A CURRENT 4-YEARS RETROSPECTIVE SURVEY OF 64 SURGICALLY TREATED ZYGOMA COMPLEX FRACTURES IN DEPARTMENT OF MAXILLOFACIAL SURGERY , UNIVERSITY HOSPITAL ‘ ST

Purpose: The goal of this material was to be an example of the complications that can occur in cases of zygoma fractures and to draw the attention of the clinicians to the need of accurate diagnose and early treatment of the associated with zygoma fractures traumas. Materials and methods: Medical records of 276 patients with different traumas in face and neck area treated in our department ware reviewed. Of those 64 suffered from zygoma fractures and they ware classified according to age, sex, cause of trauma, presence or absence of associated trauma, etc. Results: As other studies also show, we determined that the most common cause of injury was assault and road accidents, fallowed by sport, industrial, etc. Males between 20 and 40 years old ware the biggest group of patients, often after alcohol consumption. Associated traumas occurred more frequently in cases of motor vehicle accident than in other cases and ware presented by closed head trauma, ophthalmologic problems, extremities fractures, etc. Conclusion: Delayed treatment of zygoma injuries is feasible and yields in good results when the severity of trauma needs it, but early repair of such injuries prevent late complications and should be preferred when possible.


DISSCUSION
As other studies also show, we determined that the most common cause of injury was assault-37,5% followed by road accidents, sport, industrial, etc. Males between 20 and 40 years old-59,4% were the biggest group of patients, often after alcohol consumption.
Associated traumas was observed in 57,8 % and occurred more frequently in cases of motor vehicle accident than in other cases and were presented by head trauma, followed by ophthalmologic problems, extremities fractures.
Motor vehicle accidents were also the leading cause of orbital floor fractures, followed by physical assault and sports-related mechanisms.Associated facial fractures were found in some patients and the most prevalent of which was the nasal bone fracture.The most common signs and symptoms associated with zygoma complex fractures were: facial deformities, enophthalmos, diplopia, compromised mouth opening if present, inflammation of the mucosa of the maxillary sinus, and above all incidence of sensory deficit in the distribution area of the infra-orbital nerves and the dental plexus, periorbital ecchymosis, subconjunctival hemorrhage Most of the patients were examined by the ophthalmology service preoperatively and reviewed postoperatively as indicated.These injuries occur more often in patients with orbital blowout fractures compared with comminuted orbitozygomatic complex fractures or simple zygomatic fractures.
Ophthalmology consultation is recommended for all patients presenting with orbitozygomatic fractures, and is essential for patients with orbital blowout fractures, based on the high incidence of clinical ocular findings and injuries in this subgroup of patients.Forty-one of these patients were seen by an ophthalmologist as the initial consultant for ocular and orbital injuries recognized by the emergency staff.This survey reveals the lack of awareness in a regional Fig. 3. Analysis according to mechanism of trauma Associated injuries occurred in 57,8% (37 patients).Serious ocular injury occurred in 4 patients and 20 others had transitory diplopia.There were patients with associated closed head trauma with documented loss of consciousness (25), orthopedic trauma (7), skull fracture and intracranial injury (1).Associated cervical-spine fractures were not found.(fig.4 trauma center of certain ocular and periocular signs that may be indicative of more serious ocular injuries.
Enophthalmos and hypoglobus corrected in almost all patients.Correction of hypoglobus is technically easier than enophthalmos, because enophthalmic correction requires a wide, deep subperiosteal dissection and implant positioning, posterior to the equator of the globe, with the inherent risk of orbital apex injury.
Diplopia was resolved in 20 patients with preoperative impairment.Three patients suffered blindness.
19 patients had been operated via trans-oral access (Keen-Village method) and 21 patients with wire osteosinthesis and 6 patients with Ti miniplates-and-screw. 15 patients were with orbital floor fracture: 8 were treated with titanium mash; 5 were treated with frozen cartilage graft and 2 with Ti mash plus frozen cartilage graft.On the cases of zygoma complex fractures, combine with brain traumas the specialize treatment of facial injures was postponed until stabilization of brain status.Delayed repair of maxillofacial injuries in severely injured patients is feasible and yields in good results compared to early fracture repair.

CONCLUSIONS:
Maxillofacial trauma is without doubt still a very challenging area.Delayed repair of maxillofacial injuries in severely injured patients is feasible and yields in good results compared to early fracture repair.The treatment for ZCF should be selected according to the fracture types.The key of operation is to recover the malar prominence.Remodeling the length and radian of zygomatic arch guarantee the recovery of malar prominence.Zygomaticsphenoid and zygomatic-maxillary fissures are very important reference marks for reduction and fixation.
Orbital floor blowout fractures have a high incidence of muscle entrapment that must be recognized and treated early to avoid muscle necrosis and permanent ocular restriction from fibrosis.Medial orbital wall fractures with entrapment are rare, but early recognition and operative release of the entrapped muscles result in better outcomes.