Alagappan Meyyappan, S Vijayparthiban, M Semmia
Department of Oral and Maxillofacial Surgery, Chettinad Dental College and Research Institute, Chettinad Health City, Kelambakkam, Tamil Nadu, India
Click here for correspondence address and email
|Date of Submission||27-Jul-2014|
|Date of Decision||30-Jul-2014|
|Date of Acceptance||03-Aug-2014|
|Date of Web Publication||16-Dec-2014|
| Abstract|| |
Zygomatic bone forms major buttress of the facial skeleton and plays an important role in facial contour. Fractures of zygomatic complex are second most common only next to nasal bone fractures. Motor vehicle accidents and interpersonal violence are common causes. Bilateral fractures of zygomatic complex and zygomatic arch are very rare. We present a case report of isolated fractures involving bilateral zygomatic complex and zygomatic arch with oral submucous fibrosis, which is unique and first of its kind to be reported.
Keywords: Isolated bilateral zygomatic complex fractures, oral submucous fibrosis, zygoma
|How to cite this article:|
Meyyappan A, Vijayparthiban S, Semmia M. Isolated bilateral zygomatic complex and zygomatic arch fractures with oral submucous fibrosis: An unusual and rare case report. Indian J Dent Res 2014;25:675-7
Zygomatic bone forms prominence of the cheek, contributes to the floor and lateral wall of the orbit and walls of the temporal and infratemporal fossae, and completes the zygomatic arch. It is roughly quadrangular, has three surfaces, five borders, and two processes.  Fractures of zygomatic complex are second most common after nasal bone fractures. ,,, Motor vehicular accidents account for one of the most common causes ,,,,,, of zygomatic fractures, followed by interpersonal violence. , The fractures of zygomatic complex should be diagnosed carefully and requires meticulous treatment for both cosmetic and functional reasons. Bilateral isolated fractures of zygomatic complex are extremely uncommon with very few reported cases in the literature. We present here a very rare case report of isolated bilateral zygomatic complex and zygomatic arch fracture with oral submucous fibrosis treated at our hospital.
|How to cite this URL:|
Meyyappan A, Vijayparthiban S, Semmia M. Isolated bilateral zygomatic complex and zygomatic arch fractures with oral submucous fibrosis: An unusual and rare case report. Indian J Dent Res [serial online] 2014 [cited 2019 Oct 17];25:675-7. Available from: http://www.ijdr.in/text.asp?2014/25/5/675/147126
| Case report|| |
A 29-year-old male construction worker presented to the casualty of Chettinad health city, Kelambakkam, Chennai with the alleged history of RTA-skid and fall from two wheeler under the influence of alcohol. On clinical examination, he had contused and abraded wounds in right side frontal region and below the right lower eyelid. Subconjunctival hemorrhage was noted bilaterally with ecchymosis involving right side lower eyelid. Patient had step deformity on palpation of infraorbital rims bilaterally with right side infraorbital paresthesia. The oral opening was <25 mm. On intraoral palpation evidence of fibrous bands in buccal mucous membranes of both sides and rima oris were noticed [Figure 1]. Patient gave history of pan chewing for past 10 years. He had a stable dental occlusion bilaterally. Computed tomography scan of facial bones revealed bilateral zygomatic complex and zygomatic arch fractures [Figure 2] and [Figure 3]. The patient was taken up for open reduction and internal fixation of the fractures under fiberoptic assisted General Anesthesia. The fractures were approached by upper anterior vestibular incision and lateral eyebrow incision, and zygomatic complex and arch were reduced bilaterally by Keens/Balasubramaniam/buccal sulcus method. The fracture ends were fixed with 1.5 mm 'L' plates and 1.5 × 6 mm screws in zygomatic buttress [Figure 4] and 1.5 mm 4 hole straight plate and 1.5 × 6 mm screws in F-Z region [Figure 5] bilaterally. Postoperatively patient was under regular follow up and had a satisfactory recovery and wound healing [Figure 6].
|Figure 1: (a) Preoperative clinical picture (b) buccal mucosa with blanching and palbable fibrous bands|
Click here to view
|Figure 2: (a and b) Preoperative axial computed tomography scan showing bilateral zygomatic complex fractures|
Click here to view
|Figure 3: (a) Coronal and (b) sagittal preoperative computed tomography scan images|
Click here to view
|Figure 4: (a and b) Intraoperative view showing miniplates in zygomatic buttress regions bilaterally|
Click here to view
|Figure 5: (a and b) Intraoperative view showing miniplates in frontozygomatic regions bilaterally|
Click here to view
| Discussion|| |
The direction and magnitude of force delivered determine the pattern and the severity of the fracture. When a force is applied to the body of zygoma, which is made of thick cortical bone, it is dissipated along the lines of weakness through its processes to adjacent weaker bones.  Zygomatic fractures are generally associated with fractures involving maxillary sinus and orbital floor. Isolated fractures of zygoma are more common only next to nasal bone fractures followed by orbital floor blowout fractures. Isolated fractures of zygomatic complex are more common unilaterally and are generally due to low energy impact on the zygomatic bone.  Bilateral fractures of the zygoma are uncommon and accounts approximately 4% of 2067 cases of zygomatic fractures in 10 years review by Ellis et al.  The mechanism of bilateral zygomaticomaxillary complex fractures may be attributed to two separate impacts with two trajectories of forces occurring as the patient was thrown out of the vehicle.  Functional and cosmetic factors play a key role in reduction and fixation of zygomatic complex fractures. In surgical reduction of bilateral zygomatic complex fractures, it is generally advised to fix the less displaced fragment first followed by more displaced fragment since there is no uninvolved side for comparison of symmetry.  The occurrence of isolated bilateral zygomatic complex and zygomatic arch fractures are extremely rare with only one reported incidence.  There is no reported evidence of isolated bilateral zygomatic complex fractures with oral submucous fibrosis in the literature. This makes our case unique and rare. The clinical and radiographic findings and the treatment carried out are described in our case report.
| References|| |
Standring S. Grays Anatomy the Anatomical Basis of Clinical Practice. 39 th
ed. USA: Elsevier Health Sciences, Churchill Livingstone; 2005. p. 476.
Middleton DS. Management of injuries of the nose and upper jaw. Proc R Coll Med 1953;46:476.
Nysingh JG. Zygomatico-maxillary fractures with a report of 200 cases. Arch Chir Neerl 1960;12:157-68.
Lundin K, Ridell A, Sandberg N, Ohman A. One thousand maxillo-facial and related fractures at the ENT-clinic in Gothenburg. A two-year prospective study. Acta Otolaryngol 1973;75:359-61.
Schultz RC. Facial Injuries. 2 nd
ed. Chicago: Yearbook. 1977.
McCoy FJ, Chandler RA, Magnan CG, Moore JR, Siemsen G. Fracture of the zygoma. Plast Reconstr Surg 1962;29:381.
Rowe NL, Killey HC. Fractures of the Facial Skeleton. Edinburgh: Livingstone; 1968.
Larsen OD, Thomsen M. Zygomatic fractures. II. A follow-up study of 137 patients. Scand J Plast Reconstr Surg 1978;12:59-63.
Adekeye EO. Fractures of the zygomatic complex in Nigerian patients. J Oral Surg 1980;38:596-9.
Foo GC. Fractures of the zygomatic-malar complex: A retrospective analysis of 76 cases. Singapore Dent J 1984;9:29-33.
Fischer-Brandies E, Dielert E. Treatment of isolated lateral midface fractures. J Maxillofac Surg 1984;12:103-6.
Turvey TA. Midfacial fractures: A retrospective analysis of 593 cases. J Oral Surg 1977;35:887-91.
Haidar Z. Fractures of the zygomatic complex in the south-east region of Scotland. Br J Oral Surg 1978;15:265-7.
Fonseca RJ, Walker RV, Betts NJ. Oral and Maxillofacial Trauma. 3 rd
ed., Vol. 1. USA: Elsevier Health Sciences; 2004. p. 407,572.
Ellis E 3 rd
, el-Attar A, Moos KF. An analysis of 2,067 cases of zygomatico-orbital fracture. J Oral Maxillofac Surg 1985;43:417-28.
Ramanathan M, Cherian MP. Isolated bilateral zygomatic complex and arch fracture: A rare case report. Craniomaxillofac Trauma Reconstr 2010;3:185-8.
Department of Oral and Maxillofacial Surgery, Chettinad Dental College and Research Institute, Chettinad Health City, Kelambakkam, Tamil Nadu
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]