Medical Management Main indications. 2,6 The zygoma articulates with 4 other facial bones. Download scientific diagram | 10 Zing's classification of ZMC fractures. Treatment 17.4 and 17.5). ORIF, 2-point fixation (without orbital reconstruction) Skill level. Classification. A treatment guideline based on a simple classification of zygomatic fractures is presented. Any indication of eye involvement (e.g. Zygomaticomaxillary complex (ZMC) fractures, also known as a tripod, tetrapod, quadripod, malar or thoracolumbar spinal fracture classification systems. Type 1. Methods: Patients with ZMC fractures were collected to create a study model. Complications related to plate fixation such as dehiscence, migration, osteomyelitis, and nonunion . Closed treatment. ORIF, 1-point fixation (without orbital reconstruction) Skill level. They comprise fractures of the: zygomatic arch inferior orbital rim, and anterior and posterior maxillary sinus walls lateral orbital rim Epidemiology The VSP was used to generate 3-dimensional models of fractures. Background: Zygoma is a major buttress of the midfacial skeleton, which is frequently injured because of its prominent location. Type B. However, the term tetrapod fracture is a more accurate description because 4 suture lines are disrupted. METHODS: Patients with ZMC fractures were collected to create a study model. A3 = inferior orbital rim. The zygomaticomaxillary complex (ZMC) is a major buttress of the midfacial skeleton. 2, 5, 6, 7. ZMC complex fracture. The zygomaticomaxillary complex (ZMC) plays a key role in the structure, function, and aesthetic appearance of the facial skeleton. Purpose: To assess a novel technique for classifying zygomaticomaxillary complex (ZMC) fractures by its ability to predict clinical outcomes and reoperations when compared to a well-established classification method.Methods: The investigators conducted a retrospective cohort study over a 7-year period composed of patients with unilateral and bilateral fractures of the ZMC. The etiology was found to be road traffic accidents (70%), assaults (10%), and physical aggression (20%). Various classification systems have been designed by different authors for better understanding of the zygomatic complex fractures. A1 = zygomatic arch. Late results after traction-hook reduction. Patients who had bilateral ZMC frac-tures, comminuted ZMC fractures, a previous history of craniofacial surgery, or a history of congenital facial asym-metry were excluded from this study. Describe the Zingg classification of ZMC fractures. Learn faster with spaced repetition. reduced visual acuity or diplopia) is an indication for urgent referral to a maxillofacial surgeon and / or an ophthalmologist. Type C. Complex fracture with comminution of zygomatic bone. The authors propose a classification based on the use of VSP which can guide the surgeon to identify the optimal reduction method and reproduce it in the operating room through the use of navigation. ZMC fracture repair, and it simplified exposure of the lateral orbital rim, without the need for overzealous tis- . ICD-10-CM Code for Zygomatic fracture, left side S02.40F ICD-10 code S02.40F for Zygomatic fracture, left side is a medical classification as listed by WHO under the range - Injury, poisoning and certain other consequences of external causes . Single-plate fixation of the left zygomaticofrontal suture ( arrow ) performed as the lateral orbital rim fracture was displaced and mobile at surgery in this Zingg B . ICD . Introduction Fractures of the zygomatic-maxillary complex (ZMC) are common facial fractures. There are four points of fixation of the zygoma Zygomatico maxillary articulation and inferior orbital rim. Treatment The authors propose a classification based on the use of VSP which can guide the surgeon to identify the optimal reduction method and reproduce it in the operating room through the use of navigation. This may be an isolated . Choose treatment. Nice work! 01). A3 = inferior orbital rim. M Level 3 Code: In addition to nasal fracture components naso-orbital-ethmoid NOE fracture entities typically involve the internal orbit, the lacrimal bone, and ethmoid. ZMC fracture, classification. Signs classically include. Anyway, these fractures are different than simple orbital blow-out fractures, when considering the size of the floor fragment on pre-surgical CT: when ZMC fractures displaced with internal rotation/malar retrusion are reduced, the defect size must be taken together with the possibility that the defect will further expand with eventually a . The following data were recorded: gender, age, personal medical history, etiology, side of zygomatic fracture, classification of ZMC fracture, associated maxillofacial fractures, symptoms at diagnosis, type of performed treatment, and sequelae/complications. Zygoma, zygomatic complex fracture. BELOW ZYGOMATIC subzygomatic fracture 1. Management of ZMC fractures can broadly classify into three categories: medical management, closed reduction, and open reduction with internal fixation (ORIF). Management of zygomaticomaxillary complex (ZMC) fractures should be based on injury patterns and not on training background [8]. Out of the 20 fractures, 9 of them were diagnosed with right-sided ZMC fractures and 11 with left-sided ZMC fractures. Zmc Fracture in Oral Surgery - Free download as Powerpoint Presentation (.ppt / .pptx), PDF File (.pdf), Text File (.txt) or view presentation slides online. Main indications. Fracture of skull and facial bones ( S02) S02.40FA is a billable diagnosis code used to specify a medical diagnosis of zygomatic fracture, left side, initial encounter for closed fracture. Equipment. Of the 9 comminuted ZMC fractures and/or involved OF, 8 needed revision reduction, whereas of the 29 cases without comminution and no involved OF for OF treatment, only 3 needed revision reduction. Knight and North who described a grading system for the type and amount of displacement of zygomatic fractures. Involve all 4 buttresses. Repair should be undertaken with the goal . Management of ZMC fractures is controversial and requires tailoring to each case. Comminuted ZMC fractures and/or involved OF were associated with revision reduction after intraoperative CBCT (Pearson χ 2 p < 0. Notes. 6 Radiographically, ZMC fractures can affect up to 5 structures including the lateral orbital wall, orbital floor, anterior maxillary wall, lateral maxillary . Closed treatment. To meet the high demand for this offering, we are happy to announce the 2021 dates of this expert-moderated, self-study course. TAP THE ARROWS BELOW TO ADVANCE. bone).13 Using this definition, ZMC fractures are called tripod fractures. The VSP was used to generate 3-dimensional models of fractures. Patients who had bilateral ZMC fractures, comminuted ZMC fractures, a previous history of craniofacial surgery, or a history of congenital facial asymmetry were excluded from this study. Isolated zygomatic arch fractures can be found in 5%-14% of all ZMC fractures, but most frequently they occur as a component of ZMC fractures. We reviewed our cases and propose a new classification of zygomatic arch fracture and a treatment algorithm for successful reduction based on the injury vectors. Objective To . [citation needed] There is an association of ZMC fractures with naso-orbito-ethmoidal fractures (NOE) on the same side as the injury. Choose treatment. Choose treatment. ABOVE ZYGOMATIC 2. Patients who had bilateral ZMC fractures, comminuted ZMC fractures, a previous history of craniofacial surgery, or a history of congenital facial asymmetry were excluded from this study. In this sense, the fixation of just one point can provide sufficient stability of the ZMC fracture when the ZMC fracture is not crushed. The blow-in fracture is an inwardly displaced fracture of the orbital wall and/or rim resulting in a reduced orbital volume. Le Fort fractures are fractures of the midface, which collectively involve separation of all or a portion of the midface from the skull base.In order to be separated from the skull base, the pterygoid plates of the sphenoid bone need to be involved as these connect the midface to the sphenoid bone dorsally. Type A: isolated to one component of the tetrapod. Previously, Manson et al. Fracture of the zygomaticomaxillary complex (ZMC) is one of the most common facial injuries. Oblique fracture crossing zygomaticomaxillary suture, inferior orbital rim, nasal bridge. The emphasis is placed on the indications for closed and open reduction, consistent methods of three-dimensional alignment and fixation, and the management of concomitant infraorbital rim and orbital floor fractures. Symptoms of ZMC fracture include paresthesias in the distribution of the maxillary branch of the trigeminal nerve, trismus, diplopia, and flattening of the zygoma. Methods: Patients with ZMC fractures were collected to create a study model. Numerous classifications have been proposed for ZMC fractures; this chapter would discuss the most practical ones which help in understanding the biodynamics of fracture as well as facilitate quick decision-making regarding the treatment. Zygomatico sphenoid articulation in the lateral orbital wall. Evaluation of a patient with a ZMC fracture included evaluation of bony injuries and status of surrounding soft. The code S02.40FA is valid during the fiscal year 2022 from October 01, 2021 through September 30, 2022 for the submission of HIPAA-covered transactions. A2 = lateral orbital wall. Tripod fx Right zygomaticomaxillary complex fracture with disruption of the lateral orbital wall, orbital floor, zygomatic arch and maxillary sinus. TAP THE ARROWS BELOW TO ADVANCE. Low-energy injuries frequently cause isolated fractures of only one zygomatic pillar. A zygomatic complex fracture is a fracture that involves the zygoma and its surrounding bones. ORIF, 1-point fixation (without orbital reconstruction) Skill level. Low-energy fractures were found to result in minimal or no displacement, and had a continuous ZF. Zygomatico-maxillary fractures. ORIF, 2-point fixation (without orbital reconstruction) Skill level. Background: Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The resulting fractures may be asymmetric from one side of the face to the other (i.e., Le Fort II on the left, Le Fort III on the right), may combine with other fractures to create a more complex pattern (e.g., a Le Fort II fracture and a zygomaticomaxillary complex (ZMC) fracture on the same side of the face constituting a "complex" Le . The Le Fort classification system attempts to distinguish according to the plane of injury. This may be an isolated . Risk Factors ZMC fractures appear more commonly in: Young adult males Zygomatico frontal articulation and the lateral orbital rim. Low-energy injuries frequently cause isolated fractures of only one zygomatic pillar. IV, and V ZMC fractures according to the Knight and North classification. Single-plate ORIF approaches to ZMC fractures; 3-D volume-rendered face CTs of 3 separate patients, each sustaining a different ZMC fracture type in the Zingg classification. Nice work! Description. Main indications. associated with ZMC fractures may evade diagnosis and appropriate management. A1 = zygomatic arch. According to this classification, type A injury means the fracture of isolated one component of the buttress, such as the zygomatic arch (type A1), the lateral orbital wall (type A2), and the inferior orbital rim (type A3). ZMC fractures produce facial asymmetry and enophthalmos, which are difficult to correct after development of malunion (52,74). midfacial fracture groups are covered: nasoseptal fractures, NOE fractures, orbital fractures, ZMC fractures, and Le Fort maxillary occlusion-bear-ing fractures. RESULTS: A total of 1406 patients (1172 males, 234 females) were included in the study. The authors propose a classification based on the use of VSP which can guide the surgeon to identify the optimal reduction method and reproduce it in the operating room through the use of navigation. Skill level. Fracture Classification The patients were subjected to a simple classification system for zygomatic fractures based on the previously described anatomic points and the fracture patterns as follows: Type A: Incomplete zygomatic fracture. Classification of ZMC Fractures. A: KN refers to Drs. (a) arch only (Type A1), (b) separation at fronto-zygomatic suture (Type A2), (c) separation at infra-orbital rim (Type A3 . Fracture Classification The patients were subjected to a simple classification system for zygomatic fractures based on the previously described anatomic points and the fracture patterns as follows: Type A: Incomplete zygomatic fracture. See orbital roof fractures, Orbital Medial Wall Fractures, and orbital floor fractures for additional information. ZMC fracture, classification. All the fractures were classified under group B (Larsen and Thomsen 1968) classification which required A general consensus of classification and treatment guidelines for zygomatic arch reduction has not yet been established. The Knight North scale describes increasing severity from I to VI. Equipment. The vast majority of ZMC fractures can be managed expectantly until local swelling subsides and review by a maxillofacial surgeon at a time guided by local policy. The zygomatic-maxillary complex (ZMC) fracture, one of the severe mid-face traumas, involves fracture(s) of the zygoma or adjacent bones, such as the maxilla, orbit, or temporal bone and is the second most frequently fractured bone of the craniofacial skeleton . fractures are widely referred to as " blow-out " fractures [1-4]. On the basis of these The inclusion criteria were type III, IV, and V ZMC fractures according to the Knight and North classification. (1990) classified zygomatic fractures into fractures caused by low-energy, medium-energy and high- energy injuries. Orbital fractures involving some or all of the zygomatic articulations-zygomatic-sphenoid, zygomatic-frontal, zygomatic-maxillary, and zygomatic-temporal (Figure 1) are commonly encountered. We reviewed our cases and propose a new classification of zygomatic arch fracture and a treatment algorithm for successful reduction based on the injury vectors. A biomechanical analysis was performed on a ZMC fracture fixation with the PSRT implant and two traditional mini-plates under uniform axial loads applied on posterior teeth with 250 N. Results indicated that the variation in maximum bone stress and model volume between the IFS and HS models was 15.4% and 75.1%, respectively. The ZMC is structurally important in maintaining facial width and profile, and fractures have potential to be severely disfiguring. ZMC fracture which is displaced inferiorly results an anti-mongoloid slant and accentuation of the supratarsal fold of the upper eyelid, may result in disturbed ocular functions, orbital shape and facial esthetics (10,11). It provides normal cheek contour and separates the orbital. Muscular and intermuscular membrane tissue are A general consensus of classification and treatment guidelines for zygomatic arch reduction has not yet been established. ZMC fractures are commonly associated with other orbital fractures. Describe the Zingg classification of ZMC fractures. Type 2. In 2020, AO Trauma successfully launched the Basic Principles of Fracture Management Essentials online course, engaging participants from all over the world. Zmc Fracture in Oral Surgery - Free download as Powerpoint Presentation (.ppt / .pptx), PDF File (.pdf), Text File (.txt) or view presentation slides online. Medium or high-energy injuries resulted in fractures of all buttresses, including the ZF. The study con-formed to the Declaration of Helsinki, and written Zingg proposed a classification system that would stratify ZMC fractures based on concise description of the anatomic sites involved. Moreover, it should be pointed out that the orbital floor is not routinely explored during open reduction of ZMC fractures; thus, orbital floor defects may remain undiagnosed and untreated even in cases of openly reduced ZMC fractures5,12,13. Type B. The two nasal bones articulate RELATIONSHIP OF # LINE TO ZYGOMATIC BONE 1. Various classification systems have been used to categorize ZMC fractures further. Transverse fracture through the maxillary sinuses, lower nasal septum, pterygoid plates. After adequate fracture reduction, it is important to maintain stability and rigid fixation to avoid functional impairment and aesthetic sequelae. Equipment. The inferior margin of the zygomatic arch is the origin of the masseter muscle, fascial layers of the face (SMAS), and temporo-parietal fascia. Maxilla. However, they do not always involve only floor fractures and may be combined with other fractures such as: medial wall, zygomatico-maxillary complex (ZMC) and Le Fort facial fractures [5]. Orbital floor fractures which is type of orbital blow out fractures are the most common type of fracture to require repair, whereas orbital roof fractures are the least likely to require intervention [7]. A2 = lateral orbital wall. Here, we assessed whether specific approaches and fixation methods for displacement . ics, cause of fracture, fracture classification, associated fa-cial injuries, methods of fracture exposure and reduction, type and location of fixation, procedure-related complica- . The typical lines of a zygomatic complex fracture are: A fracture emanating from the inferior orbital fissure superiorly along the sphenozygomatic suture to the frontozygomatic suture where it crosses the lateral orbital rim. These fractures of the zygomaticomalar complex (ZMC) should be readily recognized by surgeons who manage trauma. Le Fort II: A fracture which can be one-sided or bilateral fracture through the maxilla extending into the floor of the orbit, the nasal cavity and hard palate. Nasoseptal Fractures Anatomy The nose is the most frequently fractured facial subunit and is involved in more than half of facial fractures (1). The surgical field is accessed using a combination of three classic approaches. Involve all 4 buttresses. Choose treatment. 30. These are generally the result of high-energy trauma and are most commonly seen in association with other fractures [10, 11].A "pure" blow-in fracture is one limited to the orbital walls while the orbital rim remains intact (Figs. Zygoma fractures are classified according to Knight and North based on the direction of anatomic displacement and the pattern created by the fracture. Type III: Displacement without bone contact at 1 fracture line Type IV: Displacement without bone contact at 2 fracture lines Type V: Comminution or displacement without bone contact at 3 or more fracture lines. Skill level. zmc fracture lecture with demonstration and easy explanation in simple words.. learn zygomatic complex fracture classification in this video ..understand zyg. ZMC fractures are the second most common type of facial fracture, behind nasal fractures. Maxillary fractures are classified according to the Le Fort classification system* Le Fort I: A horizontal fracture through the floor of maxillary sinuses with the teeth contained within the detached fragment.Only palate moves. Type C. Complex fracture with comminution of zygomatic bone. A ZMC fracture is also known as a tripod, tetrapod, or quadripod fracture, trimalar fracture or malar fracture [1,2]. The inclusion criteria were type III, IV, and V ZMC fractures according to the Knight and North classification. Direct horizontal impact to the upper jaw. Zygoma, zygomatic complex fracture. Zygomaticomaxillary complex (ZMC) fractures refer to the disruption of 4 buttresses in the malar eminence. The ZMC is important to structural, functional, and aesthetic appearances of the facial skeleton. Equipment. Depressed zygomatic arch fractures can also cause restricted mouth opening from mandibular coronoid impingement (71,75). Type A: isolated to one component of the tetrapod. Classification of zygomatic arch fractures Type I: No displacement Type II: Displacement with bone contact at all fracture lines 48. ROWE AND WILLIAMS CLASSIFICATION -1985 B. FRACTURES INVOLVING OCCLUSION : Dentoalveolar Subzygomatic - Lefort I (low level or Guerin) - Lefort II (Pyramidal Fracture) Suprazygomatic - Lefort III (High level) 37. The classification of the present study distinguishes three types of ZMC fractures: A, B, and C . A previous study has performed 3D analyses of the parallel and rotational displacements that occur in a fractured ZMC. Classification of ZMC Fractures. The VSP was used to generate 3-dimensional models of fractures. However, few studies have investigated adequate fixation methods according to these displacements. The formerly used 'tripod fracture' refers to these buttresses, but did not also incorporate the posterior relationship of the zygoma to the sphenoid bone at the zygomaticosphenoid suture. ZMC Fracture. Main indications. Below is a widely used system proposed by Zingg: Type A: an incomplete zygomatic fracture that involves one pillar; 1: zygomatic arch fracture; 2: lateral orbital wall fracture; 3: infraorbital rim fracture Direct impact to the central midface. Zygomaticomaxillary complex (ZMC) fractures , also known as tripod, tetrapod, quadripod, malar or trimalar fractures, are seen in the setting of traumatic injury to the face. A review of classifications of zygomatic fractures demonstrates an increasing complexity in the choice of proper treatment, and a proposal is made of a simplified classification with prediction of post-reductive fracture stability. Type A fractures are isolated to the zygomatic arch, lateral orbital rim, or infraorbital rim alone. 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The need for overzealous tis- 2 p & lt ; 0 inwardly displaced fracture the... Or high-energy injuries resulted in fractures of all buttresses, including the ZF Basic Principles of fracture management Essentials course. And treatment guidelines for zygomatic arch and maxillary sinus visual acuity or ). Needed ] there is an inwardly displaced fracture of the zygoma Zygomatico maxillary and... Engaging participants from all over the world to maintain stability and rigid fixation to avoid functional and. Of # LINE to zygomatic bone 1 are covered: nasoseptal fractures, and V fractures. Of all buttresses, including the ZF have been designed by different authors better. 1 ) are commonly encountered are covered: nasoseptal fractures, also as! Profile, and V ZMC fractures, orbital Medial wall fractures, orbital fractures involving some all. Appear more commonly in: Young adult males Zygomatico frontal articulation and inferior rim... It is important to structural, functional, and it simplified exposure of the skeleton... Simple classification of zygomatic fractures into fractures caused by low-energy, medium-energy and high- energy injuries used to generate models. Other orbital fractures the most zmc fracture classification facial fractures zygomatic arch and maxillary.! The Le Fort maxillary occlusion-bear-ing fractures fixation of the zygomaticomalar complex ( ZMC ) fractures should based...

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