Evaluation of sub-brow approach to the frontozygomatic suture for Open Reduction and Internal Fixation (ORIF) of Zygomatico maxillary complex (ZMC) fractures: A prospective cohort study

Introduction

Contemporary incisions used to access the frontozygomatic (FZ) sutures are the lateral brow and upper blepharoplasty incisions which are associated with specific limitations and complications. The authors describe the use of sub-brow incision as an alternate approach for exposure of the FZ region.

Methods

This is a prospective cohort study involving patients requiring surgical management of zygomatico maxillary complex (ZMC) fractures with fixation at FZ suture alone or along with fixation at infra-orbital rim and/or zygomaticomaxillary buttress. A sub-brow incision was used to expose the fracture and fixation was done with a 4-hole miniplate. The parameters evaluated were specific to the FZ region (sub-brow incision), namely surgical access, bleeding, fracture exposure time, post-operative scar, and pain. Each patient was reviewed on 1st, 5th, 7th, 10th, 30th, and 90th day.

Results

The study sample included eight male patients. The mean age was 30 years. The sub-brow incision demonstrated favorable postoperative outcomes; adequate exposure was achieved in all 8 patients. The scar formation was found to be higher on the 7th day and the least scar formation was seen by the third month. The mean pain score was found to be high on first post-operative day and the least pain was seen by the 10th day. The mean score of surgical field bleeding was found to be 1.75 which signified mild bleeding according to Fromme's scale. The mean time taken for adequate exposure of the fracture was 6.62 min. All the assessment parameters were statistically significant (P value <0.01).

Conclusion

Sub-brow incision is an effective approach for ORIF of zygomatic fractures at FZ suture. The technique is quick, simple, and associated with minimal complications.

Influence of anaesthesia and surgery on neutrophil chemotaxis

Chemotactic migration of leucocytes is one of the earliest and essential events among the host defense mechanisms against infection. Therefore, the influence of anaesthesia and surgery on leucocyte chemotaxis was investigated in patients requiring elective surgery. The chemotactic migration of peripheral blood leucocytes was measured by a modification of Boyden's method immediately before and after operation and on the second and third postoperative days. In addition, the influence of exposure to different molar concentrations of thiopentone on chemotactic migration was investigated in vitro. A statistically significant inhibition of leucocyte chemotactic migration was observed in the immediate postoperative period. (P less than 0.05). However, this inhibition was of short duration and chemotactic activity returned to normal on the day after operation under general anaesthesia. Exposure to thiopentone produced a significant and dose dependent inhibition of chemotactic migration in vitro. It is concluded that surgery under general anaesthesia and exposure to thiopentone in vitro produce a significant though reversible inhibition of chemotactic migration of leucocytes.