van Hout Wouter M M T, Van Cann Ellen M, Koole Ronald, Rosenberg Antoine J W P
Department of Oral and Maxillofacial Surgery (Head: Antoine J.W.P. Rosenberg, M.D., D.M.D., Ph.D.), University Medical Centre Utrecht, Heidelberglaan 100 (HP G05.222), PO Box 85500, 3508 GA Utrecht, The Netherlands.
Department of Oral and Maxillofacial Surgery (Head: Antoine J.W.P. Rosenberg, M.D., D.M.D., Ph.D.), University Medical Centre Utrecht, Heidelberglaan 100 (HP G05.222), PO Box 85500, 3508 GA Utrecht, The Netherlands.
J Craniomaxillofac Surg. 2016 Nov;44(11):1859-1865. doi: 10.1016/j.jcms.2016.09.002. Epub 2016 Sep 13.
This study investigates treatment outcome in zygomaticomaxillary complex (ZMC) fracture repair.
The medical records and CT-images of patients that received treatment for a unilateral ZMC fracture in 2005-2011 were studied. ZMC fractures were categorised as incomplete (type A), tetrapod (type B) or comminuted (type C). The incidence of sequelae, wound infection and secondary surgical interventions was analysed per fracture category.
A total of 153 patients were treated in the selected period. Persisting sensory disturbances in the area innervated by the infraorbital nerve were observed in 50 cases (37%), facial asymmetry in 19 cases (14%), enophthalmos in 10 cases (7%) and persisting diplopia in 9 cases (7%). Wound infection occurred in 6 cases (4%). Secondary surgical procedures of the ZMC, orbital floor, and/or extraocular muscles were performed in 14 cases (9%). C-type fractures were associated with more secondary corrections for ZMC malreduction (12%, p = 0.03), more secondary reconstructions of the orbital floor (10%, p < 0.01), and more functional corrections of diplopia by extraocular muscle correction (5%, p = 0.02).
Treatment outcome in C-type ZMC fractures is less favourable than treatment outcome in A-type and B-type fractures. Intraoperative imaging, surgical navigation devices and 3D-planning software may improve treatment outcome in C-type ZMC fractures.
本研究调查颧骨上颌骨复合体（ZMC）骨折修复的治疗结果。
研究2005年至2011年接受单侧ZMC骨折治疗的患者的病历和CT图像。ZMC骨折分为不完全性（A型）、四足型（B型）或粉碎性（C型）。分析每种骨折类型的后遗症、伤口感染和二次手术干预的发生率。
在选定时期共治疗了153例患者。50例（37%）患者眶下神经支配区域存在持续性感觉障碍，19例（14%）患者面部不对称，10例（7%）患者眼球内陷，9例（7%）患者存在持续性复视。6例（4%）发生伤口感染。14例（9%）患者对ZMC、眶底和/或眼外肌进行了二次手术。C型骨折与更多因ZMC复位不良的二次矫正（12%，p = 0.03）、更多眶底二次重建（10%，p < 0.01）以及更多通过眼外肌矫正对复视的功能矫正（5%，p = 0.02）相关。
C型ZMC骨折的治疗结果不如A型和B型骨折。术中成像、手术导航设备和三维规划软件可能改善C型ZMC骨折的治疗结果。
