Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria.
Dent Traumatol. 2024 Dec;40(6):680-687. doi: 10.1111/edt.12976. Epub 2024 Jun 20.
BACKGROUND/AIM: Paediatric maxillozygomatic complex (MZC) fractures are uncommon, and there is a scarcity of data regarding their surgical treatment. The aim of this study was to analyse choices and outcomes of open reduction and internal fixation (ORIF) for MZC fractures among 14 maxillofacial centers around the world.
This multicentric retrospective observational study included patients ≤16 years of age with quadripod MZC fractures treated with ORIF from January 2011 and December 2022. The following data were collected: age, gender, dentition stage (deciduous, mixed, and permanent), cause of injury, type of fracture, surgical approach, site of osteosynthesis (infraorbital rim, zygomaticomaxillary buttress, frontozygomatic, and zygomaticotemporal sutures), material (titanium or resorbable) and number of plates used, and outcome. The minimum follow-up was 6 months. Statistical analyses were performed with Fisher's exact test or chi-squared test, as appropriate.
Sixty-four patients (mean age, 12.3 years) with quadripod MZC fractures were included. Seventy-two percent of patients received a single-point fixation. The zygomaticomaxillary buttress was the most common site for fixation, both in single-point and two-point fixation schemes, especially in combination with the frontozygomatic suture. Increasing age was associated with a higher rate of plate removal (p < .001). Postoperative complications included 5 (7.8%) cases of wound infections, 2 (3.1%) infraorbital paraesthesia, 1 (1.6%) ectropion. Residual facial asymmetry was found in 5 (7.8%) patients and was not associated with the type of fixation (p > .05).
This study highlights the possibility of using ORIF, even with a single point of fixation, for the treatment of displaced quadripod MZC fractures in the paediatric population. The zygomaticomaxillary buttress was the preferred site of fixation and allowed for adequate stabilization with no external scars and a low risk of tooth damage. Future prospective studies with long-term follow-up are needed to establish definitive surgical protocols and clarify the surgical decision-making.
背景/目的：儿童上颌颧骨复合体（MZC）骨折并不常见，关于其手术治疗的数据也很少。本研究的目的是分析全球 14 个颌面中心对 MZC 骨折行切开复位内固定（ORIF）的选择和结果。
这是一项多中心回顾性观察研究，纳入了 2011 年 1 月至 2022 年 12 月期间接受 ORIF 治疗的≤16 岁四足 MZC 骨折患者。收集的资料包括：年龄、性别、牙列阶段（乳牙、混合牙列和恒牙）、损伤原因、骨折类型、手术入路、骨固定部位（眶下缘、颧骨上颌骨支柱、额颧缝和颧骨颞缝）、材料（钛或可吸收）和使用的接骨板数量以及结果。最低随访时间为 6 个月。Fisher 确切检验或卡方检验用于适当的统计分析。
共纳入 64 例四足 MZC 骨折患者（平均年龄 12.3 岁）。72%的患者接受单点固定。单点和两点固定方案中最常见的固定部位均为颧骨上颌骨支柱，尤其是与额颧缝结合时。年龄增加与更高的钢板取出率相关（p<.001）。术后并发症包括 5 例（7.8%）伤口感染、2 例（3.1%）眶下感觉异常、1 例（1.6%）外翻。5 例（7.8%）患者存在残留面部不对称，但与固定类型无关（p>.05）。
本研究强调了即使采用单点固定，也可以对儿童移位性四足 MZC 骨折进行 ORIF 治疗。颧骨上颌骨支柱是首选的固定部位，可提供充分的稳定性，无外部瘢痕，牙齿损伤风险低。需要进行未来的前瞻性研究，进行长期随访，以建立明确的手术方案，并阐明手术决策。
