zygoma fracture inju & complications.ppt

Zygoma fracture injuries

1. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
•Applied surgical anatomy
•Clinical features
•Radiological features
•Management
GK / MAXFAC
SDM DHARWAD

2. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Anatomy:
•central support to cheek
•buttress of lateral mid 3
rd
face
Articulations:
•Zygomatico-frontal
•Zygomatico-maxillary
•Zygomatico-temporal (arch)
•Zygomatico-sphenoid(orbital floor)
GK / MAXFAC
SDM DHARWAD

3. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
ANATOMY
Processes
Maxillary
Temporal
Frontal
Orbital
Lateral wall and floor orbit
Roof and lateral wall maxillary sinus
GK / MAXFAC
SDM DHARWAD

4. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
ANATOMY
Arch
Temporal
Zygoma
Maxilla
Muscle attachments:
Zygomaticus major / minor: malar eminence
Levator labii superioris: infraorbital rim
Masseter: arch & tuberosity GK / MAXFAC
SDM DHARWAD

5. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
•Applied surgical anatomy
•Clinical features
•Radiological features
•Management
GK / MAXFAC
SDM DHARWAD

7. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Mechanism of Injury
Direct & Indirect
In-bending at area of impact
Out-bending of weak areas (distant)
Dislocation
posterior
inferior
medial
lateral
GK / MAXFAC
SDM DHARWAD

8. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
•Applied surgical anatomy
•Clinical features
•Radiological features
•Management
GK / MAXFAC
SDM DHARWAD

9. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features
Flattening of cheek
Periorbital edema / Ecchymosis
Subconjunctival haemorrhage
Epistaxis / Surgical emphysema
Proptosis / Enophthalmos
GK / MAXFAC
SDM DHARWAD

10. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features
ENOPHTHALMOS
•Inferior & posterior
displacement
•Expansion of orbit
EXOPHTHALMOS
•Medial dislocations
GK / MAXFAC
SDM DHARWAD

11. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical Features
Paresthesia (V2) / Pain !!!
Trismus
Tenderness / Step deformity
Facial nerve weakness
Drooping of upper lip
DIPLOPIA
GK / MAXFAC
SDM DHARWAD

12. GK / MAXFAC
SDM DHARWAD
MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Clinical examination
Palpation:
•Step / tenderness / mobility
•Supra-orbital rim
•F-Z suture
•Infra-orbital rim
•Paresthesia
(lip, nose 14-11 + gingiva)

13. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
•Applied surgical anatomy
•Clinical features
•Radiology
•Management
GK / MAXFAC
SDM DHARWAD

14. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Radiographic examination
Occipto-mental view (PNS view, Waters
position)
Fronto-zygomatic suture
Zygomatico-maxillary
buttress
Inferior orbital rim
GK / MAXFAC
SDM DHARWAD

15. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Radiographic examination
Submento-vertex view (jug handle view)
Zygomatic arch
Posterior displacement
GK / MAXFAC
SDM DHARWAD

16. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Radiographic examination
C.T. Scans:
•Axial
GK / MAXFAC
SDM DHARWAD
•Coronal

17. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
•Applied surgical anatomy
•Clinical features
•Radiology
•Management
GK / MAXFAC
SDM DHARWAD

18. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
Immediate –primary care:
•ABC
•Nasal packs
Anterior / Posterior
•Control of pain
•Control of infection -Tetanus!!
•Prevent surgical emphysema
GK / MAXFAC
SDM DHARWAD

19. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
•Restoration of form & function
•Anatomic reduction
•Treatment: “Surgical intervention”
Closed v/s Open
•Displacement & comminution
•Exposure of fracture site
•Alignment
•Fixation GK / MAXFAC
SDM DHARWAD

20. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
Closed Reduction
Arch fractures
Minimal disruption
(at 2 sutures)
Intra-oral approach (Keen 1909)
GK / MAXFAC
SDM DHARWAD

21. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
Closed Reduction
•Temporal approach
(Gillies 1927)
GK / MAXFAC
SDM DHARWAD

22. Gillies Temporal Approach

23. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
Closed Reduction
•Transcutaneous
approach
GK / MAXFAC
SDM DHARWAD

24. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management
Open Reduction& fixation
F-Z Suture
Infra-orbital rim & orbital floor
Zygomatico-maxillary buttress (Intra-oral)
GK / MAXFAC
SDM DHARWAD

25. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management :Open Reduction
GK / MAXFAC
SDM DHARWAD
F-Z Suture

26. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
Management :Open Reduction
GK / MAXFAC
SDM DHARWAD
Infra-orbital rim
Zygomatico-maxillary suture

27. MAXILLOFACIAL INJURIES
Complications
•Mal-union / Non-union / fibrous union
•Malocclusion
•Plate exposure
•TMJ disorders / Ankylosis
•Infection
•Nerve Damage (Paresthesia)
•Scars
GK / MAXFAC
SDM DHARWAD

28. MAXILLOFACIAL INJURIES
Complications
Mal-union
GK / MAXFAC
SDM DHARWAD

29. MAXILLOFACIAL INJURIES
Complications
Non-union
GK / MAXFAC
SDM DHARWAD

30. MAXILLOFACIAL INJURIES
Complications
Fibrous union
GK / MAXFAC
SDM DHARWAD

31. MAXILLOFACIAL INJURIES
Complications
Malocclusion
GK / MAXFAC
SDM DHARWAD

32. MAXILLOFACIAL INJURIES
Complications
Plate Exposure / Wound dehiscence
GK / MAXFAC
SDM DHARWAD

33. MAXILLOFACIAL INJURIES
Complications
GK / MAXFAC
SDM DHARWAD
Ankylosis

34. MAXILLOFACIAL INJURIES
Complications
GK / MAXFAC
SDM DHARWAD
Infections

35. MAXILLOFACIAL INJURIES
Complications
GK / MAXFAC
SDM DHARWAD
Scarring

36. MAXILLOFACIAL INJURIES
Zygomatic complex fractures
•Applied surgical anatomy
•Clinical features
•Radiological features
•Management
•Complications GK / MAXFAC
SDM DHARWAD

37. If you cannot convince people…
confuse them

38. MAXILLOFACIAL INJURIES
GK / MAXFAC
SDM DHARWAD
Blow-out # of OrbitMid face (Le-Fort) #

39. Thank You