher Collins syndrome and Pierre Robin sequence. [ABSTRACT FROM AUTHOR]

Abstract Background Hemangiopericytoma and solitary fibrous tumor are considered related variants on the same spectrum and both may essentially be the same tumor. They are infrequently encountered in the orbital region while the zygomatic bone is an extremely rare location for these neoplasms to occur. Case presentation A 14-year-old boy presented with complaint of deformity of left infraorbital area and a firm, regular mass in the region. Orbital CT scan revealed a well-defined round isodense intraosseous lesion in the lowermost portion of the lateral orbital wall (zygomatic bone), expanding the bone and protruding anteriorly and medially. MRI showed the mass to be heterogenous and strongly enhancing with contrast medium. Inferior transconjunctival orbitotomy was performed and the mass was removed. The histopathologic examination and immunohistochemistry staining results (positive for CD34, CD31 and smooth muscle actin, but negative for CD99, S100, B-cell lymphoma 2 (bcl-2) and desmin) confirmed the diagnosis of hemangiopericytoma. The postoperative course was uneventful, with no evidence of recurrence after 5 years follow up. Conclusions This case represents the second hemangiopericytoma reported in the zygomatic bone. Although extremely rare, hemangiopericytoma/solitary fibrous tumor might be considered in the differential diagnosis of intraosseous lesions of the orbital and zygomatic region.

Introduction: Zygomatic bone (ZB), also known as the cheekbone, articulates with the maxilla, temporal sphenoid, and the frontal bones. It forms the prominence of the cheek and part of the orbit, and because of its prominence, it is susceptible to trauma. The aim of this study was to present the pattern of ZB fracture in a country in the Middle East. Patients and Methods: The medical records of all trauma cases admitted to the Department of Oral and Maxillofacial Surgery Ward, Riyadh Dental Centre, King Saud Medical City, Riyadh, Saudi Arabia, were reviewed and all cases with ZB fractures were included in this study from December 2002 to December 2012. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, IL, USA). The results were presented as simple frequencies and percentages. Results: A total of 1487 patients had maxillofacial trauma and 306 cases were diagnosed with ZB fractures during the study. There were 271 (88.6%) males and 35 (11.4%) females with male: female ratio of 7.7:1. Age group of 21–30 years has the highest number of fracture cases (133 [43.5%]). Road traffic accident (RTA) remained the leading etiology of zygomatic complex fracture (ZMCF; 221 [72.2%]). August has been observed to be associated with the highest cases of ZMCF (40 [13.1%]). The years 2005 and 2006 recorded the highest frequency of ZMCF cases (46 [15.0%] and 44 [14.4%], respectively). Conclusion: The results of this study showed that RTA is the leading cause of ZB fractures followed by assaults. The most commonly fractured site was the zygomaticomaxillary. Proper road traffic regulation is paramount to help reduce maxillofacial trauma.

Osteomyelitis (OM) of zygomatic bone (zyb) is a rare disease, characterized by relapses. We present two patients presenting with chronic discharging sinus over zyb, who had been treated in previous centers, with multiple culture-directed antibiotics, over many months, without cure. We administered intramuscular Benzathine Penicillin 1.2 million IU with oral Vitamin C 1000 mg/day, for a total of six months and achieved successful healing. In chronic OM (cOM), most bacteria are sessile, embedded in biofilm. Sessile bacteria are not picked by a swab; therefore, the bone must be biopsied. Sessile bacteria also do not grow well in culture media. Thus, the conventional cultures do not reflect the true organisms causing cOM. The Minimum Biofilm Eradication Concentration of antibiotics cause toxicity. To eradicate the biofilm bacteria in patients whose computed tomography showed absence of a sequestrum, we administer this regimen. Judicious case selection is necessary. This regimen adds to the clinician's armamentarium. [ABSTRACT FROM AUTHOR]

• 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. 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. 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. 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. IMHs are rare in the head and neck area and must be considered in differential diagnosis of isolated muscle mass in this region. [ABSTRACT FROM AUTHOR]

Zygomatic bone is one of the facial bones, which forms the prominence of the cheek. It helps in formation of walls of bony orbit, temporal, and infratemporal fossa. Nowadays, the importance of this bone is highlighted in several clinical conditions. In dental implants, when there is no adequate bone volume permitting their anchorage, zygomatic implants are long screw-shaped implants developed as a partial or complete alternative to bone augmentation procedures for the severely atrophic maxilla.1 The potential main advantages of zygomatic implants could be that bone grafting may not be needed and a fixed prosthesis could be fitted sooner.Cone Beam Computerized (CBCT) of 30 patients (15 males and 15 females) above 40 years of age who underwent radiological evaluation for implant placement in posterior atrophic maxilla were selected as the study participants with edentulism for more than 1 year. The inclusion criteria of the study was partially edentulous or completely edentulous patients with maxillary atrophied posterior region. The exclusion criteria was tumours, trauma and those with systemic complications. Informed consent was obtained from the patients before radiograph. In the study population, 39.2% were males and 60.7% were females. In relation to CBCT variation of zygomatic bone length among males. Most prevalent (30%) zygomatic bone length is observed to be 40mm females. Most prevalent (50%) zygomatic bone length is observed to be 43mm among males. Most prevalent (50%) zygomatic bone width is observed to be 4.5mm to among Females. Most prevalent (30%) zygomatic bone width is observed to be 5 mm among males. Within the limits of the study it was found that the majority of male population 30% has zygomatic bone length 40mm and in Female population 50% has 43 mm. Most prevalent (50%) zygomatic bone width is observed to be 4.5 mm and 5mm in females (30%). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Disseminated cryptococcosis is a well-characterized complication in immunocompromised patients with cryptococcal pneumonia or meningitis; however, isolated cryptococcal osteomyelitis is a rare entity that occurs in approximately 5% of patients with cryptococcosis. Cryptococcal osteomyelitis in the head and neck region is extremely rare. To the best of our knowledge, no cases of cryptococcal osteomyelitis affecting only the zygomatic bone have been reported to date.Case Presentation: A 78-year-old man without other comorbidities presented with progressive swelling of the right cheek along with pain and trismus. Clinical examination revealed a tender swelling in the right zygomatic region; the maximal mandibular opening was about 2 cm. Laboratory data showed mildly elevated inflammatory indices (C-reactive protein: 0.45 mg/dL; erythrocyte sedimentation rate: 35 mm/h). Computed tomography showed a 30-mm-diameter lesion at the right zygomatic arch. A part of the lesion has extended to the subcutaneous area of the cheeks with signs of bone destruction and surrounding contrast effects. Histopathological examination of fine-needle aspirate and needle biopsy showed cryptococcus. Furthermore, culture of the aspirate showed growth of Cryptococcus neoformans. No evidence of any other site involvement was observed. Therefore, the patient was diagnosed with isolated cryptococcal osteomyelitis and was initiated on fluconazole therapy. The treatment was effective, and all symptoms were resolved in 4 weeks. Fluconazole therapy was stopped after 6 months. There are no signs of recurrence as of 15-month follow-up. The patient has no cosmetic abnormalities or sequelae.Conclusions: Fine-needle aspiration cytology, needle biopsy, and fungal culture were useful for definitive diagnosis. Immunocompetent patients with isolated osteomyelitis may be cured with oral fluconazole alone. [ABSTRACT FROM AUTHOR]

The zygomatic bone, located in the upper and lateral area of the face, is an even and irregular quadrilateral or rhomboid shaped bone. It presents 2 faces, 4 margins and 4 angles. It forms cavities, allows muscular and aponeurotic insertion, is part of the facial architecture, distributes masticatory forces and allows the passage of the zygomatic nerve. Its postero-superior margin presents a bony prominence known as a marginal tubercle, in which the insertion of the temporal fascia is observed. The objective of this work was to describe the particular characteristics of this prominence. The sample corresponded to 30 skulls of Chilean adults of both sexes. Through a series of bone points, the presence, location, size, shape, cortical and trabeculate of the bone tissue of the marginal tubercle was described. A digital camera, precision compass and digital caliper were used to perform the measurements. The radiographic analysis required high-resolution computed tomography. The results showed that the marginal tubercle of the zygomatic bone is a constant prominence, located in the middle third of the frontal process of the bone and that most individuals showed a semilunar shape. Its height fluctuated between 3 and 4 mm, being more pronounced in men than in women. The thickness of the bone cortex was directly proportional to the prominence of the tuber, while the spongy trabeculate was inversely related to the latter. The analysis of these results seems to indicate that the biomechanical forces exerted by the masticatory musculature and transmitted by the temporal fascia, determine the external and internal morphology of this prominence, and of the zygomatic bone itself. In conclusion, it is recommended to review anatomical knowledge in the light of new imaging techniques and disciplinary integration. [ABSTRACT FROM AUTHOR]

• 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. 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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

This article reports the 9-year clinical outcome of the two-stage surgical rehabilitation of a severely atrophic edentulous maxilla with a metal-resin fixed denture supported by implants anchored in the zygomatic bone and the maxilla. After clinical and radiographic examination, zygomatic implants were inserted bilaterally and four standard implants were placed in the anterior region of the maxilla. Six months later, the implants were loaded with a provisional acrylic resin denture, and the definitive implant-supported metal-resin fixed denture was provided 1 year after implant placement. After 9 years of follow-up, no painful symptoms, peri-implant inflammation or infection, implant instability, or bone resorption was observed. In the present case, the rehabilitation of severe maxillary atrophy using the zygomatic bone as a site for implant anchorage provided good long-term functional and esthetic results. Therefore, with proper case selection, correct indication, and knowledge of the surgical technique, the use of zygomatic implants associated with standard implants offers advantages in the rehabilitation of severely resorbed maxillae, especially in areas with inadequate bone quality and volume, without needing an additional bone grafting surgery, thereby shortening or avoiding hospital stay and reducing surgical morbidity. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to evaluate zygomatic bone thickness considering a possible relationship between this parameter and cephalic index (CI) for better use of CI in the implant placement technique. Materials and Methods: CI was calculated for 60 dry Brazilian skulls. The zygomatic bones of the skulls were divided into 13 standardized sections for measurement. Bilateral measurements of zygomatic bone thickness were made on dry skulls. Results: Sections 5, 6, 8, and 9 were appropriate for implant anchorage in terms of location. The mean thicknesses of these sections were 6.05 mm for section 5, 3.15mm for section 6, 6.13 mm for section 8, and 4.75 mm for section 9. In only 1 section, section 8, did mean thickness on 1 side of of the skull differ significantly from mean thickness on the other side (P < .001). Discussion: For the relationship between quadrant thickness and CI, sections 6 and 8 varied independently of CI. Section 5 associated with brachycephaly, and section 9 associated with subbrachycephaly, presented variations in the corresponding thickness. Conclusion: Based on the results, implants should be placed in sections 5 and 8, since they presented the greatest thickness, except in brachycephalic subjects, where thickness was greatest in section 5, and in subbrachycephalic subjects, where thickness was greatest in section 9. CI did not prove to be an appropriate parameter for evaluating zygomatic bone thickness for this sampling. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this prospective study was to evaluate the safety of zygomatic bone harvesting and to determine whether a particulated zygomatic bone graft can be used simultaneously with 1stage dental implants to reconstruct resorbed edentulous alveolar ridges. Materials and Methods: Altogether, 82 dental implants were placed in 32 patients. Particulated bone grafts harvested from the zygomatic process were used in 72 of the implant sites. The volume of bone harvested, intraoperative complications, morbidity, and complications on follow-up visits were recorded. Implant survival was examined prospectively. Results: As a harvest site, the zygoma yielded enough bone to complete the reconstructions in each case. The average zygomatic bone graft volume was 0.90 mL (SD 0.30). Perforation of the maxillary sinus occurred at 11 zygomatic sites. None of these perforations led to postoperative problems. No paresthesias or other complications were noted during follow-up examinations. Mean duration of postoperative swelling was 4.5 days, and patients used pain medication for a mean duration of 4 days. After the mean follow-up period of 26.9 months postplacement, 80 of 82 implants were osseointegrated (survival rate 9 7.6%). Discusssion: Zygomatic bone is an alternative donor site for bone harvesting with low morbidity. The bone graft yielded is sufficient for use in 2 to 3 implant sites. Conclusions: The zygoma was a safe intraoral bone harvesting donor site in this patient population. Further, the use of simultaneous particulated zygomatic bone grafts and 1-stage implant placement appears to be an effective procedure. [ABSTRACT FROM AUTHOR]

This article describes a procedure to harvest bone from the zygoma for alveolar bone reconstruction. A detailed description of the bone harvesting procedure and a preliminary report of 3 patients undergoing alveolar bone reconstruction and simultaneous dental implant placement in the maxillary anterior area is presented. The technique is indicated when a modest amount of bone is needed, for example, to cover exposed implant threads and expand a narrow alveolar ridge. It also could be used as an additional source of bone with other intraoral donor sites. Surgical access to the zygoma is simple and can be performed using local anesthesia. Postoperative complications after zygomatic bone harvest are minimal. [ABSTRACT FROM AUTHOR]

Intraosseous venous malformations affecting the zygomatic bone are infrequent. Primary reconstruction is usually accomplished with calvarial grafts, although the use of virtual surgical planning, cutting guides and patient-specific implants (PSI) have had a major development in recent years. A retrospective study was designed and implemented in patients diagnosed with intraosseous venous malformation during 2006–2021, and a review of the scientific literature was also performed to clarify diagnostic terms. Eight patients were treated, differentiating two groups according to the technique: four patients were treated through standard surgery with resection and primary reconstruction of the defect with calvarial graft, and four patients underwent resection and primary reconstruction through virtual surgical planning (VSP), cutting guides, STL models developed with CAD-CAM technology and PSI (titanium or Polyether-ether-ketone). In the group treated with standard surgery, 75% of the patients developed sequelae or morbidity associated with this technique. The operation time ranged from 175 min to 210 min (average 188.7 min), the length of hospital ranged from 4 days to 6 days (average 4.75 days) and the postoperative CT scan showed a defect surface coverage of 79.75%. The aesthetic results were “excellent” in 25% of the patients, “good” in 50% and “poor” in 25%. In the VSP group, 25% presented sequelae associated with surgical treatment. The operation time ranged from 99 min to 143 min (average 121 min), the length of hospital stay ranged from 1 to 2 days (average of 1.75 days) and 75% of the patients reported “excellent” results. Postoperative CT scan showed 100% coverage of the defect surface in the VSP group. The multi-stage implementation of virtual surgical planning with cutting guides, STL models and patient-specific implants increases the reconstructive accuracy in the treatment of patients diagnosed with intraosseous venous malformation of the zygomatic bone, reducing sequelae, operation time and average hospital stay, providing a better cover of the defect, and improving the precision of the reconstruction and the aesthetic results compared to standard technique.

Background: Abnormalities of some facial bones derived from the ectomesenchyme have been found in ectodermal dysplasia (ED) patients, but the characteristics of the zygoma are unknown. Purpose: Comparison between ED patients and normal individuals to understand the anatomical features of the zygoma in ED patients. Materials and Methods: Thirty patients diagnosed with ED based on clinical features and/or gene sequence tests and 80 normal individuals were recruited from 2016 to 2018. The thickness of the zygomatic body at 12 points on the superior, middle, and inferior areas and the length of four lines were measured on a three‐dimensional cone beam computed tomography image. Differences between ED patients and normal individuals were then compared. Results: The zygomatic thicknesses and lengths were smaller in ED patients than in normal individuals. For ED patients, the largest thicknesses on the superior, middle, and inferior areas of the zygoma were 8.47 ± 1.49, 7.03 ± 1.56, and 5.99 ± 1.22 mm. Conclusion: The development of zygomatic thickness on the inferior area and the zygomatic length were insufficient in ED patients with oligodontia. Consequently, zygomatic hypoplasia presented difficulties for the "quad approach" to zygomatic implants in this group of patients. [ABSTRACT FROM AUTHOR]

Intraosseous hemangiomas are rare, and although they have been described in the calvaria and vertebrae, those occurring in the zygomatic bone are extremely rare. We report the case of a 52-year-old man who presented with a painless hard swelling in the left zygomatic process. The computed tomography and magnetic resonance imaging findings showed an intraosseous mass located in the left zygomatic bone just inferolateral to the orbit. A pathologic analysis of the surgical specimen revealed a cavernous hemangioma. The surgical defect was reconstructed with an autogenous rib bone that was fixated with titanium miniplates. The literature is reviewed and computed tomography, magnetic resonance imaging, and angiographic findings are discussed with particular reference to a surgical resection and reconstruction.

Work is devoted to research of internal structure of a zygomatic bone taking into account age, sex and loss of natural teeth that is bound to use in maxillofacial surgery of zygomatic implants. The internal structure of a zygomatic bone on 120 skulls (75 man's and 45 female) the people who died aged from 18 until 79 years is studied. Skulls had teeth on top and lower jaws that provided to these people at their life a usual physiological masticatory stress during meal on a bone of the chewing device. For an assessment of influence of loss of natural teeth on internal structure of a zygomatic bone, 170 skulls (95 man's and 75 female) the people who died aged from 45 until 82 years are in addition investigated. Skulls had different extent of loss of teeth on top and lower jaws. Among these skulls, 120 were with partial loss of teeth in the field of premolar tooth’s and molar teeth and 50 - with full loss of teeth on the top jaws. On craniological material by means of cranioscopy and craniometrics methods of research studied expressions of a series of external and measuring signs of a zygomatic bone, and also estimated its internal structure: a ratio of compact and spongiform (trabecular) substance in different departments of a zygomatic bone. It is established that at the adult the internal structure of a zygomatic bone doesn't change with age, and also doesn't depend on loss of natural teeth. Thus features of a ratio of compact and spongiform (trabecular) substance in different departments of a zygomatic bone are shown, correlation of types of a bone tissue, agrees accepted classifications in a dental implantology, with types of a bone tissue of jaws, and also the sizes and a shape of a skull.

Reconstruction of zygomatic complex defects is a surgical challenge, owing to the accurate restoration of structural symmetry as well as facial projection. Generally, there are many available techniques for zygomatic reconstruction, but they hardly achieve aesthetic and functional properties. To our knowledge, there is no such study on zygomatic titanium bone reconstruction, which involves the complete steps from patient computed tomography scan to the fabrication of titanium zygomatic implant and evaluation of implant accuracy. The objective of this study is to propose an integrated system methodology for the reconstruction of complex zygomatic bony defects using titanium comprising several steps, right from the patient scan to implant fabrication while maintaining proper aesthetic and facial symmetry. The integrated system methodology involves computer-assisted implant design based on the patient computed tomography data, the implant fitting accuracy using three-dimensional comparison techniques, finite element analysis to investigate the biomechanical behavior under loading conditions, and finally titanium fabrication of the zygomatic implant using state-of-the-art electron beam melting technology. The resulting titanium implant has a superior aesthetic appearance and preferable biocompatibility. The customized mirrored implant accurately fit on the defective area and restored the tumor region with inconsequential inconsistency. Moreover, the outcome from the two-dimensional analysis provided a good accuracy within 2 mm as established through physical prototyping. Thus, the designed implant produced faultless fitting, favorable symmetry, and satisfying aesthetics. The simulation results also demonstrated the load resistant ability of the implant with max stress within 1.76 MPa. Certainly, the mirrored and electron beam melted titanium implant can be considered as the practical alternative for a bone substitute of complex zygomatic reconstruction.