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Oral surgery module 7 > Zygomatic fractures > Flashcards

Zygomatic fractures Flashcards

1
Q

treatment goal for zygomatic fracture

A
  1. restore facial projection/ symmetry
  2. restore orbital volume/ glob position/ shape palpebral fissure
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2
Q

3 categories of timing

A
  1. immediate
  2. early
  3. delayed
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3
Q

fracture type (energy)

A
  1. low energy - minimal/ no comminution
  2. high energy - comminution at segment and fracture lines
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4
Q

fracture types

A
  1. early non-comminuted minimal displacement
  2. older minimal comminuted minimally displaced
  3. signif comminution, fragmentation of supporting butresses with instability
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5
Q

most reliable indicator of proper reduction and orientation

A

proper alignment of zygomaticosphenoid suture
anatomic reduction of zygomatic arch

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6
Q

ORIF patterns and degree is dependent on?

A
  1. degree of comminution
  2. stability of fracture
  3. presence of other features such as orbital content, facial asymmetry and inf orb nerve issues
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7
Q

treatment of non-displaced ZMC

A
  1. confirmed by CT
  2. non-surgical MX
  3. serial observation
  4. soft diet
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8
Q

treatment for displaced, minimally comminuted

A
  1. reduction alone
  2. fixation

best mangaed by open redcution and internal fixation at minimally 2 points may be 3 points

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9
Q

reduction by direct visualisation at what points?

A
  1. frontozygomatic suture
  2. zygomaticomaxillary buttress
  3. inferior orbital areas
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10
Q

advantages of ORIF

A
  1. improved alignment
  2. fixation of zygomaticomaxillary buttress provides vertical support
  3. orbital rim exposure allows inspection orbital floor
  4. inspection of fractures sites prior to closure
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11
Q

indications of orbital floor exploration

A
  1. defects larger than 5mm on CT scan
  2. severe displacement
  3. comminution
  4. soft tissue entrapment with limited upwards gaze
  5. orbtial contents herniation into maxillary sinus
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12
Q

indications for orbital floor reconstruction

A
  1. enophthalmos
  2. larger defects (5-10mm)
  3. defects posterior to the axis of the globe
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13
Q
A
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14
Q

when do we do 2 point fixation

A
  1. minimally displaced fractures
  2. zygomaticomaxillary complex fracture remains stable after initial reduction with no palpable step deformity at the infraorbital rim
  3. there are minimal changes on orbital volume and globe displacement is not evident on CT scan
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15
Q

when would you do 3 point fixation

A
  1. instability of fragmnet
  2. exploration of orbital floor required
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16
Q

Historial fixation methods

A
  • Kirschner wires
  • lag screw fixation
  • wire osteosynthesis
  • titanium plates and screws
  • restorable plates and screws
17
Q

what is the aim of reduction

A

to provide force in the direction opposite to that which caused the fracture and to re-approximate the bone to the original position

18
Q

reduction options

A
  1. stab incision and and introduction of an instrument to hook under the bone to provide traction
  2. intra-oral approach vestibular incision and introduction of similar instrument to hook under the bone to provide traction
  3. screw insertion to provide traction
  4. Carroll-Girard T-bar screw
19
Q

reduction options approach

A

temporal or oral

20
Q

what is the Gillies temporal approach

A

-incision superiorly and anteriorly to helix of ear
- 2cm in length

21
Q

Gillies temporal approach

A
  • identify incision site
  • skin incision and dissect
    -incise temporal fascia
  • introduce instrument and navigate beneath zygomatic arch
  • introduce elevator to reduce
  • close wound
22
Q

gillies approach ideal for which fracture

A

isolated arch fracture
infractured - W type fracture

23
Q

Gillies temporal instruments

A

Bristow
Rowe

24
Q

Fixation sites

A
  • 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
25
Q

when would you do a bi-coronal flap

A

access to zygomatic arch area in comminuted high energy injuries to allow 4 point fixation

26
Q

Complications of zygomaticomaxillary complex fracture

A

pain
facial asymmetry
scarring
bleeding
infraorbital nerve paraestheisa

27
Q

what should be performed before surgery

A

opthamology exam

28
Q

what does a basic eye exam include

A
  • visual acuity
  • visual fields
  • extraocular movements
29
Q

What is SOFS

A

superior orbtial fissure syndrome

30
Q

Diagnosis of SOFS

A

explained by nerve involvement
- opthalmoplegia - challenges moving eye
- ptsosis
- proptosis
-mydriasis
- anaestehsia of forehead/upper eyelid

31
Q

SOFS tx?

A

conservative with observation
many recover spontaenously

32
Q

What is RBH + OCS

A

retrobulbar haemorrhage with orbital compartment syndrome

33
Q

what is RBH and OCS comes from from

A

arterial bleed somewhere in the orbit

34
Q
A

Oral surgery module 7 (6 decks)

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