Primary Clinical Research of a Patient Specific Implant System for an Old Zygomaticomaxillary Complex Comminuted Fracture

The objective of this study was to expound a novel surgical management technique assisted by patient-specific implants(PSIs)for comminuted fractures of the zygomaticomaxillary complex(ZMC).The aim of this study was to explore the feasibility of using PSIs to accurately restore and fix comminuted fractures.A male patient with an old ZMC comminuted fracture was used to describe the workflow,technique,and method.Computerassisted surgical simulation was used to determine the optimal plan for the reduction of bone segments prior to surgery.The PSIs were used to accurately guide the surgeon’s position of the bone segments,as planned,during the operation.Oral panoramic films and cephalometric films were taken immediately at 1,3,6,and 12 months after the operation,while computed tomography images of the whole skull were taken immediately,half a year,and one year after the operation.The patient’s follow-up showed that the zygomatic symmetry recovered well post-surgery and the patient was satisfied with the outcome.This new surgical method greatly improved the facial symmetry of this patient.

Steimann Pin Repair of Zygomatic Complex Fractures

Purpose: To present the treatment of zygomaticomaxillary complex (ZMC) fractures with closed-reduction Steinmann-pin fixation and to compare it to the reduction and aesthetic outcomes of open-reduction techniques (ORIF). Materials and Methods: Case series. Charts for 23 patients with ZMC fractures presenting to the Head and Neck Surgery Department at Harbor-UCLA Medical Center from 2005 to 2009 were reviewed. Pre- and post-operative computed tomography (CT) scans were analyzed. Follow up ranged from 3 to 55 months. Interviews were conducted to evaluate the patient’s satisfaction. Patients were placed in two groups: those treated with ORIF and those treated with closed-reduction Steinmann-pin fixation. Results: Twelve patients had complete data for analysis. Average operative time was significantly lower for patients treated with closed-reduction as compared to open-reduction: 65.3 minutes vs. 162.5 minutes (p = 0.02). Bony realignment and aesthetic results were comparable in both groups. Additionally, only one 1cm facial incision was required with this repair system versus several incisions using traditional methods. Conclusions: Closed-reduction Steinmann-pin fixation of ZMC fractures provides adequate bony alignment and aesthetics. Our study supports this system in the repair of ZMC fractures as it requires significantly less operating time, one small incision, and excellent patient outcomes.

Surgical management of zygomatic complex fractures in a major trauma centre

Aim: To analyse the epidemiology, aetiology, and surgical management of zygomatic complex (ZMC) fractures in our major trauma centre, and to compare the number and location of fixation points and surgical access in our patient cohort with the literature. Methods: Retrospective analysis of all operative cases (Open Reduction and Internal Fixation) of zygomatic complex fractures over a one year period (2016). Results: A greater proportion of patients in our cohort (54%) were treated with one-point fixation compared to the literature, with the zygomaticomaxillary (ZM) buttress being the most popular fixation point (90%). ZM buttress and frontozygomatic (FZ) suture were the commonest choices for two-point fixations (70%). Buccal sulcus incision was used for ZM access in all cases. For FZ access, upper blepharoplasty incision was the most common (56%). For infra-orbital margin access, transconjunctival incision was the most common (75%). There was no significant association between number of fixation points and presence of associated injuries, impact of injury, or time to operation. There were no post-operative complications. Conclusion: A greater proportion of patients in our cohort were successfully treated with one point fixation compared to the literature, and fewer patients underwent orbital floor exploration and repair in our cohort compared to the literature. This study highlights the ongoing variation in the surgical management of ZMC fractures.