Cohn Jason E, Othman Sammy, Bosco Samuel, Shokri Tom, Evarts Marissa, Papajohn Paul, Zwillenberg Seth
Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA.
Drexel University College of Medicine, Philadelphia, PA, USA.
Craniomaxillofac Trauma Reconstr. 2020 Mar;13(1):38-44. doi: 10.1177/1943387520905164. Epub 2020 Mar 17.
Fractures of the zygomatic bone can present with complicated aesthetic and neurological pathology. Specifically, management of isolated zygomatic fracture has been sparsely discussed in the literature, and most studies are based upon older techniques. Here, we compare the results of 2 critical operative techniques as well as review the available literature in the setting of isolated zygomatic fractures.
A retrospective chart review was performed at our institution from 2010 to 2018 examining for patients who had sustained an isolated zygomatic fracture confirmed by computed tomography scan. Patients were excluded if they sustained additional maxillofacial fractures. Demographical information, symptoms on presentation, fracture management modality, and postoperative course were all collected and examined.
A total of 218 patients were identified for inclusion. The average age of this cohort was 45.5 ± 18 years, with 77.5% being male. Assault (55%) was most the frequent cause of injury with accidents being the least common (17.9%). Most patients (78.8%) underwent nonoperative management. Patients who underwent operation more often presented with zygomatic deformity (97.7% vs 18.4%), paresthesia (29.5% vs 2.9%), and trismus (29.5% vs 6.9%) when compared to their nonoperatively managed counterparts. In all, 44 operatively managed patients underwent open reduction with or without eternal fixation (Gillies Approach vs Keen Approach). There were no significant differences in the presence of zygomatic deformity, paresthesia, and trismus between the 2 operative techniques.
Isolated zygomatic arch fractures can present with discerning symptoms. Unfortunately, the literature on appropriate management is not well described. We find external fixation to provide reestablishment of both form and function with minimal required exposure, although the outcomes may be similar without the use of external fixation.
颧骨骨折可伴有复杂的美学和神经病理学问题。具体而言，孤立性颧骨骨折的治疗在文献中鲜有讨论，且大多数研究基于较老的技术。在此，我们比较两种关键手术技术的结果，并回顾孤立性颧骨骨折相关的现有文献。
2010年至2018年在我们机构进行了一项回顾性病历审查，检查经计算机断层扫描确诊为孤立性颧骨骨折的患者。如果患者还伴有其他颌面骨折，则将其排除。收集并检查人口统计学信息、就诊时的症状、骨折治疗方式及术后病程。
共确定218例患者纳入研究。该队列的平均年龄为45.5±18岁，男性占77.5%。袭击（55%）是最常见的受伤原因，事故是最不常见的原因（17.9%）。大多数患者（78.8%）接受了非手术治疗。与非手术治疗的患者相比，接受手术治疗的患者更常出现颧骨畸形（97.7%对18.4%）、感觉异常（29.5%对2.9%）和牙关紧闭（29.5%对6.9%）。共有44例接受手术治疗的患者接受了切开复位内固定或外固定（吉利斯入路与基恩入路）。两种手术技术在颧骨畸形、感觉异常和牙关紧闭的发生率方面无显著差异。
孤立性颧弓骨折可出现明显症状。遗憾的是，关于适当治疗的文献描述并不充分。我们发现外固定能够在所需暴露最小的情况下恢复形态和功能，尽管不使用外固定结果可能相似。
