zygomatic reduction,which comes when
-
Upload
jamil-kifayatullah -
Category
Health & Medicine
-
view
49 -
download
0
Transcript of zygomatic reduction,which comes when
Reduction Techniques For Zygomatic fractures. Which comes when?
Dr.Ayesha MaqsoodDr.Ayesha MaqsoodBDS, FCPSBDS, FCPS
Assistant Professor, Oral & Maxillofacial SurgeryAssistant Professor, Oral & Maxillofacial SurgeryMargalla Institute of Health Sciences & affiliated Margalla Institute of Health Sciences & affiliated hospitals,Rawalpindi.hospitals,Rawalpindi.
Zygomatic bone is responsible for the anterior and lateral projection of face
It is frequently fractured alone or with other bones of midface
Zygomatic Fractures
Zygomatic fractures cause disruption along the following articulations
Zygomaticofrontal suture Infraorbital rim Zygomaticomaxillary
buttress Zygomatic arch Zygomaticosphenoid
suture
Zygomatic Fractures
Zygoma may be fractured in a variety of
patterns,a wide variety of treatment
recommendations have evolved
From minimal reduction maneuvers
performed without fixation to complicated
types of open reduction involving multiple
exposure and fixation points
Zygomatic Fractures
Mechanism of injuryMechanism of injuryDirect blow on prominent partRelative inbending at area of impactionRelative outbending at weak areas such as
the arch,ZM suture,ZF sutureFractures are usually displaced posteriorly&
inferiorly or mediallyMore violent blow causes posterior& lateral
displacement
• Depressed malar eminenceDepressed malar eminence
• EnophthalmosEnophthalmos
• Infraorbital paresthesiaInfraorbital paresthesia
• DiplopiaDiplopia
• Inability to open the mouthInability to open the mouth
Indications for surgery
TreatmentTreatment
• as soon as possible
• Little delay Settling of periorbital edema
proper zygomatic bone examination
• Sight threatening injuries Retrobulbar
hemorrhage may require urgent surgery
Methods of ReductionMethods of Reduction• Temporal fossa (Gillies approach)
• Intra oral (Keen approach)
• Percutaneous
• Malar hook approach
• Carrol Girard screw approach
• Lateral eyebrow (Dingman approach)
Gillies Approach• 2.5 cm.incision in hair of temporal
region• Dissection upto the deep temporal
fascia• Elevator slided over the muscle
under the arch• Rowe elevator allows only the
zygoma to be lifted ,preventing pressure on temporal bone
• For medially displaced arch fractures
• For downward displaced zygoma fractures which are lifted forward
Vestibular(Keen Approach)Vestibular(Keen Approach)• Incision in the buccal sulcus
• Elevator placed under the zygomatic bone or arch
• Allows safe & direct approach to entire facial surface of midfacial skeleton
• For reduction of medially & posteriorally displaced zygomatic fractures
• The displaced segments are lifted upward and laterally
Carroll Girard ScrewCarroll Girard Screw• Incision over the cheek• Drill a small hole and insert the screw • As it is placed directly over the body of zygoma,it
provides traction in any direction• Ideally for laterally displaced arch and zygomatic
fractures
Bone HookBone Hook
• Through a stab incision on the cheek or even
through an intra oral incision
• Posterioraly displaced zygomatic fractures
Dingman ApproachDingman Approach• Lateral eyebrow incision given• For medially displaced arch• Medially and downward displaced body of
zygoma
Endoscopically assisted reduction
• Endoscopic approaches may be used to identify the arch &zygomatic fractures and they could be reduced using any technique
Conclusion• A simple arch fracture such as a medially
displaced one ,may be managed by elevation
alone because periosteal continuity will prevent
displacement.
• No technique suitable for laterally displaced
arch or zygomatic body because insufficient
periosteal continuity will not maintain reductionCont……
Conclusion• Appx. 25% of zygomatic fractures are with
minimal displacement ,which are best managed by closed reduction
• Incomplete fractures at Z.F suture are also amenable to closed reduction
• For an unstable fracture the closed redution may be used as part of open reduction
Thank youThank you