Zygomaticomaxillary arch fractures
The zygomaticomaxillary arch fracture or zygomaticomaxillary complex fractures are a group of fractures that occur on the face and can dramatically alter the appearance and the function of the midface, which includes the globe. The surgery of Zygomatic arch fractures is considered to be a risky procedure as there are very high chances of complications.
The Zygomatic arch and complex are crucial components of the anatomy and functioning of the face. As shown by various studies, it has been proved that Zygomatic arch fractures are one of the most frequently occurring fractures in patients. The higher number of Zygomatic arch fractures can also be attributed to high number of automobile accidents as well as high number of domestic violence cases. While most commonly adults are more prone to automobile mishaps and domestic violence, children suffer from Zygomatic arch fracture due to sports injuries, falls etc. Design changes in automobiles like installation of airbags and seatbelts have drastically reduced the instances of major Zygomatic arch fractures, still the no. of cases of zygomaticomaxillary fractures are quite high.
The ZMC acts as natural and fundamental reinforcing structure for the face and its position is vital to the aesthetics of the face. It gives definition to cheekbones by providing width to the middle portion of the face. The ZMC acts as a tetra point holder as the face is supported at four main places namely; maxilla, the temporal bone, frontal bone and the greater wing of sphenoid. Since it is quite a complicated structure, whenever a zygomaticomaxillary arch fracture happens, there are mostly multiple fractures at once. Due to fracture a condition known as trismus may occur. In trismus, a person is not able to completely open the mouth. In a normal person, a full opening of the jaw measures 40-50mm. but in someone suffering from trismus, it may only be 20-30 mm. Trismus may occur due to various reasons and more often than not, it is temporary in nature. Sometimes fractures of zygomaticomaxillary complex may also affect the temporomandibular joint which is also known as TMJ. Temporomandibular joint is the joint of the jaw. The TMJ is between the upper temporal bone and the mandible which is the lower jaw bone. TMJ acts as a hinge between jaw and skull. If due to some damage, temporomandibular joint is hurt, it leads to localized pain. Tenderness or pain in jaw, TMJ pain in one or both the sides, pain or difficulty in chewing are some of the symptoms of a problem in TMJ. The precise reason of temporomandibular pain cannot be determined and TMJ reacts well to home remedies. TMJ disorder generally occurs in people who have the habit of grinding or clenching their jaw.
How a surgery for the treatment of ZMC arch fracture is performed completely depends on the surgeon. A surgeon may take various different approaches during the surgery which may involve help from oculoplastic surgeons, plastic surgeons etc. In zygomaticomaxillary arch fractures, if the bones around the eyes are damaged, sometimes vision can also be compromised. Therefore, several tests are also performed to assess the status of the optic nerves. Due to multiple fractures, if the ZMC is surgically treated, the skull may also require remodeling. In children the case is even more complicated as their skulls are not fully developed. Therefore special attention is given to the remodeling surgery in children so as to not adversely affect the growth of their face and skull.
Complications and risk factors
Generally, post operative infections and complications are not that common if the surgery is performed by a highly skilled surgeon. However, some risks are always associated with surgeries which depend upon:-
Studies have proven that in case of isolated structures, even factoring in aforementioned points, the risk of infections is very low. The post-operative complications are negligible if the surgeon performs the surgery skillfully and well within time.
The right treatment plan for Zygomaticomaxillary fractures can only be effective if a suitable treatment plan is defined. In case of ZMC, the treatment aims at balancing of facial features and the reductions of the segments which have been fractured. One very important thing to be kept in mind is that the patient should be taken for the treatment as soon as possible and only highly skilled and reputed surgeon is appointed for the surgery. Only an experienced surgeon can fulfill all the requirements of the patient while keeping the post-operative complications at bay. Generally, the patient of ZMC arch fractures are taken as emergency cases, therefore efforts should be made to take the patient to the best facility in shortest time possible. Minimum the time lapse between the accident and the treatment, the better the treatment will be.