Steimann Pin Repair of Zygomatic Complex Fractures

Abstract

Purpose: To present the treatment of zygomaticomaxillary complex (ZMC) fractures with closed-reduction Steinmann-pin fixation and to compare it to the reduction and aesthetic outcomes of open-reduction techniques (ORIF). Materials and Methods: Case series. Charts for 23 patients with ZMC fractures presenting to the Head and Neck Surgery Department at Harbor-UCLA Medical Center from 2005 to 2009 were reviewed. Pre- and post-operative computed tomography (CT) scans were analyzed. Follow up ranged from 3 to 55 months. Interviews were conducted to evaluate the patient’s satisfaction. Patients were placed in two groups: those treated with ORIF and those treated with closed-reduction Steinmann-pin fixation. Results: Twelve patients had complete data for analysis. Average operative time was significantly lower for patients treated with closed-reduction as compared to open-reduction: 65.3 minutes vs. 162.5 minutes (p = 0.02). Bony realignment and aesthetic results were comparable in both groups. Additionally, only one 1cm facial incision was required with this repair system versus several incisions using traditional methods. Conclusions: Closed-reduction Steinmann-pin fixation of ZMC fractures provides adequate bony alignment and aesthetics. Our study supports this system in the repair of ZMC fractures as it requires significantly less operating time, one small incision, and excellent patient outcomes.

Share and Cite:

J. Salinas, D. Vira, D. Hu, D. Elashoff, E. Abemayor and M. John, "Steimann Pin Repair of Zygomatic Complex Fractures," International Journal of Otolaryngology and Head & Neck Surgery, Vol. 2 No. 2, 2013, pp. 74-78. doi: 10.4236/ijohns.2013.22018.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] K. Bogusiak and P. Arkuszewski, “Characteristics and Epidemiology of Zygomaticomaxillary Complex Fractures,” Journal of Craniofacial Surgery, Vol. 21, No. 4, 2010, pp. 1018-1023. doi:10.1097/SCS.0b013e3181e62e47
[2] E. H. Hagan and D. F. Huelke, “An Analysis of 319 Case Reports of Mandibular Fractures,” Journal of Oral Surgery, Anesthesia, and Hospital Dental Service, Vol. 19, 1961, pp. 93-104.
[3] W. L. Adeyemo, A. L. Ladeinde, M. O. Ogunlewe, et al. “Trends and Characteristics of Oral and Maxillofacial Injuries in Nigeria: A Review of the Literature,” Head & Face Medicine, Vol. 1, 2005, pp. 1-7. doi:10.1186/1746-160X-1-7
[4] M. R. Telfer, G. M. Jones and J. P. Shepherd, “Trends in the Aetiology of Maxillofacial Fractures in the United Kingdom (1977-1987),” British Journal of Oral and Maxillofacial Surgery, Vol. 29, No. 4, 1991, pp. 250-255.doi:10.1016/0266-4356(91)90192-8
[5] A. Alvi, T. Doherty and G. Lewen, “Facial Fractures and Concomitant Injuries in Trauma Patients,” Laryngoscope, Vol. 113, No. 1, 2003, pp. 102-106. doi:10.1097/00005537-200301000-00019
[6] B. G. Evans and G. R. Evans, “MOC-PSSM CME Article: Zygomatic Fractures,” Plastic and Reconstructive Surgery, Vol. 121, Suppl. 1, 2008, pp. 1-11. doi:10.1097/01.prs.0000294655.16607.ea
[7] K. Hwang and D. H. Kim, “Analysis of Zygomatic Fractures,” Journal of Craniofacial Surgery, Vol. 22, No. 4, 2011, pp. 1416-1421. doi:10.1097/SCS.0b013e31821cc28d
[8] Y. Kaufman, D. Stal, P. Cole, et al., “Orbitozygomatic Fracture Management,” Plastic and Reconstructive Surgery, Vol. 121, 2008, pp. 1370-1374. doi:10.1097/SCS.0b013e31821cc28d
[9] P. Kelley, R. Hopper and J. Gruss, “Evaluation and Treatment of Zygomatic Fractures,” Plastic and Reconstructive Surgery, Vol. 120, No. 7, 2007, pp. 5S-15S. doi:10.1097/01.prs.0000260720.73370.d7
[10] W. D. Appling, J. R. Patrinely and T. A. Salzer, “Transconjunctival Approach Vssubciliary Skin-Muscle Flap Approach for Orbital Fracture Repair,” Archives of Otolaryngology—Head and Neck Surgery, Vol. 119, No. 9, 1993, pp. 1000-1007. doi:10.1001/archotol.1993.01880210090012
[11] J. B. Mullins, J. B. Holds, G. Branham, et al., “Complications of the Transconjunctival Approach: A Review of 400 Cases,” Archives of Otolaryngology—Head and Neck Surgery, Vol. 123, No. 4, 1997, pp. 385-388.
[12] A. Baumann and R. Ewers, “Use of the Preseptal Transconjunctival Approach in Orbit Reconstruction Surgery,” Journal of Oral and Maxillofacial Surgery, Vol. 59, No. 3, 2001, pp. 287-291. doi:10.1053/joms.2001.20997
[13] P. N. Manson, E. Ruas, N. Iliff, et al., “Single Eyelid Incision for Exposure of the Zygomatic Bone and Orbital Reconstruction,” Plastic and Reconstructive Surgery, Vol. 79, No. 1, 1987, pp. 120-126. doi:10.1097/00006534-198701000-00023
[14] K. Hwang, “One-Point Fixation of Tripod Fractures of Zygoma through a Lateral Browincision,” Journal of Craniofacial Surgery, Vol. 21, No. 4, 2010, pp. 10421044. doi:10.1097/SCS.0b013e3181e48607
[15] B. Y. Park, S. Y. Song, I. S. Yun, D. W. Lee, D. K. Rah, W. J. Lee, “First Percutaneous Reduction and Next External Suspension with Steinmann Pin and Kirschner Wire of Isolated Zygomatic Fractures,” Journal of Craniofacial Surgery, Vol. 21, No. 4, 2010, pp. 1060-1065. doi:10.1097/SCS.0b013e3181e62cb2
[16] S. T. Kim, D. H. Go, J. H. Jung, H. E. Cha, J. H. Woo and I. G. Kang, “Comparison of 1-Point Fixation with 2-Point Fixation in Treating Tripod Fractures of the Zygoma,” Journal of Oral and Maxillofacial Surgery, Vol. 69, No. 11, 2011, pp. 2848-2852. doi:10.1016/j.joms.2011.02.073
[17] B. R. Chrcanovic, Y. S. Cavalcanti and P. Reher, “Temporal Miniplates in the Frontozygomatic Area—An Anatomical Study,” Journal of Oral and Maxillofacial Surgery, Vol. 13, 2009, pp. 201-206.
[18] M. Kurita, M. Okazaki, M. Osaki, Y. Tanaka, N. Tsuji, A. Takushima and K. Harii, “Patient Satisfaction after Open Reduction and Internal Fixation of Zygomatic Bone Fractures,” Journal of Craniofacial Surgery, Vol. 21, No. 1, 2010, pp. 45-49. doi:10.1097/SCS.0b013e3181c36304
[19] Y. O. Kim, “Transcutaneous Reduction and External Fixation for the Treatment of Noncomminutedzygoma Fractures,” Journal of Oral and Maxillofacial Surgery, Vol. 56, No. 12, 1998, pp. 1382-1387. doi:10.1016/S0278-2391(98)90398-6
[20] G. C. Rinehart, J. L. Marsh, K. M. Hemmer, et al., “Internal Fixation of Malar Fractures: An Experimental Biophysical Study,” Plastic and Reconstructive Surgery, Vol. 84, 1989, pp. 21-25. doi:10.1097/00006534-198907000-00003
[21] E. Abemayor, J. Zemplenyi, C. Mannai, D. J. Webb and R. F. Canalis, “The Fixation of Malar Fractures with the Transnasal Kirschner Wire,” Journal of Otolaryngology, Vol. 17, No. 4, 1988, pp. 179-182.
[22] M. Zingg, K. Laedrach, J. Chen, et al., “Classification and Treatment of Zygomatic Fractures: A Review of 1025 Cases,” Journal of Oral and Maxillofacial Surgery, Vol. 50, No. 8, 1992, pp. 778-790. doi:10.1016/0278-2391(92)90266-3
[23] P. R. Langsdon, T. A. Knipe, W. S. Whatley, et al., “Transconjunctival Approach to the Zygomatico-Frontal Limb of Orbitozygomatic Complex Fractures,” Facial Plastic Surgery, Vol. 21, No. 3, 2005, pp. 171-175. doi:10.1055/s-2005-922855
[24] F. Holzle, S. Swaid, T. Schiwy, et al., “Management of Zygomatic Fractures via a Transconjunctival Approach with Lateral Canthotomy While Preserving the Lateral Ligament,” Mund.Kiefer.Gesichtschir., Vol. 8, 2004, pp. 296-301.
[25] L. P. Zhong and G. F. Chen, “Subciliary Incision and Lateral Cantholysis in Rigid Internal Fixation of Zygomatic Complex Fractures,” Chinese Journal of Traumatology, Vol. 7, No. 3, 2004, pp. 170-174.
[26] D. J. Courtney, “Upper Buccal Sulcus Approach to Management of Fractures of the Zygomatic Complex: A Retrospective Study of 50 Cases,” British Journal of Oral and Maxillofacial Surgery, Vol. 37, No. 6, 1999, pp. 464-466. doi:10.1054/bjom.1999.0010
[27] H. Matsumura, H. Yakumaru and K. Watanabe, “Temporal Approach for Reduction of Zygomatic Fractures: Clinical Results and Advantages of the Technique,” Journal of Plastic Surgery and Hand Surgery, Vol. 28, No. 1, 1994, pp. 49-53. doi:10.3109/02844319409015995

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.