ZYGOMAZYGOMA Dr V.RAMKUMARDr V.RAMKUMAR CONSULTANT CONSULTANT

DENTAL&FACIOMAXDENTAL&FACIOMAXILLARY SURGEONILLARY SURGEON

REG NO: 4118 –REG NO: 4118 –TAMILNADU-TAMILNADU-INDIA(ASIA)INDIA(ASIA)

The zygoma and its articulating The zygoma and its articulating bonesbones

IINTRODUCTION

SURGICAL ANATOMY

CLASSIFICATION

Fractures of the body of the zygomatic complex involving the orbit

1. Minimal or no displacement

2. Inward and downward displacement

3. Inward and posterior displacement

4. Outward displacement

5. Comminution of the complex as whole

Fractures of the body of the zygomatic complex not involving the orbit

1.Minimal or no displacement

2. V-type in fracture

3. Comminuted

Signs and Symptoms

1. Flattening of cheek

2. Swelling of cheek

3. Periorbital haematoma

HAEMORRHAGE

4. Subconjunctival haemorrhage

5. Ecchymosis and tenderness intra-orally zygomatic buttress.

6. Limitation of ocular movement.

7. Diplopia:

Causes

1.Physical Interfences

Intramuscular edema

detachement of IR, IO

herniation of periorbital fat

fibrous adhesions & fat atrophy in post-traumatic healing

2.Functional interferences

displacement of globe due to disturbance of IR, IO

enophthalmous & globe ptosis.

3.Neurological cause

paralysis due to m\neuromuscular injury or edema

supranuclear impairment of 3,4,6th C.N.

superior orbital fissure damage

8.Enophthalmous:

Causes:

loss / decrease of vol. Of orbital content

increase in vol. Of bony orbit

loss of ligament support

post traumatic fibrosis, scar contraction, fat atrophy.

9.Lowering of pupil level

10.Epistaxis

11.Tenderness over orbital rim & FZS

12.Step deformity of infra orbital rim

13.Seperation at FZS

14.Limitation of mandibular movement

15.Anaesthesia of cheek, temple, upper teeth & gingiva

16.Possible gagging of back teeth on injured side

TECHNIQUES OF REDUCTION TECHNIQUES OF REDUCTION AND FIXATIONAND FIXATION

REDUCTION REDUCTION CLOSED REDUCTION – GILLIES et al 1927CLOSED REDUCTION – GILLIES et al 1927 OPEN REDUCTION - DINGMAN et al 1964OPEN REDUCTION - DINGMAN et al 1964 - KEEN et al 1909- KEEN et al 1909 FIXATION APPROACHESFIXATION APPROACHES - LATERAL EYEBROW INCISION- LATERAL EYEBROW INCISION - UPPER BUCCAL SULCUS INCISION- UPPER BUCCAL SULCUS INCISION - LOW INFRA ORBITAL INCISION- LOW INFRA ORBITAL INCISION - OTHERS - PERCUTANEOUS- OTHERS - PERCUTANEOUS

PERCUTANEOUS APPROACH

PERI ORBITAL INCISIONS

INDIRECT REDUCTION

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