Success of day-case treatment of zygomatic and orbital fractures

Traditionally, surgical management of zygomaticomaxillary complex (ZMC) and orbital fractures occurs within two to three weeks of the injury, followed by an overnight admission to allow for extended eye observations. This is due to the risk of postoperative retrobulbar haemorrhage (RBH) or orbital compartment syndrome (OCS), a rapidly progressive and sight threatening emergency that requires immediate intervention. In September 2016 the oral and maxillofacial surgery (OMFS) department at Leeds Teaching Hospitals redesigned their trauma service with a full-time trauma consultant, a dedicated clinic, and a weekly morning elective trauma theatre list. This allowed for standardisation of the management of patients with OMFS injuries. Furthermore, a formal day-case ZMC and orbital fracture pathway was developed to allow patients to undergo surgical management of such fractures with a same-day discharge. This has since been identified as an area of excellence by the Getting It Right First Time (GIRFT) programme, and is in line with the addition of ZMC and orbital fractures to the procedural list written by the British Association of Day Case Surgery (BADS). Unbeknown to the unit, the volume of day-case procedures was the highest within the UK, demonstrating the importance of GIRFT in highlighting areas of good or unique practice. The aim of this study was to determine the impact of our day-case pathway and designated OMFS trauma service on compliance with recent recommendations by GIRFT and BADS. Secondly, it was to determine the safety of same-day discharge with regards to postoperative complications.     

Quantitative assessment of symmetry recovery in navigation-assisted surgical reduction of zygomaticomaxillary complex fractures

Purpose

To evaluate the effects of surgical navigation in zygomaticomaxillary complex (ZMC) fracture reduction. ZMC symmetry was assessed quantitatively.

Emerging Trends of Zygomaticomaxillary Complex Fractures and Their Etiological Analysis in a Tertiary Health Centre from Eastern India: A Retrospective Study

IntroductionMaxillofacial region is one of the most complicated arrangements of bony and soft tissues in human body, superiorly bounded by cranial bones and inferiorly by the mandible with interposed dentition. This is one of the reasons which make injuries to this region difficult to manage and often controversial. The severity and patterns of these injuries have changed considerably due to the increasing reliance on fast road transportation facilities and interpersonal violence.Materials and methodsThe aim of the present study is to analyze retrospectively the changing patterns of mid-face fractures in a sample of patients reporting to Department of Oral and Maxillofacial Surgery in AIIMS Bhubaneswar, India, from April 2017 to April 2018. A performa was prepared which included age, sex, etiology of injury, alcohol influence, and treatment given during hospital stay.ResultsRoad traffic accidents contributed 68.11% of zygomaticomaxillary complex (ZMC) fractures, followed by assault (18.11%) and fall from height (13.76%). RTA was the major cause of atypical ZMC fractures as compared to conventional ZMC fractures (P < 0.001).DiscussionDue to modern lifestyle and changes in fast transportation, recent fracture patterns do not follow the tell-tale signs or patterns and often need unique and patient-specific treatment plan, making the skills of maxillofacial surgeons the pivotal factor in better prognosis.     

颧骨复合体骨折手术前后咬合力的对比研究

目的:应用计算机咬合分析系统,评价颧骨复合体骨折手术前后的咬合力变化情况。方法:临床收集15例颧骨复合体骨折病例。所有患者在全麻下行切开复位坚固内固定治疗。利用T-ScanⅡ(牙合)力测量系统在术前一周内、术后3月和术后6月(牙合)力测定。分析患者的总(牙合)力(TOF)、MIP/MAX指数、(牙合)力不对称指数(AOF)、(牙合)力中心点的位置(COF)及其咀嚼时的最大位移距离(MCOF)进行比较研究。结果:颧骨复合体骨折术后3个月时总(牙合)力有所上升,6个月时与术前相比已有显著差异(P<0.05),此时咀嚼功能已有提高。MIP/MAX指数略有下降。不对称指数术后呈下降趋势,在术后3个月和6个月时均比术前明显减小。(P<0.05,P<0.01)。术后(牙合)力中心点位置逐渐趋向正常,咀嚼时(牙合)力中心点最大位移距离有下降趋势,在术后6个月时较术前有明显改善,表明患者的咀嚼功能有所提高.结论:T-scan-Ⅱ能定量评价切开复位坚固内固定治疗,对颧骨复合体患者的咀嚼功能的变化,术后患者的总(牙合)力及平衡性明显提高。     

Application of optimized three-dimensional digital surgical guide plates for complex midfacial fractures

IntroductionThe treatment of midfacial fractures is always difficult. The purpose of this study was to verify whether optimized three-dimensional (3D) digital surgical guide plates combined with preformed titanium plates improved the treatment effect in complex midfacial fractures.Patients and methodsTwenty-six patients with complex midfacial fractures were recruited and randomized into three groups: ten for Group A, eight for Group B, and eight for Group C. Group A was treated with a combination of preformed titanium plates and optimized 3D digital surgical guide plates. Group B was treated with preformed titanium plates only. Group C was treated conventionally. Clinical effects, patient-reported outcome measures (PROMs), midfacial contour, facial symmetry, surgical accuracy, △orbital volume (the absolute value of the bilateral orbital volume difference), and maximum deviation were evaluated in each of the three groups.ResultsGroup A had the best postoperative clinical effects and patient-reported outcomes. Significant improvements in midfacial contour (L1[0.72±0.29 mm, P = 0.001], L2[1.04±0.46 mm, P < 0.001]), facial symmetry (S1[0.71±0.30 mm, P < 0.001], S2[0.96±0.58 mm, P < 0.001], S3[0.86±0.40 mm, P < 0.001], S5[0.81±0.16 mm, P = 0.003], S8[0.95±0.30 mm, P < 0.001], S9[1.03±0.38 mm, P < 0.001], S11[0.64±0.46 mm, P < 0.001]) and surgical accuracy (M1[R, 0.82±0.31 mm, P < 0.001], M2[R, 0.87±0.44 mm, P < 0.001], M3[L, 0.88±0.22 mm, P = 0.004], M3[R, 1.06±0.31 mm, P = 0.003], M4[L, 0.96±0.45 mm, P = 0.008], M4[R, 1.11±0.57 mm, P = 0.003], M5[R, 0.76±0.26 mm, P < 0.001], M6[L, 1.00±0.46 mm, P = 0.003], M6[R, 1.00±0.58 mm, P = 0.001], M7[0.87±0.53 mm, P = 0.001], M8[R, 0.91±0.53 mm, P < 0.001], M9[R, 0.81±0.32 mm, P = 0.010], M10[R, 1.19±0.42 mm, P = 0.009], M11[L, 0.85±0.51 mm, P = 0.021], M11[R, 0.96±0.49 mm, P = 0.003]) were found in Group A compared with the other two groups. The results of △orbital volume and maximum deviation analysis showed an ideal surgical treatment effect in Group A.ConclusionOptimized 3D digital guide plates can accurately locate preformed titanium plates and effectively improve the treatment effect in complex midfacial fractures.