| The zygomatic complex and its multiple joints comprise the most prominent area of the face.This condition often subjects these bones to traumatic forces from several sources,which can lead to various types of fractures.The zygoma is a robust bone that is seldom fractured, and the most affectted areas are suture,where associated fractures occur more frequently.In general,low-energy injuries result in its separation at the articulating buttresses and in minor displacement.moderate and high-energy injuries lead to increasing displacement and comminuting Fracture sequels parallel trauma severity and include facial asymmetry, dysfunction,limited mouth opening, enophthalmos, diplopia, and ocular globe diplopia.It is enumerated that more than30%of all facial bone fractures involve zygomatic complex.At present, the level of diagnosis and treatment on zygomatic complex fractures has greatly improved since the preoperative diagnosis of digitization that the data obtained from CT, making out and implementation of the surgical planning with personalized, evidence-based medicine methods, but there are still many neglected and difficult problems to be not resolved,which affecting the scientific and reasonable treatment. These questions are as following:1.The shortage of the epidemiological data observed on the disease seriously disturbs a reasonable treatment plan in clinic.2.Surgical methods on zygomatic fracture should be further improved, complications from the common facial coronal incision and small incision Serious shortage of pidemiological and clinical observation data of the disease results in that should not be ignored, such as more bleeding,sensitive disfunction on skin of auriculotemporal area, bold on coronal incision,facial small incision revealed nonvisualized operating field that is easy to damage nerves,to cause ectropion,and obvious surgical scars. These shortcomings need to overcome.3. When many patients refuse to surgical facial skin incision, the traditional surgical procedures are unable to visualize the operating fields.4. Damaged infraorbital nerve problem has been ignored, and the distress on the patient is difficult to solve. clinician need a new way to evaluate and treat the complication from injury and surgical precedure.This systemic study consists of four parts:l.to evaluate the epidemiology treatment,and complications of zygomatic bone fractures or/and zygomatic arch fractures associated with other facial and other parts fractures of body;2.To explore a new approach thatis better than coronal scalp incision and facial percutaneous small incision in operati on of zygomatic bone and zygomatic arch fracture;3.to investigate the surgical method of simple unilateral zygomatic fracture which can keep facial symmetry and excellent stability of reduction and fixation;4. to explore the therapeutic effect of HBO on infraorbital nerve injury induced by trauma or surgery, and also to study the prognosis difference of neural functional recovery between them.In part1, this survey was performed in the first hospital affiliated with yangtze River university,from August2008to August2013. The records of97patients with zygomatic bone fractures were reviewed.Data regarding gender,age,addictions,day of trauma,etiology,sings and symptoms,oral hygiene condition,day of initial evaluation,hospital admission,day of surgery,surgical approach,pattern of fractures treatment performed,post-operative antibiotic,day of hospital discharge,and post-operative complications were collected.The Jackson’s classification proposed a non-displaced or minimally displaced orbito-zygomatic fracture as a type Ⅰ fractures. type Ⅱ is a segmental fracture of the infraorbital rim. When there is a displaced fracture of the zygomatic body,usually with isolated fragment at the anterior orbital rim and/or at the zygomatic maxillary buttress, it is classified as type III fracture. The type IV fractures are classified as a fragmented orbito-zygomatic fracture and are usually associatied with defects of the orbital wall.All surgical procedures were carried out by the same oral and maxillofacial surgeon as professor.The fixation of zygomatic fracture was performed using1.5mm titanium RIF system made by Cibai company. The data were subjected to descriptive statistical analyses.The results showed that the most frequent fractures occurred during the fourth decades of life.The most frequent etiology was traffic accident,and symptoms and signs included pain and edema. Type I fractures were the main injury observed,and the surgical treatment of choice was always rigid internal fixation.Post-operative antibiotic therapy was solely employed when there was an indication.most frequent complications that were observed was the disfunction of orbital nerve.we consider that the treatment protocol yielded desired post-operative results and also success rates comparable to published data around world.In part2, the authors applied the modified auriculotemporal Incision in43patients with zygomatic bone and zygomatic arch fracture that need open reposition,and evaluate the exposure degree, bleeding, post operative elasticity and texture of skin, facial nerve function,and satisfactory degree. In present study,it was foundthat the upper part of Zygomaticarch and lateral orbital margin could be greatly explored for operation of zygomatic bone and zygomatic arch fracture in all43patiens by application of this approach. Less bleeding wasobserved in operation.All patients had primary healing and none ofthem with temporal numbness and facial palsy. After6monthsfollow-up,41cases (95.35%) and43cases (100%) showed fine elasticity ofoperative skin and atisfactory degree,respectively. It was concluded that the modified auriculotemporal incision showed better than conventional approach in operation of zygomatic bone and zygomatic arch fracture,and it is a worthy approach for generalization.In part3,17cases with zygomatic fracture were entered into the study.The patients were given maxillary vestibular sulcus incision and zygomatic temporal bone head traction fixation. Clinical examinations were followed up at1month,3months,6months and1year. CT scan test and cephametric analysis with X-ray measurement were taken at3months after surgery to achieve the height of the bilateral external orbital rim, the width of the bilateral Inferior orbital rim and the length of the bilateral zygomatic arch.Then a comparison of the survey datas was taken with test. It is found that the soft tissue of all17cases healed primarily. No obvious recurrence like displacement or deformation of the zygoma could be seen a year after the surgery. CT and head shadow analysis X-ray taken at3months showed that the zygoma healed well on fracture line and the comparison of the datas revealed no obvious difference (P>0.05). It can be expected that the surgical approach and fixation improvement method proposed for simple unilateral zygomatic fracture is a satisfied surgical method with no facial scars, excellent stability of reduction and fixation, and good function, which is worthy for wider applicationIn part4,a total of57patients with infraorbital nerve injury have been chosen from the outpatient of the stomatology department affiliated to the NO.1People’s Hospital of Jingzhou since March,2008.38patients were found nerve injury because of the zygomatic orbital floor fractures caused by trauma impaction.18of the38patients were just given routine medicine treatment, while20received HBO treatment in addition to routine medicine Treatment.Other19patients had nerve injury induced by the reset operation of zygomatic orbital floor fractures.8of these19patients were in the routine medicine treatment group, while11were given HBO treatment in addition. Follow-up visits have been taken at one week, one month, three months, six months, one year and2years to investigate the therapeutic effect on neural functional recovery. Based on the2year’s follow-up visit, the functional recovery of infraorbital nerve could be described as fully recovery, partial recovery or invalid. A comparison of the two groups was taken with X2test to assess the therapeutic effect of HBO. While another comparison of the two groups all are given HBO treatment was taken to study the prognosis difference between them. Results showed that the therapeutic effect for the HBO group was better than that for the routine medicine treatment(X2=20.8367, P<0.005) in the38patients caused by trauma impaction. In the19patients whose nerve injury was caused by reset operation, the effect for HBO group was also better than whom didn’t received HBO treatment(X2=40.6526, P<0.005). Moreover,between the two groups given HBO therapy, better effect could be found in patients caused by operation(X2=52.5148, P<0.005). There seems apparent that HBO therapy could produce better therapeutic effect in patients with Infraorbital nerve injury caused by trauma or surgery.And better effect could be received especially in the patients whose nerve injury were found after operation. It remains to be Further investigated that how to choose the treatment timepoint, dose and other relevant parameters. |
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