Zygomatic bone fractures do not need special procedures to clarify the diagnosis. For specialists, stating such damage is not difficult, since it is very easy to recognize.
What characterizes the damage?
Damage is characterized by the lowering of the bones of the cheekbones, which forms the so-called "step" on the face of the victim. This type of deformation, as a rule, is localized in the infraorbital part.
Fractures of the zygomatic bone also make it impossible to open the mouth completely, which is a clear indication of the existing trauma. The patient cannot move his lower jaw. In this case, the fiber of the eye is covered with hemorrhages.
If severe fractures of the zygomatic bone are obtained, then nose bleeding from the nostril located on the affected side is possible.
Usually, for greater certainty, when making a diagnosis, they resort to the use of X-ray equipment, which makes it possible to take a picture showing damage. Many traumatologists claim that it is extremely difficult to diagnose a cheekbone fracture from an image. But undetected fractures can provoke negative consequences, leading to pathological changes in the skull.
What types of zygomatic bone fracture exist?
As a rule, two types of injury are distinguished : a fracture of the zygomatic bone with an offset and a fracture of the zygomatic bone without an offset.
Injury accompanied by displacement is characterized by damage to the upper jaw sinuses. It can be closed, open, linear or fragmented.
If up to 10 days have passed from the date of the injury, then it is considered fresh, but if more than 10 days or more, then this is an outdated fracture. If a month has passed from the moment of damage, then the bone is considered to be incorrectly fused or not fused.
Symptoms of a fracture injury with displacement
Following a fracture of the zygomatic bone, the following symptoms are observed:
- Bleeding, swelling, and a wound masking retraction into the cheekbones.
- Swelling of the eyelids, which prevents the closure of the eyes.
- Frequent bleeding from the nostril located on the side of the damaged cheekbone.
- It is difficult for the patient to open his mouth. Also, he cannot move the lower jaw in different directions.
- Often there is a visual impairment, diplopia associated with the displacement of the eyeball.
- When the zygomatic bone is sinking, the patient has a sharp pain on palpation.
- Zygomatic arch fractures can be combined with cheek bone fractures. In this case, the resulting angle of displacement of bone fragments, as a rule, is directed into the temporal fossa.
What is the main task of specialists?
The main task of medical workers during the treatment of injury is to restore bone integrity. Fractures with displacement are eliminated by surgical intervention, since in this case the reduction of bone fragments and their fixation is required. Surgical intervention can occur in the patient’s mouth and outside.
Fractures without displacement are treated conservatively with the help of drugs, as well as the impact of physiotherapy procedures.
What complications can arise?
What complications can a fracture of the zygomatic bone cause? The consequences of late contact of the victim for medical assistance may be as follows:
- deformation of the face, which can become persistent;
- mandibular contracture;
- chronic maxillary sinusitis;
- maxillary osteomyelitis.
Mandibular contracture can provoke a displacement of a part of the zygomatic bone inward and backward, which contributes to pinching and development of coarse scars in the soft tissues of the coronary mandibular process.
Maxillary sinusitis in a chronic form and also post-traumatic osteomyelitis provoke bone fragments that are introduced into the sinuses and its lumens.
Treatment of patients with zygomatic bone injury
How the fracture of the zygomatic bone is eliminated. Treatment may be conservative or surgical, depending on the extent of the lesion.
With fresh injuries (not more than 10 days from the moment of injury) without displaced fragments, conservative methods can be used. Rest is generally recommended. Cold is placed on the area of the broken cheekbone. Such measures are carried out within the first two days after the incident.
Pressure on the zygomatic bone should be excluded. Opening the mouth should be as limited as possible for two weeks.
Treatment for chronic fracture
In a chronic fracture (more than 10 days) with a displacement element, only surgical intervention is indicated. When repositioning bone fragments in the cheekbone, it is contraindicated to open the mouth. With this lesion, deformation of the face, loss of sensitivity to pain in the area of damage to the infraorbital and zygomatic nerves, and double vision are possible.
Fractures of the zygomatic bone and zygomatic arch are eliminated by various methods.
Lamberg Way
This is the most commonly used treatment. It is used when damage to the sinus wall is minor. To set the bone, a hook with one tooth is used. The patient takes a horizontal position. He is lying on his back.
The main stages of treatment with the Lamberg method
- The victim’s head is on the healthy side.
- A single-tooth hook is inserted through the skin into the region of the displaced zygomatic bone, first in the horizontal direction, and then moves with an acute angle point to the inner surface.
- The fragment is set by the movement opposite to the displacement. Manipulation is carried out until the bone clicks.
Keen's Way
This method is applicable when the zygomatic bone is torn from the upper jaw, as well as the frontal and temporal bone. First, an incision is made in the mucous membrane in the zone of the transitional fold of the upper jaw behind the alveolar ridge. An elevator is introduced by a doctor through a wound under a displaced bone. By moving up and out, the bone moves to the correct position.
Village Way
It is an improvement on the previous method. It is used to reposition the bones of the arch of the cheekbone. The incision is made along the transition fold in the region of the first and second molars. The elevator of Karapetyan is introduced into the cavity of the cheekbones or arches that are being repaired.
Dubov's way
This method is applicable for damage that is combined with an injury to the walls of the sinus of the upper jaw. How is the fracture of the zygomatic bone corrected in this case? The operation involves an incision along the upper arch of the mouth from the incisor located in the center to the second molar. The mucous periosteal flap exfoliates, the side wall of the upper jaw and sinus is exposed. Shattered bone fragments. Including the bottom of the orbit. Artificial anastomosis is superimposed with the lower course of the nose. The sinus is tightly closed with a swab of gauze soaked in iodoform. Its end is introduced through the nose. A wound near the mouth is sutured tightly. The tampon is removed after 2 weeks.
Casanyan Converse Method
This method is similar to Dubov’s treatment. But there is some difference. To keep the bone fragments in the correct position when tamping the sinuses, a soft rubber tube is used instead of gauze.
Gillis, Kilner, Ston's Way
With a fracture of the cheek bone, a 2 cm incision is made in the temple area. In this case, the doctor retreats back from the border of the hairline. A wide Gillis elevator or bent forceps are inserted into the wound. The tool advances into the displaced bone. The support for the tool is a tight gauze swab. Thanks to this manipulation, debris can be repaired.
Duchange Method
With this method, the cheekbone bone is reduced with forceps specially designed for these purposes with cheeks and sharp teeth. Through the skin, using this tool, you can grab the cheekbone bone and repone it. Instead of these forceps, “bullet forceps” or Khodorovich-Barinova forceps can be used.
The method of treatment of Malanchuk-Khadarovich
This method is used for fractures of fresh and old. A hook with one tooth is inserted under the bone of the cheekbone or arch and together with the fragment is displaced outward by means of a lever. The lever rests on the cranial bones.
Osteosynthesis by means of a wire seam or polyamide thread
A fracture of the zygomatic bone, the severity of which is high, is treated by applying a wire suture. This method is used in the cheekbone and forehead or cheekbone and upper jaw when exposing the fracture gap in these areas. To fix the bone fragments of the cheekbone, small plates of metal with small screws are used.
Casanyan's Way
This method of treatment is used if the reduction of the fragments by means of one manipulation is not obtained, and they cannot be held in the correct position. The incision is made in the region of the lower eyelid, as a result of which the cheek bone is exposed in the area of the infraorbital region. A channel is formed in the bone through which a thin stainless wire is drawn . The exposed end bends in the form of a hook or loop. Through this procedure, the zygomatic bone is fixed to the shaft, which is mounted in a cap of gypsum.
The method of Shinbarev
The zygomatic bone is fixed with a single-tooth hook to the gypsum suture bandage. With a single fracture of the arc, the hook is introduced strictly along the lower edge at the site of the debris retreat. A seam is applied to the skin. The patient should follow a sparing diet. Pressure on the cheekbone must be avoided.
Bragin's method
Often during a fracture with displacement using a single-tooth hook, it is not possible to fix the fragments in the correct position, since only one fragment of the broken arc is subject to active movement. In this case, a double-toothed hook is used. Holes are located on it, through which you can hold under the fragments of linguature and fixation to the outer bus.
Matasa Birini Method
A thin wire is drawn through a tendon in the temporal muscle above the cheekbone arc through a large, curved needle. A formed loop of wire extends outward. In this way, the zygomatic arch is repaired.
Matasa Birini Method
This method involves suturing a wire. This technique is shown when other methods do not help. A cut of the cheekbone arc is made along the lower edge, the length of which is 2 cm. Damaged areas are assembled into a single whole. Holes are made at the ends of the fragments by means of a small bur. Using a thread of polyamide fragments are connected. They are given the correct fixation. The ends of the thread are tied, and the wound is sutured tightly.
In a fracture with many fragments, bone fragments can be fixed with a quick-hardening plastic plate. Its width is 1.5 cm, and the length corresponds to the zygomatic arch of the patient.
After the fragments are repositioned with a curved needle, a thread of polyamide is drawn from the outside under each fragment. The ends of the thread are tied under the plate. Turunda with iodoform is placed between the plate and the skin. So the occurrence of pressure sores is prevented. On the 8-10th day, the plate is removed.
In the absence of a functional disorder and a large period of time from the date of the fracture (more than 1 year), a resection of the coronoid process or an osteotomy of the zygomatic bone is used.
Conclusion
Zygomatic bone fracture, the photo of which is presented in this article, belongs to the category of severe cases in the field of traumatology.
Untimely treatment of damage can cause a number of undesirable consequences. Therefore, after receiving an injury, it is strongly recommended not to postpone a visit to the doctor. The specialist will prescribe the necessary examination and choose the appropriate treatment method.