Zygomatic fractures Flashcards
treatment goal for zygomatic fracture
- restore facial projection/ symmetry
- restore orbital volume/ glob position/ shape palpebral fissure
3 categories of timing
- immediate
- early
- delayed
fracture type (energy)
- low energy - minimal/ no comminution
- high energy - comminution at segment and fracture lines
fracture types
- early non-comminuted minimal displacement
- older minimal comminuted minimally displaced
- signif comminution, fragmentation of supporting butresses with instability
most reliable indicator of proper reduction and orientation
proper alignment of zygomaticosphenoid suture
anatomic reduction of zygomatic arch
ORIF patterns and degree is dependent on?
- degree of comminution
- stability of fracture
- presence of other features such as orbital content, facial asymmetry and inf orb nerve issues
treatment of non-displaced ZMC
- confirmed by CT
- non-surgical MX
- serial observation
- soft diet
treatment for displaced, minimally comminuted
- reduction alone
- fixation
best mangaed by open redcution and internal fixation at minimally 2 points may be 3 points
reduction by direct visualisation at what points?
- frontozygomatic suture
- zygomaticomaxillary buttress
- inferior orbital areas
advantages of ORIF
- improved alignment
- fixation of zygomaticomaxillary buttress provides vertical support
- orbital rim exposure allows inspection orbital floor
- inspection of fractures sites prior to closure
indications of orbital floor exploration
- defects larger than 5mm on CT scan
- severe displacement
- comminution
- soft tissue entrapment with limited upwards gaze
- orbtial contents herniation into maxillary sinus
indications for orbital floor reconstruction
- enophthalmos
- larger defects (5-10mm)
- defects posterior to the axis of the globe
when do we do 2 point fixation
- minimally displaced fractures
- zygomaticomaxillary complex fracture remains stable after initial reduction with no palpable step deformity at the infraorbital rim
- there are minimal changes on orbital volume and globe displacement is not evident on CT scan
when would you do 3 point fixation
- instability of fragmnet
- exploration of orbital floor required
Historial fixation methods
- Kirschner wires
- lag screw fixation
- wire osteosynthesis
- titanium plates and screws
- restorable plates and screws
what is the aim of reduction
to provide force in the direction opposite to that which caused the fracture and to re-approximate the bone to the original position
reduction options
- stab incision and and introduction of an instrument to hook under the bone to provide traction
- intra-oral approach vestibular incision and introduction of similar instrument to hook under the bone to provide traction
- screw insertion to provide traction
- Carroll-Girard T-bar screw
reduction options approach
temporal or oral
what is the Gillies temporal approach
-incision superiorly and anteriorly to helix of ear
- 2cm in length
Gillies temporal approach
- identify incision site
- skin incision and dissect
-incise temporal fascia - introduce instrument and navigate beneath zygomatic arch
- introduce elevator to reduce
- close wound
gillies approach ideal for which fracture
isolated arch fracture
infractured - W type fracture
Gillies temporal instruments
Bristow
Rowe
Fixation sites
- fixation at site of frontozygomatic suture
- application of mini plates and screw
- plate stabilisation and frontozygomatic suture
intra-oral - zygomaticomaxillary buttress along fracture line - infraorbital region
when would you do a bi-coronal flap
access to zygomatic arch area in comminuted high energy injuries to allow 4 point fixation
Complications of zygomaticomaxillary complex fracture
pain
facial asymmetry
scarring
bleeding
infraorbital nerve paraestheisa
what should be performed before surgery
opthamology exam
what does a basic eye exam include
- visual acuity
- visual fields
- extraocular movements
What is SOFS
superior orbtial fissure syndrome
Diagnosis of SOFS
explained by nerve involvement
- opthalmoplegia - challenges moving eye
- ptsosis
- proptosis
-mydriasis
- anaestehsia of forehead/upper eyelid
SOFS tx?
conservative with observation
many recover spontaenously
What is RBH + OCS
retrobulbar haemorrhage with orbital compartment syndrome
what is RBH and OCS comes from from
arterial bleed somewhere in the orbit
