Les fractures de l’os zygomatique : à propos de 356 cas

Outpatient management of facial fractures in France: Current state

Maxillofacial trauma is still very common in France with possible involvement of all face bones. Outpatient surgery is an axis strongly put forward by the public authorities. The aim of this study is to establish a current state in the outpatient management of facial fractures in France in 2019 before COVID infection. A closed and semi-open-ended questionnaire was sent to French hospitals treating facial fractures in order to evaluate current and possible future practices in terms of outpatient and perioperative management. Data extracted from the Program for giving Medical significance to Information Systems (PMSI) thanks to the Agency for Information on Hospital Care (ATIH) were also studied to obtain proportions of outpatient care by department. About the questionnaire 43 replies were received. Nasal fractures were the only type of fracture having a minimum average length of stay below 24hours (12.00±16.65) as well as an actual average length of stay (14.22±24.24). Concerning data extracted from the PMSI, 14510 stays were found. Currently only nasal fractures and zygomatic arch fractures requiring simple reduction without osteosynthesis are performed on an outpatient basis. Mandibular fractures could be performed as an outpatient procedure. Access to the operating room and organizational problems specific to each center are factors that limit the development of outpatient management of these facial fractures. Some incompressible parameters such as the monitoring required following the management of these fractures as well as the patients' comorbidities must be taken into account.

Risk of Ear-Associated Diseases After Zygomaticomaxillary Complex Fracture

PURPOSE

Investigate the risk of ear-associated diseases after zygomaticomaxillary complex (ZMC) fracture in a population-based retrospective cohort study.

MATERIALS AND METHODS

This is a retrospective cohort study using Taiwan's National Health Insurance Research Database of reimbursement claims. A total of 1,330 ZMC fracture patients and 5,320 non-ZMC fracture participants were included and newly developed ear-associated disease data were collected. A Poisson regression and multivariate Cox proportion hazard regression were used for data analysis.

RESULTS

The ZMC fracture cohort had a higher incidence of tinnitus than non-ZMC fracture cohort (IRR 1.64, 95 % CI 1.37-1.96), particularly in younger patients (≤34 years of age; IRR 4.05, 95 % CI 3.18-5.15) and male patients (IRR 2.08, 95 % CI 1.12-3.73). ZMC fracture patients also showed a significantly increased risk of having trigeminal neuralgia [IRR 4.06, 95 % CI 3.34-4.94, adjusted HR 4.07 (1.02-16.3)]. For sudden hearing loss and peripheral vertigo, the incidence densities were higher in the ZMC fracture cohort, but these relationships were not significant in the multivariate Cox proportional hazard regression analyses (HR 2.69, 95 % CI 0.76-9.53 for risk of sudden hearing loss; HR 1.36, 95 % CI 0.77-2.40 for risk of peripheral vertigo).

CONCLUSIONS

The findings of the study suggest an increased risk of ear-associated diseases among individuals with ZMC fractures, particularly within 2-years follow-ups after injury. We suggest performing detailed examinations for ear-associated diseases in patients with ZMC fractures for early diagnosis and adequate treatment.

[Zygomatic arch fracture extended to the glenoid fossa: a cause of TMJ pain]

INTRODUCTION

Fractures of the zygomatic arch extended to the glenoid fossa are rare and seldom reported.

OBSERVATION

A 26-year-old man with a slightly dislocated fracture of the zygoma associated with trismus, and localized pain in the right Temporo-Mandibular Joint (TMJ) on palpation, but without any condylar fracture. The craniofacial CT scan revealed a fracture of the zygoma extended to the glenoid fossa. The treatment was an intraoral reduction of the zygoma and screw fixation of the glenoid fossa lateral region.

DISCUSSION

The risk of delayed healing by mobilization of the bone fragments was opposed to the risk of TMJ ankylosis due to a prolonged immobilization of the joint. Osteosynthesis of the fracture was finally chosen.

Isolated bilateral zygomatic complex and arch fracture: a rare case report

This is an unusual case of isolated bilateral zygomatic complex and arch fracture, which is extremely rare. The literature has no such report of a case.

Treatment with individual orbital wall implants in humans - 1-Year ophthalmologic evaluation

BACKGROUND

In 2009 a method of creating individual, patient specific orbital wall implants using rapid prototyping (RP) was shown in a preliminary human study. That study showed that it is financially viable to produce anatomical models and that this technology could be used in the repair of orbital floor fractures.

MATERIALS AND METHODS

In this study, 24 consecutive subjects who had sustained orbital fractures (14 males, 6 females) without any coexisting central nervous system or globe injury were assessed post-operatively. The first series of 12 patients, recruited during the period 2005-2006, were treated with classical method (CM) of forming titanium mesh by manual manipulation, based on individual subjective assessment of the extent and shape of damaged orbital walls. The following 12 cases, recruited between 2007 and 2008, were treated with patient specific titanium mesh implants designed with an RP method. Early (2 weeks) and late (12 months) follow-up was performed. Patients were evaluated by binocular single vision (BSV) test and an assessment of eye globe motility.

RESULTS

The superiority of the RP treatment method over CM was shown on the basis of early results when BSV loss area and reduction of vertical visual disparity (VVD) in upgaze were considered. Better outcomes for the RP group were confirmed in the late follow-up results which showed a reduction of BSV loss area, correction of primary globe position and a very significant improvement in upgaze.

CONCLUSIONS

One-year post-operatively, functional assessment of pre-bent individual implants of the orbital wall has shown the technique to be a predictable reconstruction method. Nevertheless longer follow-up and an increase in the number of cases treated are required for the full evaluation of the technique.