SURGICAL TREATMENT OF ZYGOMATIC COMPLEX FRACTURES

Abstract

THE ZYGOMATIC BONE IS RESPONSIBLE FOR PROTECTING THE ORBITAL CONTENTS AND THE MIDFACIAL CONTOUR. FRACTURE OF THE ZYGOMATIC COMPLEX IS THE SECOND MOST COMMON FACIAL INJURY IN MAXILLOFACIAL TRAUMA, ITS ETIOLOGY CONSISTS MAINLY OF TRAFFIC ACCIDENTS, VIOLENT AGGRESSIONS, FALLS AND SPORTS INJURIES, PREDOMINANTLY IN YOUNG MALE ADULTS.
ACCORDING TO THE AUTHORS KNIGHT AND NORTHM, ZYGOMATIC FRACTURES CAN BE CLASSIFIED INTO SIXGROUPS: I - FRACTURES WITHOUT DISPLACEMENT; II - ZYGOMATIC ARCH FRACTURES; III - FRACTURES WITH DISPLACEMENT AND WITHOUT ROTATION; IV - FRACTURES WITH DISPLACEMENT AND MEDIAL ROTATION; V - FRACTURES WITH DISPLACEMENT AND LATERAL ROTATION; VI - COMPLEX FRACTURES.
THE ZYGOMATIC COMPLEX CONSISTS OF FOUR PILLARS CONNECTED BY FOUR SUTURE LINES TO THE FRONTAL, SPHENOID, TEMPORAL, AND MAXILLARY BONES. THUS, THE PURPOSE OF SURGICAL TREATMENT IS THAT ADEQUATE ANATOMICAL ALIGNMENT IN ALL FOUR SUTURE LINES IS NECESSARY TO AVOID CHANGES IN FACIAL APPEARANCE, EYEBALL POSITION AND FUNCIONAL IMPAIRMENT.
THE FOLLOWING SIGNS AND SYMPTOMS ARE EVALUATED TO DETERMINE A BETTER CLINICAL MANAGEMENT: MOUTH OPENING RESTRICTION, DIPLOPIA, IMPAIRED VISION, OCLUSAL ALTERATION, INFRAORBITAL NERVE NEUROLOGICAL DISORDER, CLINICAL AND RADIOLOGICAL ASYMMETRY-RELATED TO FRACTURE DISPLACEMENT.
COMPLICATIONS IF THE PATIENT DOES NOT UNDERGO THE SURGICAL PROCEDURE INCLUDE: ENOPHTHALMOS,
DIPLOPIA, EXTRAOCULAR MUSCLE ENTRAPMENT, FACIAL ASYMMETRY, PERSISTENT FLATTENING OF THE MALAR PROMINENCE, SENSORINEURAL DISORDERS OF THE INFRAORBITAL NERVE, MALOCCLUSION AND LIMITATION OF JAW MOVEMENT. IT IS CONCLUDED THAT SURGICAL INTERVENTION IS AN EFFECTIVE TREATMENT MODALITY IN FRACTURES OF THE ZYGOMATIC COMPLEX, AND IN CERTAIN CASES IT CAN BE TREATED ONLY WITH AN INTRAORAL
APPROACH AND RIGID FIXATION IN THE ZYGOMATIC-MAXILLARY SUPPORT. THE RISK OF COMPLICATIONS AFTER FRACTURES OF THE ZYGOMATIC COMPLEX INCREASES WITH THE HIGHER LEVEL OF COMPLEXITY.