• 27
    Oct
  • Etiology and Pattern of Zygomatic Complex Fractures: RESULTS

One-hundred-two (76.1%) males and 32 (23.9%) females were recorded during the study period, giving a malerfemale ratio of 3.2:1. They ranged in age from 18-70 years, with a mean age of 32 years. Patients in the 21-30-year age group (62 or 46.3%) were most often involved (Table 1). The etiology of zygomatic complex fractures are shown in Table 2. There was a significant association between road traffic accidents and fractures among the age groups (%2=38.919, df=24, p<0.05) but none between road traffic accidents and sex (%2=3.574, df =3, p>0.05).

Table 1. Age and Gender Distribution of Patients

Age Range Male

Female

Percent
(Years) (No)

(No)

11-20 7

6

9.7
21-30 46

16

46.3
21-40 27

6

24.6
41-50 16

4

14.9
51-60 CM

1.5
61-70 4

3.0
Total 102

32

100

Table 2. Etiology of Zygomatic Fractures

Cause Number Percent
Road traffic accidents

110

82.1
Missiles

12

9.0
Assault

6

4.5
Falls

5

3.7
Sport

1

0.7
Total

134

100

One-hundred-nineteen (88.8%) patients sustained fractures of the zygomatic bone, 11 (8.2%) had fractures of the zygomatic arch and four (3.0%) patients had fractures of both the arch and the zygomatic bone. There was a significant association between fractures of the zygomatic bone and road traffic accidents (x2=35.519, df=6, pO.001). Fifty-nine (44.0%) patients sustained other maxillofacial fractures (Table 3). There was no significant association between these fractures and age (%2=18.714, df=12, p>0.05), sex (%2=5.855, df=4, p>0.05) or site of zygomatic complex fracture (%2=2.053, df=4, p>0.05).
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Table 3. Distribution of Associated Maxillofacial Fractures

Fracture Type Number Percent
Mandible

22

37.3
Le Fort II

18

30.5
Orbital

8

13.5
Le Fort III

6

10.2
Nasal

5

8.5
Total

59

100

Table 4. Clinical Features of Zygomatic Complex Fractures

Clinical Feature Number Percent
Subconjunctival ecchymosis

85

63.4

Circumorbital ecchymosis

81

60.4

Limitation of mandibular
movements

75

56.0

Flattening of the cheek

64

47.8

Depression over the arch

8

6.0

Diplopia

13

9.0

Enophthalmos

4

3.0

The presenting features of zygomatic complex fractures are shown in Table 4, and Table 5 shows the radiographic views requested for diagnosis of these fractures. The radiological findings are shown in Table 6. The majority 113 (84.3%) of fractures were treated under endotracheal general anesthesia. Eight (6.0%) were treated under local anesthesia and intravenous sedation. In 13 (9.7%) patients, no active treatment of the fracture was performed (Table 7).
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Table 5. Distribution of Radiographic Investigations

Investigation Number

Percent

Occipitomental + postero-anterior + lateral view

52

38.8

Occipitomental + postero-anterior view

46

34.3

Submentovertex view

21

15.7

Occipitomental view

13

9.7

Computed tomography CM

1.5

Total 134

100

Table 6. Radiologic Findings Associated with Zygomatic Complex Fractures

Radiologic Finding Number Percent
Antral opacity

60

44.8

*Fracture at the ZF and ZM sutures

52

38.8

Fracture at the ZF suture only

38

28.4

Fracture at the ZM suture only

30

22.4

V-shaped arch fracture

7

5.2

Comminution of the zygomatic arch CM

1.5

Comminution of the zygomatic bone

1

0.7

The approaches and methods of management of zygomatic complex fractures are shown in Table 7. The Gillies approach in 34 (25.4%) was the commonest method of reduction. The upper buccal sulcus approach was used in only one (0.7%) patient. Where internal fixation was required, transosseous wiring with 0.5 mm diameter soft stainless wire was performed. The duration of follow-up ranged from four weeks to two years. The following postoperative complications were recorded—blindness in four (3.0%), persistent flattening of the cheek in four (3.0%), and persistent enophthalmos in one (0.7%).
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Table 7. Approaches and Treatment for Zygomatic Complex Fractures

Treatment

No

Percent
1. Gillies approach

34

25.4 ‘
2. Lateral eyebrow approach

23

17.2
3. Upper buccal sulcus approach

1

0.7
4. Fixation at the ZF suture only

23

17.2
5. Fixation at the ZM suture only

14

10.4
6. Fixation at the ZF and ZM sutures

17

12.7
7. No treatment due to financial constraints

2

1.5
8. Antral packing

9

6.7
9. Observation

7

5.2
10. Lost to follow-up

4

3.0
Total

134

100
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