An Anthropometric and Three-Dimensional Computed Tomographic Evaluation of Two-Point Fixation of Zygomatic Complex Fractures

Background Maintaining stability and restoring the aesthetic appearance are the fundamental goals when managing zygomatic fractures. We aimed to evaluate the stability and anthropometric outcomes of zygomatic fracture patients who underwent two-point fixation involving the infraorbital rim and zygomaticomaxillary buttress via the transconjunctival and gingivobuccal approaches without any skin incisions.

Methods We examined 15 zygomatic fracture patients who underwent two-point fixation during a 3-year period. Stability was evaluated using three-dimensional facial bone computed tomography. Superoinferior and anteroposterior displacement of the zygoma was quantified. The aesthetic appearance of the periorbital region was evaluated using indirect anthropometry with standardized clinical photographs. The ratios between the eye fissure height and width, and lower iris coverage ratio were used to evaluate aesthetical changes. The bony displacement and aesthetic ratios were analyzed using Wilcoxon or Friedman tests. The correlation between the preoperative zygoma position and anthropometric values was analyzed.

Results The positions of the zygoma were similar to those on the contralateral side at the long-term follow-up. The preoperative anthropometric measurements on the fractured side differed from those on the contralateral side, although these values were close to the normal values at the long-term follow-up. Furthermore, we noted that the anteroposterior displacement strongly positively correlated with the lower iris coverage rate (Spearman's coefficient= 0.678, P=0.005).

Conclusions Two-point fixation of zygomatic fractures achieved stable outcomes on long-term follow-up, and also appeared to be reliable in restoring the aesthetic appearance of the periorbital region.

Keywords

Zygomatic fractures - Fracture fixation - Anthropometry

This article was presented at the 71st congress of Korean society of plastic and reconstructive surgeons, Nov 1-3, 2013, in Seoul, Korea.

Publication History

Received: 28 March 2014

Accepted: 08 July 2014

Article published online:
05 May 2022

• References

• 1 Pospisil OA, Fernando TD. Review of the lower blepharoplasty incision as a surgical approach to zygomatic-orbital fractures. Br J Oral Maxillofac Surg 1984; 22: 261-268
• 2 Manson PN, Ruas E, Iliff N. et al. Single eyelid incision for exposure of the zygomatic bone and orbital reconstruction. Plast Reconstr Surg 1987; 79: 120-126
• 3 Rinehart GC, Marsh JL, Hemmer KM. et al. Internal fixation of malar fractures: an experimental biophysical study. Plast Reconstr Surg 1989; 84: 21-25
• 4 O'Hara DE, DelVecchio DA, Bartlett SP. et al. The role of microfixation in malar fractures: a quantitative biophysical study. Plast Reconstr Surg 1996; 97: 345-350
• 5 Dal Santo F, Ellis 3rd E, Throckmorton GS. The effects of zygomatic complex fracture on masseteric muscle force. J Oral Maxillofac Surg 1992; 50: 791-799
• 6 Tarabichi M. Transsinus reduction and one-point fixation of malar fractures. Arch Otolaryngol Head Neck Surg 1994; 120: 620-625
• 7 Kim JH, Lee JH, Hong SM. et al. The effectiveness of 1-point fixation for zygomaticomaxillary complex fractures. Arch Otolaryngol Head Neck Surg 2012; 138: 828-832
• 8 Hwang K. One-point fixation of tripod fractures of zygoma through a lateral brow incision. J Craniofac Surg 2010; 21: 1042-1044
• 9 Novelli G, Ferrari L, Sozzi D. et al. Transconjunctival approach in orbital traumatology: a review of 56 cases. J Craniomaxillofac Surg 2011; 39: 266-270
• 10 Kwon HJ, Han KH, Kim JH. et al. Photogrammetry based on standardized clinical photography using cephalostat: comparison with anthropometric analysis. J Korean Soc Plast Reconstr Surg 2007; 34: 24-36
• 11 Rohner D, Tay A, Meng CS. et al. The sphenozygomatic suture as a key site for osteosynthesis of the orbitozygomatic complex in panfacial fractures: a biomechanical study in human cadavers based on clinical practice. Plast Reconstr Surg 2002; 110: 1463-1471
• 12 Langsdon PR, Rohman GT, Hixson R. et al. Upper lid transconjunctival versus transcutaneous approach for fracture repair of the lateral orbital rim. Ann Plast Surg 2010; 65: 52-55
• 13 Kelley P, Hopper R, Gruss J. Evaluation and treatment of zygomatic fractures. Plast Reconstr Surg 2007; 120: 5S-15S
• 14 Fujioka M, Yamanoto T, Miyazato O. et al. Stability of one-plate fixation for zygomatic bone fracture. Plast Reconstr Surg 2002; 109: 817-818
• 15 Han K, Kim D, Park M. et al. Web uni-limb z-plasty for correction of alar web deformity in unilateral cleft lip nasal deformities: photogrammetric analysis. J Korean Soc Plast Reconstr Surg 2011; 38: 740-746
• 16 Starck WJ, Griffin Jr JE, Epker BN. Objective evaluation of the eyelids and eyebrows after blepharoplasty. J Oral Maxillofac Surg 1996; 54: 297-302
• 17 Raschke GF, Rieger UM, Bader RD. et al. The zygomaticomaxillary complex fracture-an anthropometric appraisal of surgical outcomes. J Craniomaxillofac Surg 2013; 41: 331-337