Cases reported "Zygomatic Fractures"

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1/40. Reconstructive surgery for complex midface trauma using titanium miniplates: Le Fort I fracture of the maxilla, zygomatico-maxillary complex fracture and nasomaxillary complex fracture, resulting from a motor vehicle accident.

    maxillofacial injuries resulting from trauma can be a challenge to the Maxillo-Facial Surgeon. Frequent causes of these injuries are attributed to automobile accidents, physical altercations, gunshot wounds, home accidents, athletic injuries, work injuries and other injuries. Motor vehicle accidents tend to be the primary cause of most midface fractures and lacerations due to the face hitting the dashboard, windshield and steering wheel or the back of the front seat for passengers in the rear. Seatbelts have been shown to drastically reduce the incidence and severity of these injuries. In the united states seatbelt laws have been enacted in several states thus markedly impacting on the reduction of such trauma. In the philippines rare is the individual who wears seat belts. Metro city traffic, however, has played a major role in reducing daytime MVA related trauma, as usually there is insufficient speed in traffic areas to cause severe impact damage, the same however cannot be said for night driving, or for driving outside of the city proper where it is not uncommon for drivers to zip into the lane of on-coming traffic in order to overtake the car in front ... often at high speeds. Thus, the potential for severe maxillofacial injuries and other trauma related injuries increases in these circumstances. It is however unfortunate that outside of Metro Manila or other major cities there is no ready access to trauma or tertiary care centers, thus these injuries can be catastrophic if not addressed adequately. With the exception of Le Fort II and III craniofacial fractures, most maxillofacial injuries are not life threatening by themselves, and therefore treatment can be delayed until more serious cerebral or visceral, potentially life threatening injuries are addressed first. Our patient was involved in an MVA in Zambales, seen and stabilized in a provincial primary care center initially, then referred to a provincial secondary care center for further stabilization before his transfer to Manila and then ultimately to our Maxillo-Facial Unit. There was a two week-plus delay in the definitive management because of this. As a result of the delay, fibrous tissue and bone callus formation occurred between the various fracture lines, thus once definitive fracture management was attempted, it took on a more reconstructive nature. Hospital based Oral and Maxillo-Facial Surgeons are uniquely trained to manage all aspects of the maxillo-facial trauma, and their dental background uniquely qualifies them in functional restoration of lower and midface fractures where occlusion plays a most important role. Likewise, their training in clinical medicine which is usually integrated into their residency education (12 months or more) puts them in a unique position to comfortably manage the basic medical needs of these patients. In instances where trauma may affect other regions of the body, an inter-multi-disciplinary approach may be taken or consults called for. In this instance, an opthalmology consult was important. In fresh trauma, often seen in major trauma centers (i.e. overseas), a "Trauma Team" is on standby 24 hours a day, and is prepared to assess and manage trauma patients almost immediately upon their arrival in the ER. The trauma team is usually composed of a Trauma Surgeon who is a general surgeon with subspecialty training in traumatology who assesses and manages the visceral injuries, an Orthopedic Surgeon who manages fractures of the extremities, a Neurosurgeon for cerebral injuries and an Oral and Maxillo-Facial Surgeon for facial injuries. In some institutions, facial trauma call is alternated between the "three major head and neck specialty services", namely Oral and Maxillo-facial Surgery, otolaryngology-head & neck Surgery and Plastic & Reconstructive Surgery. (ABSTRACT TRUNCATED)
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2/40. Simultaneous reconstruction of the area of the temporo-mandibular joint including the ramus of the mandible in a posttraumatic case. A case report.

    A new technique for the simultaneous reconstruction of the glenoid fossa and the ramus of the mandible is described. By combining and adapting procedures already described, the missing bone of the zygomatic arch, temporo-mandibular joint and ramus was replaced in one operation in a post-traumatic case. The indication for this operation is discussed. It is rather limited. The technique can be used for reconstruction of skeletal defects after tumour resection and in congenital aplasias of this region.
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3/40. The use of the Naugle orbitometer in maxillofacial trauma.

    BACKGROUND AND OBJECTIVES: Objective measuring of globe position is not a universal practice in the management of orbital trauma. Few studies in the literature advocate its routine use. methods AND MATERIALS: The Hertel exophthalmometer is the most widely used instrument; however, in trauma involving the lateral orbital rim (e.g., in zygoma fractures), the results are inaccurate because the displacement of the zygomatic bone interferes with its reference point on the lateral orbital rim. A more recent measuring device, the Naugle orbitometer, was introduced in 1992. It uses the superior orbital rim (frontal bar) and inferior orbital rim (malar eminence) as reference points. RESULTS AND/OR CONCLUSIONS: This article reports experience with this instrument in objective measuring the position of the globe in orbital trauma. These measurements are used 1) to monitor fractures that may not require repair but should be followed and observed for dystopia or enophthalmos, 2) to determine the adequacy of fracture repair, and 3) to determine the volume adjustment required for correcting enophthalmos. Future studies will be directed to compare the accuracy of Naugle and Hertel exophthalmometers.
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4/40. Hydroxyapatite cement in craniofacial trauma surgery: indications and early experience.

    BACKGROUND AND OBJECTIVES: Reconstruction of the nonstress-bearing portions of the craniofacial skeleton has recently utilized several alloplastic compounds. One such recent compound is hydroxyapatite cement (HAC)--a calcium-phosphate-based product. Its chemical structure consists primarily of calcium phosphate, as does human bone, and this similarity in the mineral structure renders it biocompatible. methods AND MATERIALS: Based on clinical indications for HAC, the authors have classified acquired craniofacial defects into four types. This article presents 5 clinical cases with craniofacial fractures, sustained in various accidents, in which hydroxyapatite cement was used to prevent cranial deformities or to reinstate contour. RESULTS AND/OR CONCLUSIONS: Complications were encountered in some of these cases, but all patients healed without any secondary complications. While the short-term experience using hydroxyapatite cement in craniofacial trauma surgery has been favorable, long-term studies in humans are required to validate the safety and efficacy of this product.
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5/40. Pediatric zygomatico-orbital complex fractures: the use of resorbable plating systems. A case report.

    Maxillofacial trauma in the pediatric population is infrequent--only 5% of all facial fractures occur in children. Operative intervention is indicated when a displacement of normal structures is present, resulting in either a functional or cosmetic deformity. Some midface fractures in children may be managed with closed reduction and maxillomandibular fixation. When open reduction is indicated, plate-and-screw fixation has been the preferred method of stabilization. This article presents a case of an isolated zygomatico-orbital complex fracture in a 6-year-old boy. Open reduction and internal fixation of the fractures through a preexisting facial wound were performed using a resorbable plate-and-screw system. A review of the literature and a discussion of the technique precede the case presentation. The rapid healing of pediatric facial bones does not obviate the need for fracture reduction and fixation with titanium plates and screws. The resorbable system offers an alternative with excellent results.
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6/40. Midface reconstruction with titanium mesh and hydroxyapatite cement: a case report.

    Reconstruction of the midface following trauma generally involves the simple assemblage of the existing bony fragments with the usage of miniplate osteosynthesis. Fractures of the maxilla are of significant functional as well as aesthetic importance. Occasionally, reestablishment of the bony structure is not possible without the concomitant use of bone grafts to replace areas where bone loss is present due to extensive comminution. Calvarial bone grafts are often used; however, they are not ideal, due to donor site morbidity, resorption, and difficulty in contouring the grafts to the curves of the face. This article will review a case of severe midfacial trauma in which a significant portion of the comminuted midface was successfully reconstructed with titanium mesh and hydroxyapatite cement.
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7/40. replantation of an avulsed zygomatic bone as a freeze-preserved autologous graft: a case report.

    We describe a very rare case of midface fracture where the zygomatic bone had been completely avulsed. The fragment was preserved in a frozen state for 40 days, then replanted and the graft was taken. The conditions favourable for the taking of the freeze-preserved zygomatic graft were: (1) an appropriate preservation method, (2) conservation of the periosteum on the zygomatic bone, (3) diversity of the haemodynamics of the zygomatic membranous bone, (4) immobilization of the zygoma by rigid fixation, and (5) a rich blood supply at the recipient site.
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8/40. Computer-aided reduction of zygomatic fractures.

    Reconstruction of the craniofacial skeleton after traumatic injury relies on immediate adjacent nondisplaced bone for restoration of contour. In complex fractures, neighboring bone may be lost or significantly fragmented, leaving little guidance to the 3-dimensional skeletal architecture. Recently, image guidance systems have been used in neurosurgery and sinus and spine surgery for intraoperative corroboration using preoperative radiologic images. We report the intraoperative use of an image guidance system for real-time localization of displaced facial skeletal segments during reduction and internal fixation.
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9/40. zygomatic fractures: reduction with the T-bar screw.

    The prominent zygomatic bone is one of the most commonly fractured. Fracture with displacement of the bone results in a cosmetic and functional deformity. The fractured zygomatic bone is usually dislocated in an inferomedial and posterior direction, which results in a cosmetic deformity with loss of ipsilateral malar prominence, possible depression of the zygomatic arch, asymmetry of the bony orbital circumference, and possible enophthalmos. Fracture of the zygomatic bone may result in ocular, maxillary antral, and mandibular dysfunction; diplopia, restricted extraocular muscle movement, or intraocular injuries; infection or obstruction of the maxillary antrum; and restricted mandibular function and malocclusion. Various surgical methods have been used to reduce the displaced fractured zygomatic bone. Our preferred method for reduction is the T-bar (Carroll-Girard) screw. This clinical study reviews 30 cases of zygomatic complex fractures, outlines the surgical technique used, illustrates the proper use of the T-bar screw with anatomic schematics and clinical cases, and presents illustrative case summaries.
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10/40. Zygomatic bone fractures complicated by retrobulbar haemorrhage.

    The two patients described in this report demonstrate retrobulbar haemorrhage as a complication of zygomatic bone fracture. Successful treatment of this rare but very serious complication involves urgent consultation with an ophthalmology service, and immediate medical and surgical management. It is extremely important to check the vision of patients with zygomatic bone fracture, before and after surgery, and consideration should be given to obtaining an ophthalmology opinion for all fractures involving the orbit. A simple examination, which every dentist should be able to perform, should include inspection of the eye, a test of visual acuity, testing eye movements, testing visual fields, reaction of the pupils, and an examination for proptosis.
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