High-Impact Comminuted Fracture of the Zygomatico-Maxillary-Orbital Complex: A Case Report
DOI:
https://doi.org/10.21270/archi.v14i8.6655Keywords:
Facial Injuries, Zygoma, Maxilla, Orbit, Accidents, TrafficAbstract
Facial fractures are frequently associated with motorcycle accidents due to the exposure of the face during high-energy collisions. Among these fractures, those involving the zygomaticomaxillary-orbital complex (ZMC) are particularly concerning due to their anatomical and functional relevance. This study aims to report a clinical case of a patient who suffered facial trauma following a motorcycle accident.A 22-year-old female patient with no comorbidities was admitted to the Oral and Maxillofacial Surgery and Traumatology service at Santa Casa de Misericórdia de Araçatuba with a history of a motorcycle accident that had occurred two days prior. Upon evaluation, periorbital ecchymosis on the right side and a laceration in the right zygomatic region, previously sutured at the referring hospital, were observed. The patient had patent airways, preserved ocular motility, and visual acuity. Intraoral examination revealed a complete dentition with no occlusal changes; however, a step deformity was identified in the right zygomatic region. Computed tomography confirmed a comminuted fracture of the right ZMC.The patient was diagnosed with a ZMC fracture and underwent surgery for fracture reduction and fixation under general anesthesia. Access was achieved through the pre-existing laceration in the right zygomatic region, combined with a supraciliary incision on the same side. Fixation was performed using 1.5 mm system plates and screws, along with a titanium mesh for orbital floor reconstruction. Postoperative tomography confirmed the proper positioning of the osteosynthesis material, and physical examination demonstrated satisfactory functional and aesthetic outcomes.The patient was discharged 48 hours after surgery with home care instructions and prescriptions. At the first outpatient follow-up, 17 days postoperatively, the patient exhibited preserved ocular motility and visual acuity, as well as maintained facial aesthetics, with reduced edema and ecchymosis. In conclusion, the treatment of facial trauma, particularly those resulting from motorcycle accidents, requires the application of advanced techniques such as the use of plates and titanium meshes. These resources allow for the restoration of facial anatomy, function, and aesthetics, ensuring efficient recovery and improved quality of life for the patient.
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References
1. Cavalcante DKF, Veloso SRM, Durão MA, Melo VC, Monteiro GQM, Porto GG. Do Helmet Use and Type Influence Facial Trauma Occurrence and Severity in Motorcyclists? A Systematic Review and Meta-analysis. J Oral Maxillofac Surg. 2021;79(7):1492-1506.
2. Cini MA, Prado BG, Hinnig Pde F, Fukushima WY, Adami F. Influence of type of helmet on facial trauma in motorcycle accidents. Br J Oral Maxillofac Surg. 2014;52(9):789-92.
3. Kostakis G, Stathopoulos P, Dais P, Gkinis G, Igoumenakis D, Mezitis M, Rallis G. An epidemiologic analysis of 1,142 maxillofacial fractures and concomitant injuries. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(5 Suppl):S69-73.
4. Buller J, Bömelburg C, Kruse T, Zirk M. Does maxillary sinus size affect the risk for zygomatic complex fractures? Clin Anat. 2023;36(4):564-569.
5. Zingg M, Laedrach K, Chen J, Chowdhury K, Vuillemin T, Sutter F, Raveh J. Classification and treatment of zygomatic fractures: a review of 1,025 cases. J Oral Maxillofac Surg. 1992;50(8):778-90.
6. He D, Li Z, Shi W, Sun Y, Zhu H, Lin M, Shen G, Fan X. Orbitozygomatic fractures with enophthalmos: analysis of 64 cases treated late. J Oral Maxillofac Surg. 2012;70(3):562-76.
7. Silveira GR, Zardo M, Gonçalves RCG, Takahashi A. Uso de malha de titânio no tratamento de fraturas de assoalho de órbita: relato de caso. Innov Implant J Biomater Esthet. 2010;5(3):60-3.
8. Yamsani B, Gaddipati R, Vura N, Ramisetti S, Yamsani R. Zygomaticomaxillary Complex Fractures: A Review of 101 Cases. J Maxillofac Oral Surg. 2016;15(4):417-424.
9. Senthilkumar R, Prakash S, Anandan H. Analysis of Outcome of Zygomatic Fracture Management. Int J Sci Stud. 2017;5(5):216-219.
10. Cornelius CP, Mayer P, Ehrenfeld M, Metzger MC. The orbits--anatomical features in view of innovative surgical methods. Facial Plast Surg. 2014;30(5):487-508.
11. Brown MS, Ky W, Lisman RD. Concomitant ocular injuries with orbital fractures. J Craniomaxillofac Trauma. 1999;5(3):41-6; discussion 47-8.
12. Kim J, Kim S, Chung S, Chung YK. Zygomatic arch fracture: a new classification and treatment algorithm with epidemiologic analysis. J Craniofac Surg. 2014;25(4):1389-92.
13. Silva BCL, Souto-Souza D, de Souza GM, Magesty RA, de Cassia Ávila B, Galvão EL, Falci SGM. Comparison between resorbable plates vs. titanium plates for treatment of zygomatic fractures: a systematic review with meta-analysis. Oral Maxillofac Surg. 2021;25(3):289-301.
14. Oliveira RB, Silveira RL, Machado RA, Nascimento MMM. Utilização de diferentes materiais de reconstrução em fraturas do assoalho de órbita: relato de seis casos. Rev Cir Traumatol Buco-Maxilo-Fac. 2005;5(3):43-50.
15. Souza BB, Landim FS, Cunha Filho GS, Santos JC, Medeiros Junior MD. Titanium screen use on the wall for reconstruction in orbital type blow out fracture: Case report. Rev Cir Traumatol Buco-Maxilo-Fac. 2018;18(1):19-23.
