Zygoma /certified fixed orthodontic courses by Indian dental academy
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats. Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics, Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call 0091-9248678078
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Zygoma /certified fixed orthodontic courses by Indian dental academy
- 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
- 8. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiological features • Management
- 9. MAXILLOFACIAL INJURIES Zygomatic complex fractures Anatomy: • central support to cheek • buttress of lateral mid 3rd face Articulations: • Zygomatico-frontal •Zygomatico-maxillary • Zygomatico-temporal (arch) • Zygomatico-sphenoid(orbital floor) GK / MAXFAC SDM DHARWAD
- 10. MAXILLOFACIAL INJURIES Zygomatic complex fractures ANATOMY Processes Maxillary Temporal Frontal Orbital Lateral wall and floor orbit Roof and lateral wall maxillary sinus GK / MAXFAC SDM DHARWAD
- 11. MAXILLOFACIAL INJURIES Zygomatic complex fractures ANATOMY Arch Temporal Zygoma Maxilla Muscle attachments: Zygomaticus major / minor: malar eminence GK MAXFAC Levator labii superioris: infraorbital rim /DHARWAD SDM
- 12. MAXILLOFACIAL INJURIES Zygomatic complex fractures Mechanism of Injury Direct & Indirect In-bending at area of impact Out-bending of weak areas (distant) Dislocation posterior inferior medial lateral GK / MAXFAC SDM DHARWAD
- 14. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiological features • Management GK / MAXFAC SDM DHARWAD
- 15. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical Features Flattening of cheek Periorbital edema / Ecchymosis Subconjunctival haemorrhage Epistaxis / Surgical emphysema Proptosis / Enophthalmos GK / MAXFAC SDM DHARWAD
- 16. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical Features ENOPHTHALMOS • Inferior & posterior displacement • Expansion of orbit EXOPHTHALMOS • Medial dislocations GK / MAXFAC SDM DHARWAD
- 17. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical Features Paresthesia (V2) / Pain !!! Trismus Tenderness / Step deformity Facial nerve weakness Drooping of upper lip DIPLOPIA GK / MAXFAC SDM DHARWAD
- 18. MAXILLOFACIAL INJURIES Zygomatic complex fractures Clinical examination Palpation: • Step / tenderness / mobility • Supra-orbital rim • F-Z suture • Infra-orbital rim • Paresthesia (lip, nose 14-11 + gingiva) GK / MAXFAC SDM DHARWAD
- 19. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiology • Management GK / MAXFAC SDM DHARWAD
- 20. MAXILLOFACIAL INJURIES Zygomatic complex fractures Radiographic examination Occipito-mental view (PNS view, Waters position) Fronto-zygomatic suture Zygomatico-maxillary buttress Inferior orbital rim GK / MAXFAC SDM DHARWAD
- 21. MAXILLOFACIAL INJURIES Zygomatic complex fractures Radiographic examination Submento-vertex view (jug handle view) Zygomatic arch Posterior displacement GK / MAXFAC SDM DHARWAD
- 22. MAXILLOFACIAL INJURIES Zygomatic complex fractures Radiographic examination C.T. Scans: GK / MAXFAC SDM DHARWAD
- 23. MAXILLOFACIAL INJURIES Zygomatic complex fractures • Applied surgical anatomy • Clinical features • Radiology • Management GK / MAXFAC SDM DHARWAD
- 24. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Immediate – primary care: • ABC • Nasal packs Anterior / Posterior • Control of pain • Control of infection - Tetanus!! • Prevent surgical emphysema GK / MAXFAC SDM DHARWAD
- 25. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management • Restoration of form & function • Anatomic reduction • Treatment: “Surgical intervention” Closed v/s Open • Displacement & comminution • Exposure of fracture site • Fixation GK / MAXFAC SDM DHARWAD
- 26. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Closed Reduction Arch fractures Minimal disruption (at 2 sutures) Intra-oral approach (Keen 1909) GK / MAXFAC SDM DHARWAD
- 27. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Closed Reduction • Temporal approach (Gillies 1927) GK / MAXFAC SDM DHARWAD
- 28. Gillies Temporal Approach GK / MAXFAC SDM DHARWAD
- 29. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Closed Reduction • Transcutaneous approach GK / MAXFAC SDM DHARWAD
- 30. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management Open Reduction & fixation F-Z Suture Infra-orbital rim & orbital floor Zygomatico-maxillary buttress (Intra-oral) GK / MAXFAC SDM DHARWAD
- 31. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management : Open Reduction F-Z Suture GK / MAXFAC SDM DHARWAD
- 32. MAXILLOFACIAL INJURIES Zygomatic complex fractures Management : Open Reduction Zygomatico-maxillary suture Infra-orbital rim GK / MAXFAC SDM DHARWAD
- 33. MAXILLOFACIAL INJURIES Orbital floor Fractures (blow out #s) Shape: Pyramidal Apex Optic foramen Roof, Lateral wall, floor & medial wall Direct injury to globe intraoccular pressure GK / MAXFAC SDM DHARWAD Fracture floor/medial wall
- 34. MAXILLOFACIAL INJURIES Orbital floor Fractures (blow out #s) • Applied anatomy • Clinical features • Radiographic features • Management GK / MAXFAC SDM DHARWAD
- 35. MAXILLOFACIAL INJURIES Orbital floor Fractures (blow out #s) Applied anatomy Floor : Zygoma & Maxilla Entrapment “Trap door effect” Diplopia , Enophthalmos GK / MAXFAC SDM DHARWAD
- 36. MAXILLOFACIAL INJURIES Orbital floor Fractures (blow out #s) Clinical features Pain Edema Ecchymosis Proptosis Paraesthesia Emphysema Diplopia GK / MAXFAC SDM DHARWAD
- 37. MAXILLOFACIAL INJURIES Orbital floor Fractures (blow out #s) Radiographic features Occipito-mental view ( PNS, Water’s View) “Hanging Drop” CT Scan: Coronal cuts: Floor Axial cuts: Medial wall GK / MAXFAC SDM DHARWAD
- 38. MAXILLOFACIAL INJURIES Orbital floor Fractures (blow out #s) Management Diplopia & Enophthalmos Surgical & surgical only Create a new floor Bone Cartilage Metal: titanium GK / MAXFAC SDM DHARWAD
- 39. MAXILLOFACIAL INJURIES Orbital floor Fractures (blow out #s) Management Incidence – 2 / 62 Reconstruct floor to prevent enophthalmos & diplopia SDM DHARWAD
- 41. If you cannot convince people… confuse them
- 42. Thank You
Notas del editor
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- Prominent position – frequently fractured Either alone or in combination with other bones of midface Fractures include disruption of any of 5 articulations
- Articulates with zygomatic process of maxillary bone: infraorbital rim Zygomatic process of temporal bone :in front of the glenoid fossa External angular process of frontal bone:to form fz suture With in orbit articulates with medially orbital floor & laterally G.W.sphenoid By virtue of its attachments Forms floor & lateral wall of orbit & roof and lateral wall of maxillary sinus
- Arch: contributions from three bones temporal, zygomatic & maxillary Muscle attachments Nerves Z facial br of zygomatic nerve enters orbit through inferior orbital fissure divides into Z temporal which supplies area around zf suture & z facial which passes along inferior and lateral surface of the orbit exciting through a foramen on malar eminence to supply that area Infraorbital nerve through posterior margin of inferior orbital fissure, travels through a in its first 2/3rds of its course obliquely and medially across orbital floor and then through a canal in the infraorbital rim to exit the zygoma @ 1cm below the infraorbital rim grove
- Direct violent forces to cotralateral side can cause disruption of zygoma due to reciprocal transfer of forces but not common, bilateral zygoma fracutres are usually in association with other facial bones involved as in lefort 3 and is because of higher energy involvemnt. Fractures are dislocated posteriorly,inferiorly & medialy are most frequent. Orbital #s are compressed with overlapping # fragments & while reducing, orbital fractures become more severe. These are impacted fractures More extensive injuries are dislocated posteriorly inferiorly and laterally. The arch and soft tissue attachments must be disrupted to permit this. Any zygomatic complex fracture should include a discontinuity along the floor of the orbit. The direction of dislocation involves the rotation of the bone in several planes this has resulted in several classifications
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- Loss of prominence of malar eminence may partially conceled by soft tissue swelling Proptosis due to swelling with in muscular planes and tissue planes Echymosis and hematoma usually confined to distribution of orbital septum spectacle hematoma Epistaxis on ipsilateral nostril secondary to hemorrhage into maxillary sinus
- Clinical pictures to be added.
- Paresthesia V2 contusion or compression of nrve by bone fragments within the area of infraorbital foramen specially medially displaced fractures and will resolve only after elevation of fracture. Limitation in mouth opening due to swelling with in muscular and soft tissue planes, medially displaced arch, and posteriorly displaced body
- Difference betwqeen proptosis & exopthalmos
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- Tetanus immunization schedule microbiology of tetanus check with dinesh Fully immunised : last dose with in 10yrs .5ml toxoid Partially immunised: more than 10yrs .5ml toxoid
- Immediate intervention nessasary Prevent Enopthalmos diplopia Approach through blepharoplasty incision for floor medial and lateral wall Sub conjunctival approach with lateral canthplexy alternative Aim to reconstruct the floor / medial wall Choice of graft : calvarium