Westermark A, Jensen J, Sindet-Pedersen S
Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark.
Oral Surg Oral Diagn. 1992;3:27-30.
The present paper reviews the results obtained with different modalities of treatment employed in isolated fractures of the zygomatic complex. Seventy-three patients were re-examined with respect to infraorbital nerve function. The results obtained suggest that the incidence of hypoaesthesia of the infraorbital nerve following fracture of the zygomatic complex can be reduced if rigid fixation is applied on the infraorbital rim. The zygomatic bone is a protruding part of the human skeleton and is therefore easily affected by trauma to the facial region. The etiology and clinical appearance of fractures of the zygomatic complex are well known and previously described in detail (Afzelius and Rosen 1980, Ellis et al. 1985, Jungell and Lindqvist 1987). Fractures of the zygomatic complex are rarely fractures of the zygoma itself but of its connection to the skull and facial skeleton, e.g. the frontozygomatic suture, the zygomatico-maxillary suture, the zygomatic arch and the infraorbital rim. A fracture of the infraorbital rim usually involves the infraorbital foramen or bone close to it. Such a fracture also extends into the orbital floor through or adjacent to the infraorbital canal. Dislocation of the fractured zygomatic complex may thus result in injury to or compression of the infraorbital nerve. Such an injury may cause numbness/hypoaesthesia/dysaesthesia in the distribution of the nerve. Accordingly, reduced infraorbital nerve function is a frequently reported sequela of fractures of the zygomatic complex. Thus impaired infraorbital nerve function prior to treatment has been reported to occur in approximately 80% of such cases (Table 1). With respect to persistent impaired function of the infraorbital nerve, the literature demonstrates varying results following different types of treatment, ranging from 22% to 50% persistent hypoaesthesia (Table 1). Interestingly, the return of infraorbital nerve function continues with an extended observation period between treatment and follow-up and it has been claimed that infraorbital nerve function may continue to improve even after one year following injury/surgery (Afzelius and Rosen 1980). Cases with persistent and disturbing impaired function of the infraorbital nerve may be considered for decompressive nerve surgery or microsurgical reconstruction of the infraorbital nerve (Mozsary and Middleton 1983). The present report is a retrospective study and aimed to evaluate the recovery of infraorbital nerve function obtained with different modalities of treatment of isolated fractures of the zygomatic complex.
本文综述了在颧复合体孤立性骨折中采用不同治疗方式所取得的结果。对73例患者进行了眶下神经功能的复查。所取得的结果表明，如果在眶下缘进行坚固固定，颧复合体骨折后眶下神经感觉减退的发生率可以降低。颧骨是人体骨骼的突出部分，因此很容易受到面部区域创伤的影响。颧复合体骨折的病因和临床表现是众所周知的，并且此前已有详细描述（阿夫泽利乌斯和罗森，1980年；埃利斯等人，1985年；容格尔和林德奎斯特，1987年）。颧复合体骨折很少是颧骨本身的骨折，而是其与颅骨和面部骨骼的连接处骨折，例如额颧缝、颧上颌缝、颧弓和眶下缘。眶下缘骨折通常累及眶下孔或其附近的骨头。这样的骨折还会通过眶下管或其附近延伸至眶底。骨折的颧复合体脱位可能会导致眶下神经损伤或受压。这种损伤可能会在神经分布区域引起麻木/感觉减退/感觉异常。因此，眶下神经功能减退是颧复合体骨折常见的后遗症。据报道，在这类病例中，约80%在治疗前存在眶下神经功能受损（表1）。关于眶下神经功能持续受损的情况，文献表明不同类型治疗后的结果各异，持续性感觉减退的发生率在22%至50%之间（表1）。有趣的是，眶下神经功能在治疗与随访之间的观察期延长后仍会持续恢复，并且有人声称即使在受伤/手术后一年，眶下神经功能仍可能继续改善（阿夫泽利乌斯和罗森，1980年）。对于眶下神经功能持续且令人困扰地受损的病例，可以考虑进行减压性神经手术或眶下神经显微外科重建（莫扎里和米德尔顿，1983年）。本报告是一项回顾性研究，旨在评估在颧复合体孤立性骨折的不同治疗方式下眶下神经功能的恢复情况。
