EVALUATION OF THE Y-SHAPED MODIFICATION OF THE TRANSCONJUCTIVAL APPROACH IN OPEN REDUCTION OF ZYGOMATIC MAXILLARY COMPLEX FRACTURE (CLINICAL TRIAL)

Document Type : Original Article

Authors

1 Oral Surgery Department, Faculty of Dentistry, Alexandria University

2 Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt

Abstract

Introduction: Conventional incisions that are commonly used for the exposure of lower eyelid and treatment of Zygomaticomaxillary Complex (ZMC) fractures, includes both transcutaneous and transconjunctival approaches. The decision between the incisions is based on the need for adequate exposure of the fracture site and a desired aesthetically acceptable incision. A “Y” shaped technique was claimed to fulfill both adequate exposure and esthetic outcomes.
Aim: This study was conducted to evaluate the Y-shaped modification of the transconjunctival in the management of zygomatic maxillary complex fracture.
Materials and Methods: This study was based on seventeen patients with zygomaticomaxillary complex fractures. Post-operative patient evaluation was performed with consideration to intraoperative accessibility, exposure duration, postoperative pain and edema, post-operative wound healing and infection, scarring, and postoperative orbital movement and ocular complications.
Results: The average exposure duration was (20:00±03:41) minutes, and the fractures were accessible in all of the operated cases. No scars were detected in all cases 6 weeks post-operatively. There was a significant difference between post-operative pain status in different intervals (p < 0.001). A significantly high percentage of cases didn’t have post-ocular complications 15(88.2%) (p < 0.001).
Conclusion: The modification of the transconjunctival approach with a cutaneous Y-shaped incision provides commodious surgical exposure for ZMC fractures.

Keywords

References

1-         Lee EI, Mohan K, Koshy JC, Hollier LH Jr. Optimizing the surgical management of zygomaticomaxillary complex fractures. Semin Plast Surg. 2010;24:389-97.
2-         Waheed El-Anwar M, Elsheikh E, Sweed AH, Ezzeldin N. Electromyography assessment in zygomaticomaxillary complex fractures. Oral Maxillofac Surg. 2015;19:375-9. 
3-         Meslemani D, Kellman RM. Zygomaticomaxillary complex fractures. Arch Facial Plast Surg. 2012;14:62-6.
4-         Ishida K. Evolution of the surgical approach to the orbitozygomatic fracture: From a subciliary to a transconjunctival and to a novel extended transconjunctival approach without skin incisions. J Plast Reconstr Aesthet Surg. 2016;69:497-505. 
5-         Gomes PP, Passeri LA, Barbosa JR. A 5-year retrospective study of zygomatico-orbital complex and zygomatic arch fractures in Sao Paulo State, Brazil. J Oral Maxillofac Surg. 2006;64:63-7. 
6-         Bourguet J. Les hernies graisseuses de l’orbite: Notre traitement chirurgical. Bull Acad Med (Paris). 1924;92.
7-         Novelli G, Ferrari L, Sozzi D, Mazzoleni F, Bozzetti A. Transconjunctival approach in orbital traumatology: a review of 56 cases. J Craniomaxillofac Surg. 2011;39:266-70.
8-         Martinez AY, Bradrick JP. Y modification of the transconjunctival approach for management of zygomaticomaxillary complex fractures: a technical note. J Oral Maxillofac Surg. 2012;70:97-101.
9-         Rajkumar K, Mukhopadhyay P, Sinha R, Bandyopadhyay TK. ''Y'' Modification of the Transconjunctival Approach for Management of Zygomatic Complex Fractures: A Prospective Analysis. J Maxillofac Oral Surg. 2016;15:45-51.
10-      Marinho R, Maia B. Management of Fractures of the Zygomaticomaxillary Complex. Oral Maxillofacial Surg Clin N Am. 2013;25:617-36.
11-      Devi RS.  Comparison of y- modification of transconjunctival approach versus subtarsal – lateral eyebrow approach for zygomaticomaxillary complex fractures: A Prospective study. M.Sc. Thesis. Oral and Maxillofacial Surgery department, Tamilnadu Government Dental College and Hospital, Chennai. 2015
12-      Ellis E, Reddy L. Status of the internal orbit after reduction of zygomaticomaxillary complex fractures. J Oral Maxillofac Surg. 2004;62:275-83. 
13-      Gopalakrishnan S. A public health perspective of road traffic accidents. J Family Med Prim Care. 2012;1:144-50. 
14-      Holtmann B, Wray RC, Little AG. A randomized comparison of four incisions for orbital fractures. Plast Reconstr Surg. 1981;67:731-7. 
15-      Subramanian B, Krishnamurthy S, Suresh Kumar P, Saravanan B, Padhmanabhan M. Comparison of various approaches for exposure of infraorbital rim fractures of zygoma. J Maxillofac Oral Surg. 2009;8:99-102.
16-       Dickinson AJ, Gausas RE. Orbital lymphatics: do they exist? Eye (Lond). 2006;20:1145-8.
17-      Shoukath S, Taylor GI, Mendelson BC, Corlett RJ, Shayan R, Tourani SS, et al. The Lymphatic Anatomy of the Lower Eyelid and Conjunctiva and Correlation with Postoperative Chemosis and Edema. Plast Reconstr Surg. 2017;139:628e-37e.
18-      Ilankovan V. Transconjunctival approach to the infraorbital region: a cadaveric and clinical study. Br J Oral Maxillofac Surg. 1991;29:169-72.
19-      Appling WD, Patrinely JR, Salzer TA. Transconjunctival approach vs subciliary skin-muscle flap approach for orbital fracture repair. Arch Otolaryngol Head Neck Surg. 1993;119:1000-7.
20-      Ridgway EB, Chen C, Colakoglu S, Gautam S, Lee BT. The incidence of lower eyelid malposition after facial fracture repair: a retrospective study and meta-analysis comparing sub- tarsal, subciliary, and transconjunctival incisions. Plast Reconstr Surg. 2009; 124:1578-86.
21-      Manson PN, Crawley WA, Yaremchuk MJ, Rochman GM, Hoopes JE, French JH Jr. Midface fractures: advantages of immediate extended open reduction and bone grafting. Plast Reconstr Surg. 1985;76:1-12.
Alexandria Dental Journal
Volume 47, Issue 1
A (Oral and maxillofacial surgery, oral medicine, periodontology, oral radiology, oral pathology, oral biology)
April 2022
Pages 9-15

Files

Share

How to cite

Statistics