• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.12 no.1
• /
• pp.103-113
• /
• 1990

The study was based on a series of 252 patient with facial bone fractures who visited to Chun Cheon Sacred Heart Hospital, College of Medicine, Hallym University during the period of Dec., 1984 trough Nov., 1989. The results obtained are as follows; 1. The most frequent etiologic factor was traffic accident(45.2%). 2. The ratio of male to female was 5.5 : 1 and 2nd decade(44%) was the highest age group in incidence. 3. Monthly incidence was the highest in Aug(14.3%). 4. The most common site of fracture was mandible(55.3%) and zygoma complex(24.2%), nasal bone(11.6%), maxilla(8.9%) were next in order of frequeny. 5. In mandible fractures, the most frequent site was symphyseal area(36.9%) and 142 cases(85%) had fractures only in mandible. 6. In maxillary fractures, fracture with other facial bones(85.2%) was more frequent than fracture on maxilla only. The major fracture type on maxilla was Le Fort II type. 7. In fracture of zygoma complex, zygoma & zygomatic arch was the most frequent site(52.0%) and zygomatic arch(24.7%), zygoma(23.3%) were next in order. 8. Open reduction was major method of treatment in facial bone fractures except nasal bone ; mandible(62.9%), maxilla(77.8%), zygoma complex(65.8%). 9. Maxillofacial fractures were most frequently combined with head & neck injury(43.1%), and upp. & low. extremities(29.4%), chest and abdomen(11.9%) were in order of frequency.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.11 no.1
• /
• pp.1-11
• /
• 1989

This is a retrospective study on maxillofacial fractures. This study was based on a series of 442 patients with maxillofacial fractures treated at Dept, of oral and Maxillofacial Surgery, College of Dentistry, Chon Buk National University from Jan, 1984 to Sep. 1988. The results obtained were as follows: 1. The ratio of Male/Female was 4.8 : 1, and 3rd decade (43.9%) was the highest age group in incidence. 2. Monthly incidence was the highest in Oct,(10.6%). 3. The most frequent maxillofacial fracture site was mandible (70.0%), and zygoma & zygomatic arch (13.6%), maxilla(11.7%) and nasal bone (4.7%) were next in order of frequency. 4. Traffic accidents (47.5%), fight(24.8%) were the most common causes of maxillofacial fractures. 5. The most frequent chief complaint was painful swelling(40.7%). 6. In mandibular fractures, the most frequent fracture site was symphyseal area(28.9%) and simple fracture was the most frequent in type of fracture (71.2%). 7. In maxillary fractures, fracture with other facial bones (64.5%) was more frequent than fracture of maxilla only. The most common type of fracture was unilateral fractures(37.1%). 8. In fracture of zygoma complex, zygoma fracture was the most frequent fracture type(40.3%), zygoma and zygomatic arch fx, (30.6%), zygomatic arch fx, (29.1%) were next in order 9. Open reduction was major method of treatment in maxillofacial fractures : Mandible (77.5%), Maxilla (61.3%), Zygoma complex(43.1%). 10. Maxillofacial fractures were most frequently combined with head injury(39.3%), and lower extremities(17.0%), upper extremities(13.6%) were next in order.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.16 no.1
• /
• pp.89-98
• /
• 1994

This study was based on a series of 213 patients with facial bone fractures treated at college of Medicine, Dong-A university from Mar. 1990 to Jun. 1993. The results obtained were as follows : 1. The ratio of male to female was 8.3 : 1 and 3rd decade(34.3%) was the highest age group in incidence. 2. Monthly incidence was the highest in Jan. & Jun.(10.3%) 3. Onset time and daily incidence was the highest in pm. 9:00-12:00(21.4%), Sunday(18.8%). 4. Traffic acidents(38.5%) were the most frequent etiologic factor. 5. The most common site of fracture was zygoma & zygomatic arch(42.3%) and mandible (37.8%), maxilla (10.9%) and nasal bone(9.0%) were next in order of frequency. 6. In mandible fractures, the most frequent site was symphyseal area(43.0%) and IMF & open reduction was major method of treatment. 7. In zygoma & zygomatic arch fractures, zygoma(62.0%) was the most common fracture site and open reduction was the most frequent treatment method. 8. In maxilla fractures, the major fracture type was Le Fort I type (72.4%) and treatment was done by IMF & open reduction primarily. 9. postoperative complications were mal-union, fibrous-union, infection, osteomyelitis etc.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.11 no.1
• /
• pp.21-31
• /
• 1989

This is a series of continuing research on facial bone fractures of Koreans worked by Dept. of Oral and Maxillofacial surgery, Dental College of Yonsei University, Seoul, Korea, since 1972. The study was based on a series of 630 patients with facial bone fractures treated as in-patient at Yonsei Medical Center, Yonsei University, during the period of Jan., 1982 through Dec., 1987. The results obtained are as follows: 1. The ratio of Men to Women was 4.3 : 1, and admissions for facial bone fractures have been increased year after 1984. 2. The age frequency was highest in the third decade(38.3%), and fourth, second, fifth decade in orders. 3. The traffic accident was the most frequent cause of facial bone fractures (51.3%). 4. The most common location of facial bone fractures was the Mandible(35.3%), and Zygoma complex(29.8%), Nasal bone(15.0%), Maxilla(11.0%) were next in order of frequency. 5. In 291 patients of Mandible fractures, 226(77.7%) had fractures only in Mandible and 65(22.3%) had another facial bone fractures. The most frequent fracture site of Mandible was the Symphysis(43.0%) and Angle(22.4%), and Simple fracture was the most frequent in type of fracture(66.9%). Intermaxillary fixatin & Open reduction was major method of treatment(36.9%). 6. In 394 patients of Midface fractures 323)82.0%) had fractures only in Midface and 71(18.0%) had another facial bone fractures. The most frequent site of Midface fractures was zygoma complex & zygomatic arch(42.7%), and Simple fracture was the most common type of fractures. Observation(Maxilla :44.2%, Zygoma :51.0%) and Open Reduction(Maxilla :20.0%. Zygoma :23.5%) were the major method of treatment. 7. The frequency of Nasal bone fracture was about 1/5 of Midface fractures, and Closed Reduction(45.2%) was the major method of treatment. 8. The complication was reported in only 16 patients, and Malunion was the major complication. 9. Head(44.4%), Lower extrimities(14.5%) and Eye(12.3%) were injured commonly with facial bone fractures. 10. The elapsed time from injury to hospital was within 24 hours in 73.8% of patients, however 15.5% of patients arrived the hospital 72 hours after injury.

• Archives of Plastic Surgery
• /
• v.45 no.4
• /
• pp.325-332
• /
• 2018

Background Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of the extended transconjunctival approach (ETA) combined with T-bar screw reduction in minimizing scarring and complications for the treatment of ZMC fractures. Methods A total of 26 patients underwent ZMC reduction through the ETA and intraoral approach. A skin incision measuring roughly 5 to 8 mm in length was placed following the lateral canthal skin crease. After releasing the inferior crus of the lateral canthal tendon for canthotomy, the medial periosteum of the lateral orbital rim was preserved for canthal reattachment. A limited subperiosteal dissection and partial relaxing incision of the orbicularis oculi were performed to expose the fracture line of the inferior orbital rim and zygomaticofrontal suture. Reduction was performed using a T-bar screw through the transconjunctival incision and an elevator through the intraoral incision. Results The aesthetic and functional results were excellent. Successful reduction was achieved and the skin incision was less than 8 mm in 20 cases (76.9%). Only six patients had an additional skin incision (less than 5 mm) to achieve reduction. No cases of ectropion, entropion, or excessive scarring were noted. Conclusions The ETA using a T-bar screw is a useful method for maximizing aesthetic results in ZMC fractures, with the advantages of minimal scarring, faster recovery, and maintenance of pretarsal fullness.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.32 no.4
• /
• pp.359-362
• /
• 2010

The zygoma is second most commonly vulnerable facial bone in fracture, in number only by nasal fractures. It is difficult to evaluate reduction state intraoperatively, because almost surgeons reduce the fractured zygoma by blind method. We suggest the use of orthopedic C-arm intraoperatively. We use plain radiography, CT to evaluate preoperative state. Gilles approach or intraoral approach were used to reduce the fractured zygomatic arch. The C-arm was positioned at chin area, used to evaluate reduction intraoperatively. We got postoperative image by CT or submento-vertex view. There are variable methods to evaluate reduction intraoperatively: palpation, ultrasonography, CT, plain films. C-arm is considered superior diagnostic tool to other methods. The use of intraoperative C-arm was very efficient, it could bring better results.

• Archives of Plastic Surgery
• /
• v.38 no.3
• /
• pp.287-294
• /
• 2011

Purpose: Reduction malarplasty is one of the common aesthetic procedures performed in the Orient. We have analyzed effective operative methods according to the pivot point for the osteotomy and reposition of the zygoma for reduction malarplasty after confirming the shapes of the individual zygomas. Methods: Thirty-six patients had been received malarplasty over the last 10 years. The average follow-up period was 16 months. We categorized the patients into three groups according to their prominent appearance features. Group I had a prominently protruded zygomatic body, group II had a prominently protruded zygomatic arch, and group III had a prominently protruded body and zygomatic arch. In the group I, two parallel oblique osteotomies on the body, the middle portion was removed, and with the zygomatic arch as the pivot point, the body was repositioned inwards. In the group II, the zygomatic body and arch osteotomy is performed, with the body as the pivot point, and the arch is depressed medially. In the group III, using the two aforementioned methods, the zygoma was repositioned medially. In each case, postoperative complications and patients satisfaction over the surgery were surveyed. Results: Each group had 25, 5 and 12 patients respectively. No significant complications were found except for one patient who experienced a non-union of zygomatic bone. In the case of group I, four patients underwent a secondary operation. Conclusion: Reduction malarplasty is popular as an effective facial contouring surgery. In order to obtain more effective results,however, the zygomatic shape should be identified, and appropriately repositioned by different operative technique according to pivot points.

• Archives of Plastic Surgery
• /
• v.34 no.6
• /
• pp.813-817
• /
• 2007

Purpose: The zygomatic arch is a key element which composes the facial contour. In many cases of zygomatic arch fracture, it is difficult to fix rigidly the fractured segments. If reduced bone segments were not fixed rigidly, they are proven to be displaced by mastication or unintentional external forces. So, unfixed zygomatic arch fracture after reduction may require a external device of prevention of collapse. We introduce a new protector which stabilizing the fractured segments to prevent for collapse of the reduced zygomatic arch fracture. Methods: After reduction of zygomatic arch with blind approach(Gillies', Dingman or Keen's approach), bone segments was pulled with percutaneous traction suture in medial aspect of zygomatic arch. Then, the suture was fixed with Aqua $splint^{(R)}$, externally. And intraoperative and postoperative X-ray was done. The splint was removed on 14 days after the operation. Results: 5 patients were treated with this method. 4 patients of total patients had no collapse in zygomatic arch. There was minimal collapse in one patient. Postoperative complications such as facial nerve injury, mouth opening difficulty, contour deformity, infection, scar were not observed. Conclusion: In comparison with other techniques, this technique has several advantages which are simple and easy method, short operation time, no scar, less soft tissue injury, and facilitated removal of splint. Therefore, Aqua $splint^{(R)}$ would be a good alternative to prevent for collapse in unstable zygomatic arch fractures

• Archives of Plastic Surgery
• /
• v.48 no.1
• /
• pp.69-74
• /
• 2021

Background In inferomedially rotated zygomatic fractures sticking in the maxillary sinus, it is often difficult to achieve complete reduction only by conventional intraoral reduction. We present a new intraoral reduction technique using a Kirschner wire and its clinical outcome. Methods Among 39 inferomedially impacted zygomatic fractures incompletely reduced by a simple intraoral reduction trial with a bone elevator, a Kirschner wire (1.5 mm) was vertically inserted from the zygomatic body to the lateral orbital rim in 17 inferior-dominant rotation fractures and horizontally inserted to the zygomatic arch in nine medial-dominant and 13 bidirectional rotation fractures. A Kirschner wire was held with a wire holder and lifted in the superolateral or anterolateral direction for reduction. Following reduction of the zygomaticomaxillary fracture, internal fixation was performed. Results Fractures were completely reduced using only an intraoral approach with Kirschner wire reduction in 33 cases and through an additional lower lid or transconjunctival incision in six cases. There were no surgical complications except in one patient with undercorrection. Postoperative 6-month computed tomography scans showed complete bone union and excellent bone alignment. Four patients experienced difficulty with upper lip elevation; however, these problems spontaneously resolved after manual tissue lump massage and intralesional steroid (Triamcinolone) injection. Conclusions We completely reduced infraorbital rim fractures, zygomaticomaxillary buttresses, and zygomaticofrontal suture fractures in 84% of patients through an intraoral approach alone. Intraoral Kirschner wire reduction may be a useful option by which to obtain effective and powerful reduction motion of an inferomedially rotated zygomatic body.

• Archives of Craniofacial Surgery
• /
• v.14 no.2
• /
• pp.96-101
• /
• 2013

Background: Among facial fractures, nasal bone fracture, zygomatic arch fracture and mandibular subcondyle fracture take a large portion. Among surgical operations for nasal bone fracture, zygomatic arch fracture and mandibular subcondyle fracture, closed reduction has been generally used but, unlike open reduction, there is a problem in evaluating its accuracy of reduction. Methods: An assessment was made from October 2011 until April 2013 prospectively on 37 patients. For all the operations, closed reductions were executed in a conventional way and simultaneously using C-Arm to verify the reduction of fractures. Two images of plain radiography, one taken before operation and another one taken one day after the operation, were compared. After obtaining images of plain radiography using C-Arm immediately after the correction upon operation, they were compared with the images of plain radiography taken one day after the operation. Results: The fracture reductions of 26 patients among 27 nasal fracture patients were satisfactory but one patient showed a marginal overcorrection of less than 1 mm. The fracture reductions of 7 patients among 8 zygomatic arch fracture patients were satisfactory but one patient showed a marginal undercorrection of less than 2 mm. All of two mandibular subcondyle fracture patients showed less than 2 mm undercorrection. Conclusion: Closed reduction guided by C-Arm for nasal bone fracture, zygomatic arch fracture and mandibular subcondyle fracture was clinically useful because it could make a real-time assessment on fractured areas and add immediate corrections during the operation.