• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.1
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• pp.54-59
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• 1999

This study was based on a series of 164 patients with zygomatic bone fracture treated at Department of Oral and Maxillofacial Surgery of Chonnam University Hospital from January 1992 to December 1996. The male-to-female ratio was 7:1. Their ages ranged from 8 to 78 years, with a median age of 35.6 years. The age frequency was highest in the second decade (30.5%), and third decade (23.8%), fifth decade (16.5%) in orders. The monthly distrbution of incidence showed October to be the month in which the greatest percentage occured (14.0%). The major cause of zygomatic bone fracture was alleged traffic accidents (53.7%). The incidence of concomitant facial bone fractures was 69,5%, and maxilla fracture (52.4%) was most frequently combined. The admission route was through emergency room (72.3%) and through outpatient department (26.8%). The incidence of associated injuries was 37.2%. The intraoral approach was the major method of treatment in zygomatic bone fracture (57.1%). The most frequent type of zygoma fracture was class IV (33.5%), and class III (25.6%) was next in order of frequency. Complications were enophthalmos (7.3%), facial asymmetry (6.7%), paresthesia (6.1%), and diplopia (2.4%) These results suggest that correct diagnosis and treatment of severity of fracture, concomitant fracture, and associated injuries are necessary, and co-operative treatment with medical department should be performed to reduce postoperative complication.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.4
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• pp.359-362
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• 2010

The zygoma is second most commonly vulnerable facial bone in fracture, in number only by nasal fractures. It is difficult to evaluate reduction state intraoperatively, because almost surgeons reduce the fractured zygoma by blind method. We suggest the use of orthopedic C-arm intraoperatively. We use plain radiography, CT to evaluate preoperative state. Gilles approach or intraoral approach were used to reduce the fractured zygomatic arch. The C-arm was positioned at chin area, used to evaluate reduction intraoperatively. We got postoperative image by CT or submento-vertex view. There are variable methods to evaluate reduction intraoperatively: palpation, ultrasonography, CT, plain films. C-arm is considered superior diagnostic tool to other methods. The use of intraoperative C-arm was very efficient, it could bring better results.

• Archives of Craniofacial Surgery
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• v.14 no.2
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• pp.119-123
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• 2013

Except for special situations, it is generally agreed that best results in the treatment of facial fractures is expected if reduction is done within the first 2 or 3 weeks after injury. We reduced facial bone fractures at 4 to 7 weeks after trauma. A 44-year-old female patient underwent open reduction for her right zygomaticomaxillary complex fracture at 7 weeks after injury. A 59-year-old female patient underwent surgery for the right mandible body and left parasymphysis fractures at 4 weeks after injury. Using traditional approaches, granulation tissue and callus were removed from the fracture sites, and malunited fracture lines were separated by a small osteotome. We reduced the displaced fractured zygoma and mandible to their normal anatomical positions and fixed them using titanium plates. No complications such as asymmetry, malunion, malocclusion, or trismus were seen. Unfavorable asymmetric facial contours were corrected, and we obtained good occlusion with favorable bony alignment. The functional and aesthetic outcomes were satisfactory. Through removal the callus and limited osteotomy, a successful approach to the previously fractured line was possible, and an exact correction with symmetry was obtained. This method can be a good option for obtaining good mobility and clinical results in treating delayed facial bone fractures.

• Archives of Craniofacial Surgery
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• v.23 no.3
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• pp.111-118
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• 2022

Background: Although the zygomatic arch is an important structure determining facial prominence and width, no consensus exists regarding the classification of isolated zygomatic arch fractures, and the literature on this topic is scarce. To date, five papers have subdivided zygomatic arch fractures; however, only one of those proposed classifications includes the injury vector, although the injury vector is one of the most important factors to consider in fracture cases. Furthermore, the only classification that does include the injury vector is too complicated to be suitable for daily practice. In addition, the existing classifications are clinically limited because they do not consider greenstick fractures, nondisplaced fractures, or coronoid impingement. In the present study, we present a rearrangement of the previously published classifications and propose a modified classification of isolated zygomatic arch fractures that maximizes the advantages and overcomes the disadvantages of previous classification systems. Methods: The classification criteria for isolated zygomatic arch fractures described in five previous studies were analyzed, rearranged, and supplemented to generate a modified classification. The medical records, radiographs, and facial bone computed tomography findings of 134 patients with isolated zygomatic arch fractures who visited our hospital between January 2010 and December 2019 were also retrospectively analyzed. Results: We analyzed major classification criteria (displacement, the force vector of the injury, V-shaped fracture, and coronoid impingement) for isolated zygomatic arch fracture from the five previous studies and developed a modified classification by subdividing zygomatic arch fractures. We applied the modified classification to cases of isolated zygomatic arch fracture at our hospital. The surgery rate and injury severity differed significantly from fracture types I to VI. Conclusion: Using our modified classification, we could determine that both the injury force and the injury vector meaningfully influenced the surgery rate and the severity of the injuries.

• Archives of Craniofacial Surgery
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• v.23 no.4
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• pp.171-177
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• 2022

Background: The treatment of zygoma complex fractures is of crucial importance in the field of plastic surgery. However, surgical methods to correct zygoma complex fractures, including the number of fixation sites, differ among operators. Although several studies have compared two-point and three-point fixation, no comparative research has yet been conducted on one-point versus two-point fixation using computed tomography scans of surgical results. Therefore, the present study aimed to address this gap in the literature by comparing surgical results between one-point and two-point fixation procedures. Methods: In this study, we randomly selected patients to undergo surgery using one of two surgical methods. We analyzed patients with unilateral zygoma complex fractures unaccompanied by other fractures according to whether they underwent one-point fixation of the zygomaticomaxillary buttress or two-point fixation of the zygomaticomaxillary buttress and the zygomaticofrontal suture. We then made measurements at three points-the zygomaticofrontal suture, inferior orbital wall, and malar height-using 3-month postoperative computed tomography images and performed statistical analyses to compare the results of the two methods. Results: All three measurements (zygomaticofrontal suture, inferior orbital wall, and malar height) showed significant differences (p< 0.05) between one-point and two-point fixation. Highly significant differences were found for the zygomaticofrontal suture and malar height parameters. The difference in the inferior wall measurements was less meaningful, even though it also reached statistical significance. Conclusion: Using three parameters in a statistical analysis of imaging findings, this study demonstrated significant differences in treatment outcomes according to the number of fixations. The results indicate that bone alignment and continuity can be achieved to a greater extent by two-point fixation instead of one-point fixation.

• Archives of Plastic Surgery
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• v.48 no.1
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• pp.69-74
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• 2021

Background In inferomedially rotated zygomatic fractures sticking in the maxillary sinus, it is often difficult to achieve complete reduction only by conventional intraoral reduction. We present a new intraoral reduction technique using a Kirschner wire and its clinical outcome. Methods Among 39 inferomedially impacted zygomatic fractures incompletely reduced by a simple intraoral reduction trial with a bone elevator, a Kirschner wire (1.5 mm) was vertically inserted from the zygomatic body to the lateral orbital rim in 17 inferior-dominant rotation fractures and horizontally inserted to the zygomatic arch in nine medial-dominant and 13 bidirectional rotation fractures. A Kirschner wire was held with a wire holder and lifted in the superolateral or anterolateral direction for reduction. Following reduction of the zygomaticomaxillary fracture, internal fixation was performed. Results Fractures were completely reduced using only an intraoral approach with Kirschner wire reduction in 33 cases and through an additional lower lid or transconjunctival incision in six cases. There were no surgical complications except in one patient with undercorrection. Postoperative 6-month computed tomography scans showed complete bone union and excellent bone alignment. Four patients experienced difficulty with upper lip elevation; however, these problems spontaneously resolved after manual tissue lump massage and intralesional steroid (Triamcinolone) injection. Conclusions We completely reduced infraorbital rim fractures, zygomaticomaxillary buttresses, and zygomaticofrontal suture fractures in 84% of patients through an intraoral approach alone. Intraoral Kirschner wire reduction may be a useful option by which to obtain effective and powerful reduction motion of an inferomedially rotated zygomatic body.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.3
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• pp.264-276
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• 1995

This is a clinical and retrospective study on the patients with oral and maxillofacial trauma. This study was based on a series of 917 patients were treated as in-patients, at Chon-buk National University Hospital, during the period of Jan., 1989 through Dec., 1993. The results obtained were as follows : 1. The ratio of men to women were 3.59 : 1 in oral and maxillofacial injuries, 3.92 : 1 in facial bone fractures, and 3.18 : 1 in soft tissue injuries. 2. The oral and maxillofacial injuries occurred most frequently in the third decade(32.2%), and fourth, second, fifth decade in orders. 3. The major etiologic factors were traffic accident(57.4%) and fall-down(17.1%), interpersonal accident(16.6%), and industrial accident were next in order of frequency. 4. The incidence of facial bone fracture was 72.1%, soft tissue injury 58.8%, and dental injury 40.5%. 5. The most common site of fracture were mandible(62.9%) and maxilla(19.9%), zygoma and zygomatic arch(18.7%), and nasal bone(4.7%) were next in order of frequency. 6. The most common type of soft tissue injury was laceration(51.0%). The lesion of soft tissue injuries were mostly 1 or 2 lesions and deep.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.19 no.4
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• pp.367-376
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• 1997

The 234 patients who received treatment of midfacial fractures at the Department of Oral and Maxillofacial Surgery of Chonnam University Hospital from Jan. 1, 1992 to Dec. 31, 1996 were analyzed clinicostastically. Results obtained were as follows ; Male predominated over females by a ratio of 5.3 to 1. The frequently developing age groups were first 3rd (25%), 4th (21%) and the 2nd (18%) decade on succession. The peakest month was the August (16%), and May (11%), September (9%), October (9%). When it comes to the reasons for in-patients, traffic accident was predominant to 38%. In the 234 cases of midfacial fractures, zygomaticomaxillary complex fracture was the most by 37%. The most common with injury show that facial laceration marked by 49%, neurologic injury 24%, and mandibular fracture 20% each by each. About the time from injury onset to operation, 55% of cases were less than a week while the others (45%) more than a week. 3 plates were used for operation : 2 for zygoma or maxilla fracture and 3 for zygomatiomaxillary complex fracture. especially 4 for Le Fort I fracture, 5.5 for Le Fort I, II ; I, III ; II, III fracture, 7 for Le Fort I,II,III fracture were used. 20 patients (8%) appealed their complication and the most common was reported as infection. Above results suggest that early diagnosis and treatment of fracture site, systemic condition and associated injuries are necessary, and coorperative treatment with medical department should be performed.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.4
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• pp.376-379
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• 2001

There are many causes of trismus. Aetiology can be roughly divided into muscle spasm, mechanical interference, extracapsular ankylosis, intracapsular ankylosis. Trismus caused by mechanical interference between postero-lateral wall of zygoma-maxillary complex and coronoid process following reduction of fractured facial bone is rare. Especially on maxillary bone fracture, when we faced the trismus following removal of intermaxillary fixation, we got used to solve that problem by physical exercise. We obtained good results by coronoidectomy on patients with limited mouth opening who were referred from department of plastic surgery, St. Marys' hospital, the Catholic university of Korea. We report our experience with literature review.

• Archives of Plastic Surgery
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• v.33 no.6
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• pp.688-694
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• 2006

Purpose: Reconstruction of the craniofacial defects can be carried out with autogenous tissues, allogenic implants, or alloplastic materials. Titanium mesh systems have been used for bony reconstruction in non load-bearing areas. They offer several advantages: immediate availibility without any donor site morbidity, easy handling, stable 3-D reconstruction, and low susceptibility to infection. The aim of this study is to evaluate the usefulness and complications of titanium mesh system in the reconstruction of the craniofacial defects. Methods: From Jan. 2000, to Dec. 2004, we performed reconstruction of craniofacial bone defects in 21 patients who had benign or malignant tumor and fracture events in the cranium, orbit, nasal bone, maxilla, zygoma and the mandible. The size of the defects ranged from $1.0{\times}1.5cm$ to $12{\times}10cm$. Two different mesh systems, micro-titanium augmentation mesh and dynamic mesh was used for bony reconstruction in non load-bearing areas. The patients were evaluated from 1 to 4 yrs clinically and radiographically with a mean follow up period of 1.5 yrs. Results: There were no serious complications, including wound infection, foreign body reaction, exposures or loos of the mesh, central infection and pathologic findings of bone around mesh exception of one patient, who had expired of skull base tumor recurrence. Long-term stability of the reconstructions and the overall functional and aesthetic outcome was excellent. Conclusion: Our experiences demonstrate that the Titanium mesh system is a relatively safe and efficient method in the craniofacial reconstruction and have broadens our choices of therapeutic procedures in the craniomaxillofacial surgery.