Trans facial fixation of mid face fractures in cranio-maxillofacial trauma management at Armed Forces Institute of Dentistry

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Nida ul Nasar and S Gulzar Ali Bukhari

Armed Forces Institute of Dentistry, Pakistan

: J Spine Neurosurg

Abstract

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The objective was to develop an optimal technique for fixing mid face (Zygomatico- maxillary complex) fractures in craniomaxillofacial trauma management in the perspective of preventable high incidence maxillofacial trauma due to non-wearing of helmet and seat belt. The Zygomaticomaxillary Complex (ZMC) with its prominent convexity in the face is highly vulnerable to injury. Its fractures are inherently unstable due to Superficial Muscular Aponeurotic System (SMAS) and strong masseteric muscle attachment. The ZMC is also called beauty or cheek bone. Less than optimal results of restoration of form and function after fixing it back to the pre-injury state have resulted in variety of techniques. In this study, we evaluated a novel approach to the reduction, fixation and stabilization of ZMC fractures with optimum aesthetic results in order to prevent post traumatic malar depression, the cause of unaesthetic appearance and restricted jaw function. The purpose of this study was to fix the (Midface fractures) ZMC fractures with open reduction and fixation using trans facial fixation technique and then evaluating pre and post management malar depression along with mouth opening along with conventional methods of ORIF (open reduction and internal fixation) Then it’s both ends are fixed at frontozygomatic bone above and nasomaxillary buttress of anterior maxilla after optimal reduction of ZMC. Both fixing areas define the prominence of face and are well placed ahead of ZMC in the face. It gives advantage for addressing projection, the most important aspect required during reduction and fixation, along with post management stability. Patients were evaluated and compared for preoperative findings of malar depression and mouth opening with post op finding. During the follow-up, the patients were routinely evaluated using computed tomography. Treatment was successful in all cases; there were no complications at surgery or postoperatively. During follow-up, all patients had satisfactory facial symmetry, no noticeable scar and no functional impairment. However due to limited number of patients and follow up time, further large scale, multicenter studies are recommended.

Biography

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Nida ul Naser is a medical student in the Armed Forces Institute of Dentistry, Pakistan. Her major research interest includes, maxillofacial surgery, facial fractures, dentistry etc.

E-mail: drnida2011@gmail.com