J Korean Assoc Oral Maxillofac Surg.  2018 Aug;44(4):151-158. 10.5125/jkaoms.2018.44.4.151.

Zygomaticomaxillary buttress and its dilemma

• Malaviya P
• Choudhary

• KMID: 2419230
• DOI: http://doi.org/10.5125/jkaoms.2018.44.4.151

Abstract

Zygomatic fractures are the second most common fractures of the facial skeleton, after nasal bone fractures. Due to its uniqueness, the malar bone plays a very important role in maintaining appropriate facial contours. Zygomatic fractures can cause ocular and mandibular functional impairment, along with cosmetic defects. With the help of advanced imaging techniques and various treatment options, the management of zygomatic fractures has become more sophisticated and less invasive. This article discusses zygomatic fractures in detail: their clinical and radiographic features, and the various treatment options available.

Keyword

Surgical approaches; Zygomatic bone; Zygomatic fractures

MeSH Terms

Nasal Bone
Skeleton
Zygoma
Zygomatic Fractures

Reference

1. Ellis E 3rd, Kittidumkerng W. Analysis of treatment for isolated zygomaticomaxillary complex fractures. J Oral Maxillofac Surg. 1996; 54:386–400. PMID: 8600255.

2. Chowdhury SR, Menon PS. Etiology and management of zygomaticomaxillary complex fractures in the armed forces. Med J Armed Forces India. 2005; 61:238–240. PMID: 27407768.

3. Nayyar MS. Management of zygomatic complex fracture. J Coll Physicians Surg Pak. 2002; 12:700–705.

4. Manson PN, Hoopes JE, Su CT. Structural pillars of the facial skeleton: an approach to the management of Le Fort fractures. Plast Reconstr Surg. 1980; 66:54–62. PMID: 7394047.

5. Hwang K, Kim DH. Analysis of zygomatic fractures. J Craniofac Surg. 2011; 22:1416–1421. PMID: 21772174.

6. Rowe NL, Killey HC. Fractures of the facial skeleton. 2nd ed. Edinburgh, London: E&S Livingstone;1968.

7. Knight JS, North JF. The classification of malar fractures: an analysis of displacement as a guide to treatment. Br J Plast Surg. 1961; 13:325–339. PMID: 13757119.

8. Marinho RO, Freire-Maia B. Management of fractures of the zygomaticomaxillary complex. Oral Maxillofac Surg Clin North Am. 2013; 25:617–636. PMID: 24055372.

9. Nakib S, Schön R. Mittelgesichtsfrakturen. MKG Chirurg. 2014; 7:35–38.

10. Hardt N, Kuttenberger J. Craniofacial trauma. Berlin, Heidelberg, New York: Springer;2010.

11. Cornelius CP, Gellrich N, Hillerup S, Kusumoto K, Schubert W, Fusetti S. AO Surgery Reference [Internet]. Davos: AO Foundation;cited 2017 Jan 15. Available from: https://www2.aofoundation.org/wps/portal/surgery.

12. Evans BG, Evans GR. MOC-PSSM CME article: Zygomatic fractures. Plast Reconstr Surg. 2008; 121(1 Suppl):1–11.

13. Kovács AF, Ghahremani M. Minimization of zygomatic complex fracture treatment. Int J Oral Maxillofac Surg. 2001; 30:380–383. PMID: 11720038.

14. Patil S, Patil RS. Zygomatic arch fracture reduction via Gillie's (temporal) approach—report of 3 cases. Indian J Mednodent Allied Sci. 2014; 2:126–129.

15. Salinas JB, Vira D, David H, Elashoff D, Abemayor E, John MS. Steimann pin repair of zygomatic complex fractures. Int J Otolaryngol Head Neck Surg. 2013; 2:74–78.

16. Rehman AU, Ansari SR, Shah SM, Rehman B. Pattern of zygomatic bone fractures and treatment modalities: a study. Pakistan Oral Dent J. 2010; 30:36–40.

17. Ellis E, Zide M. Surgical approaches to the facial skeleton. 2nd ed. Philadelphia: Lippincott Williams & Wilkins;2006.

18. Fernandes YB, Maitrot D, Kehrli P, Tella OI Jr, Ramina R, Borges G. Supraorbital eyebrow approach to skull base lesions. Arq Neuropsiquiatr. 2002; 60:246–250. PMID: 12068354.

19. Ahamed T, Sundararajan V, Ramanathan S. Management of zygomatic complex fractures with two point fixation. IJSS Case Rep Rev. 2014; 1:25–26.

20. Langsdon PR, Rohman GT, Hixson R, Stumpe MR, Metzinger SE. Upper lid transconjunctival versus transcutaneous approach for fracture repair of the lateral orbital rim. Ann Plast Surg. 2010; 65:52–55. PMID: 20548223.

21. Rajkumar K, Mukhopadhyay P, Sinha R, Bandyopadhyay TK. ‘Y’ Modification of the transconjunctival approach for management of zygomatic complex fractures: a prospective analysis. J Maxillofac Oral Surg. 2016; 15:45–51. PMID: 26929552.

22. Oestreicher J, Mehta S. Complications of blepharoplasty: prevention and management. Plast Surg Int. 2012; 2012:252368. PMID: 22655191.

23. Thangavelu K, Ganesh NS, Kumar JA, Sabitha S, Nikil . Evaluation of the lateral orbital approach in management of zygomatic bone fractures. J Nat Sci Biol Med. 2013; 4:117–121. PMID: 23633846.

24. Ebenezer V, Ramalingam B, Sivakumar M. Treatment of zygomatic complex fractures using two point fixation under general anaesthesia. World J Med Sci. 2014; 10:179–183.

25. Rohrich RJ, Janis JE, Adams WP Jr. Subciliary versus subtarsal approaches to orbitozygomatic fractures. Plast Reconstr Surg. 2003; 111:1708–1714. PMID: 12655219.

26. Habal MB, Chaset RB. Infraciliary transconjunctival approach to the orbital floor for correction of traumatic lesions. Surg Gynecol Obstet. 1974; 139:420–422. PMID: 4604609.

27. Manganello-Souza LC, Rodrigues de Freitas R. Transconjunctival approach to zygomatic and orbital floor fractures. Int J Oral Maxillofac Surg. 1997; 26:31–34. PMID: 9081250.

28. Crosara J, Rosa E, Silva M. Comparison of cutaneous incisions to approach the infraorbital rim and orbital floor. Braz J Oral Sci. 2009; 8:89–91.

29. Holtmann B, Wray RC, Little AG. A randomized comparison of four incisions for orbital fractures. Plast Reconstr Surg. 1981; 67:731–737. PMID: 7243973.

30. Heckler FR, Songcharoen S, Sultani FA. Subciliary incision and skin-muscle eyelid flap for orbital fractures. Ann Plast Surg. 1983; 10:309–313. PMID: 6847091.

31. Bähr W, Bagambisa FB, Schlegel G, Schilli W. Comparison of transcutaneous incisions used for exposure of the infraorbital rim and orbital floor: a retrospective study. Plast Reconstr Surg. 1992; 90:585–591. PMID: 1409993.

32. Netscher DT, Patrinely JR, Peltier M, Polsen C, Thornby J. Transconjunctival versus transcutaneous lower eyelid blepharoplasty: a prospective study. Plast Reconstr Surg. 1995; 96:1053–1060. PMID: 7568479.

33. Giraddi GB, Syed MK. Preseptal transconjunctival vs. subciliary approach in treatment of infraorbital rim and floor fractures. Ann Maxillofac Surg. 2012; 2:136–140. PMID: 23482434.

34. Coronal approach [Internet]. Davos: AO Foundation;2009. 12. 03. cited 2017 Jan 15. Available from: https://goo.gl/SQAHMr.

35. Rajmohan S, Tauro D, Bagulkar B, Vyas A. Coronal/hemicoronal approach: a gateway to craniomaxillofacial region. J Clin Diagn Res. 2015; 9:PC01–PC05.

36. Zhuang QW, Zhang XP, Wang X, Zhang J, Li ZP, Si YM, et al. Coronal approach to zygomaticomaxillary complex fractures. Eur Rev Med Pharmacol Sci. 2015; 19:703–711. PMID: 25807420.

37. Srivastava A, Sharma R, Chandramala R. Versatility of buccal sulcus approach for zygomatic complex fractures. E-J Dent. 2012; 2:46–51.

38. Courtney DJ. Upper buccal sulcus approach to management of fractures of the zygomatic complex: a retrospective study of 50 cases. Br J Oral Maxillofac Surg. 1999; 37:464–466. PMID: 10687908.

39. de Souza Carvalho AC, Pereira CC, Queiroz TP, Magro-Filho O. Intraoral approach to zygomatic fracture: modified technique for infraorbital rim fixation. J Craniofac Surg. 2012; 23:537–538. PMID: 22421848.

40. Kühnel TS, Reichert TE. Trauma of the midface. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2015; 14:Doc06. PMID: 26770280.

41. Dakir A, Muthumani T, Prabu NP, Mohan R, Maity A. One point fixation of zygomatic tripod fractures in the zygomatic buttress through Keen's intraoral approach: a review of 30 cases. J Pharm Bioallied Sci. 2015; 7(Suppl 1):S238–S241. PMID: 26015722.

42. Fujioka M, Yamanoto T, Miyazato O, Nishimura G. Stability of one-plate fixation for zygomatic bone fracture. Plast Reconstr Surg. 2002; 109:817–818. PMID: 11818879.

43. Kim JH, Lee JH, Hong SM, Park CH. The effectiveness of 1-point fixation for zygomaticomaxillary complex fractures. Arch Otolaryngol Head Neck Surg. 2012; 138:828–832. PMID: 22986716.

44. Rana M, Warraich R, Tahir S, Iqbal A, von See C, Eckardt AM, et al. Surgical treatment of zygomatic bone fracture using two points fixation versus three point fixation--a randomised prospective clinical trial. Trials. 2012; 13:36. PMID: 22497773.

45. Bui TG, Bell RB, Dierks EJ. Technological advances in the treatment of facial trauma. Atlas Oral Maxillofac Surg Clin North Am. 2012; 20:81–94. PMID: 22365431.

46. Lee CH, Lee C, Trabulsy PP. Endoscopic-assisted repair of a malar fracture. Ann Plast Surg. 1996; 37:178–183. PMID: 8863979.