Prevalence of orbital floor reconstructon in zygomaticomaxilary complex fractures
Date
2019
Authors
Gani, Muhammad Sikander
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Abstract
Zygomaticomaxillary Complex (ZMC) fractures are a common phenomenon and tend
to cause functional and aesthetic problems. Orbital wall involvement is commonly
associated with ZMC fractures. There is a lack of consensus regarding the best surgical
approach to these fractures. Many surgeons prefer a transcutaneous lower eyelid
approach to the infraorbital rim approach with exploration of the internal orbit whereas
others prefer to avoid it and use a transconjunctival approach to the internal orbit only
if necessary. Avoiding the transcutaneous approaches and unnecessary exploration of
the internal orbit results in fewer lower eyelid complications. The current trend is a
minimally invasive approach to limit skin incisions and thus minimise external scars.
This study aims to determine the prevalence of orbital wall reconstruction in ZMC
fractures over a seven-year period (1 January 2010 to 31 December 2016) at the
Charlotte Maxeke Johannesburg Academic Hospital.
METHODS AND MATERIALS
This study included 150 patients with isolated ZMC fractures at the Charlotte Maxeke
Johannesburg Academic Hospital from 1 January 2010 to 31 December 2016. Isolated
zygomatic arch fractures and multiple facial fractures that included the zygoma were
excluded. Data on gender, age, aetiology, orbital fractures, and reconstruction, as well
the surgical approaches and treatment were recorded.
4 RESULTS
A total of 128 patients were male (85.31%) and 22 were female (14.67%) with a male
to female ratio of 5.81:1. The ZMC fractures occurred mainly in the third decade (74
cases, 49.33%) of life with the left side being involved in 83 (55.37%) and the right
side in 67 (44.67%) cases. Interpersonal violence (63%) was the main cause followed
by road traffic accidents (34%). Orbital fractures were reported in 47 (31%) patients
and orbital reconstruction was performed in 39(26%) patients. A statistical significance
was noted with the infraorbital approach and orbital reconstruction. The majority of the
patients (44%) had three surgical approaches (transoral maxillary vestibular, lateral
brow, and infraorbital approaches) with 3-point fixation (46%).
CONCLUSIONS
Males comprised the majority of the patients in this study. The mean age was 31.5
years. A correlation between the infraorbital approach and orbital reconstruction
showed that majority of the patients had transcutaneous approaches to the infraorbital
rim even though orbital reconstruction was not required. This study shows that the
international trends or protocols are not followed when treating ZMC fractures at this
facility.
Description
A research report submitted in partial fulfilment of the requirements for the
degree of Master of Science in Dentistry to the Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg.
June 2019.