Zygoma & complications / /certified fixed orthodontic courses by Indian dental academy
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Zygoma & complications / /certified fixed orthodontic courses by Indian dental academy
- 1. MAXILLOFACIAL INJURIES INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
- 2. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiological features • Management www.indiandentalacademy.com
- 3. MAXILLOFACIAL INJURIES Zygomatic complex fractures Anatomy: • central support to cheek • buttress of lateral mid 3rd face Articulations: • Zygomatico-frontal •Zygomatico-maxillary • Zygomatico-temporal (arch) • Zygomatico-sphenoid(orbital floor) www.indiandentalacademy.com
- 4. MAXILLOFACIAL INJURIES Zygomatic complex fractures ANATOMY Processes Maxillary Temporal Frontal Orbital Lateral wall and floor orbit Roof and lateral wall maxillary sinus www.indiandentalacademy.com
- 5. MAXILLOFACIAL INJURIES Zygomatic complex fractures ANATOMY Arch Temporal Zygoma Maxilla Muscle attachments: Zygomaticus major / minor: malar eminence Levator labii superioris: infraorbital rim www.indiandentalacademy.com
- 6. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiological features • Management www.indiandentalacademy.com
- 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 www.indiandentalacademy.com
- 8. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy •Clinical features • Radiological features • Management www.indiandentalacademy.com
- 9. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical Features Flattening of cheek Periorbital edema / Ecchymosis Subconjunctival haemorrhage Epistaxis / Surgical emphysema Proptosis / Enophthalmos www.indiandentalacademy.com
- 10. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical Features ENOPHTHALMOS • Inferior & posterior displacement • Expansion of orbit EXOPHTHALMOS • Medial dislocations www.indiandentalacademy.com
- 11. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical Features Paresthesia (V2) / Pain !!! Trismus Tenderness / Step deformity Facial nerve weakness Drooping of upper lip DIPLOPIA www.indiandentalacademy.com
- 12. 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) www.indiandentalacademy.com
- 13. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiology • Management www.indiandentalacademy.com
- 14. MAXILLOFACIAL INJURIES Zygomatic complex fractures Radiographic examination Occipto-mental view (PNS view, Waters position) Fronto-zygomatic suture Zygomatico-maxillary buttress Inferior orbital rim www.indiandentalacademy.com
- 15. MAXILLOFACIAL INJURIES Zygomatic complex fractures Radiographic examination Submento-vertex view (jug handle view ) Zygomatic arch Posterior displacement www.indiandentalacademy.com
- 16. MAXILLOFACIAL INJURIES Zygomatic complex fractures Radiographic examination C.T. Scans: • Axial • Coronal www.indiandentalacademy.com
- 17. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiology • Management www.indiandentalacademy.com
- 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 www.indiandentalacademy.com
- 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 www.indiandentalacademy.com
- 20. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Closed Reduction Arch fractures Minimal disruption (at 2 sutures) Intra-oral approach (Keen 1909) www.indiandentalacademy.com
- 21. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Closed Reduction • Temporal approach (Gillies 1927) www.indiandentalacademy.com
- 23. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Closed Reduction • Transcutaneous approach www.indiandentalacademy.com
- 24. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Open Reduction & fixation F-Z Suture Infra-orbital rim & orbital floor Zygomatico-maxillary buttress (Intra-oral) www.indiandentalacademy.com
- 25. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management : Open Reduction F-Z Suture www.indiandentalacademy.com
- 26. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management : Open Reduction Zygomatico-maxillary suture Infra-orbital rim www.indiandentalacademy.com
- 27. MAXILLOFACIAL INJURIES Complications • Mal-union / Non-union / fibrous union • Malocclusion • Plate exposure • TMJ disorders / Ankylosis • Infection • Nerve Damage (Paresthesia) • Scars www.indiandentalacademy.com
- 32. MAXILLOFACIAL INJURIES Complications Plate Exposure / Wound dehiscence www.indiandentalacademy.com
- 36. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiological features • Management •Complications www.indiandentalacademy.com
- 37. MAXILLOFACIAL INJURIES Mid face (Le-Fort) # www.indiandentalacademy.com Blow-out # of Orbit
- 38. Thank You www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com
Notas do Editor
- {"5":"Arch: contributions from three bones temporal, zygomatic & maxillary\nMuscle attachments\nNerves \nZ facial br of zygomatic nerve enters orbit through inferior orbital fissure divides into\nZ temporal which supplies area around zf suture & z facial which passes along inferior and lateral surface of the orbit exciting through a foramen on malar eminence to supply that area\nInfraorbital nerve through posterior margin of inferior orbital fissure, travels through a in its first 2/3rds of its course obliquely and medially across orbital floor and then through a canal in the infraorbital rim to exit the zygoma @ 1cm below the infraorbital rim grove \n","11":"Paresthesia V2 contusion or compression of nrve by bone fragments within the area of infraorbital foramen specially medially displaced fractures and will resolve only after elevation of fracture.\nLimitation in mouth opening due to swelling with in muscular and soft tissue planes, medially displaced arch, and posteriorly displaced body\n","17":"This should be the first slide\n","12":"Difference betwqeen proptosis & exopthalmos\n","1":"This should be the first slide\n","18":"Tetanus immunization schedule microbiology of tetanus check with dinesh \nFully immunised : last dose with in 10yrs .5ml toxoid\nPartially immunised: more than 10yrs .5ml toxoid\n","7":"Direct violent forces to cotralateral side can cause disruption of zygoma due to reciprocal transfer of forces but not common, bilateral zygoma fracutres are usually in association with other facial bones involved as in lefort 3 and is because of higher energy involvemnt. \nFractures are dislocated posteriorly,inferiorly & medialy are most frequent. Orbital #s are compressed with overlapping # fragments & while reducing, orbital fractures become more severe. These are impacted fractures\nMore extensive injuries are dislocated posteriorly inferiorly and laterally. The arch and soft tissue attachments must be disrupted to permit this.\nAny zygomatic complex fracture should include a discontinuity along the floor of the orbit.\nThe direction of dislocation involves the rotation of the bone in several planes this has resulted in several classifications\n","35":"1) Clossure of periosteal incissions\nPrevents lengthening of soft tissues soft tissue diastasis\n2) Refixation of tissues at several points of facial skeleton\nDue to inacurate allignment ( common in comminuted fractures)\nFix #ed Zygoma to adjacent unfractured bone Therefore expose unfractured land marks and use as guide\nCommonly seen at\ninfra orbital rim, and junction of orbital process of zygoma to greater wing of sphenoid\n","8":"This should be the first slide\n","36":"This should be the first slide\n","3":"Prominent position – frequently fractured\nEither alone or in combination with other bones of midface\nFractures include disruption of any of 5 articulations\n","9":"Loss of prominence of malar eminence may partially conceled by soft tissue swelling\nProptosis due to swelling with in muscular planes and tissue planes\nEchymosis and hematoma usually confined to distribution of orbital septum spectacle hematoma\nEpistaxis on ipsilateral nostril secondary to hemorrhage into maxillary sinus \n","4":"Articulates with \nzygomatic process of maxillary bone: infraorbital rim\nZygomatic process of temporal bone :in front of the glenoid fossa\nExternal angular process of frontal bone:to form fz suture\nWith in orbit articulates with medially orbital floor & laterally G.W.sphenoid\nBy virtue of its attachments\nForms floor & lateral wall of orbit & roof and lateral wall of maxillary sinus\n","10":"Clinical pictures to be added.\n"}