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Facial anatomy
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
The zygoma is the cheekbone (Figure 3.3) and is therefore a very important bone when it comes to beauty. It sits proud on the upper lateral part of the face, forming the bony prominence of the cheek as well as the lateral wall of the orbit. The zygoma has a body, the palpable bony protuberance you can feel when you press on your cheek which articulates with the maxilla, an arch which extends posteriolaterally and attaches to the temporal bone; and a frontal process articulates superiorly with the frontal bone. The zygoma not only offers protection to the cheek and globe but also offers attachments for many muscles of the face, which are discussed in greater detail in the facial muscles chapter.
Nasal Cavity and Paranasal Sinus Malignancy
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Cyrus Kerawala, Peter Clarke, Kate Newbold
The body of the zygoma, midline of the palate and pterygoid plates need to be divided. The palatal osteotomy is placed in the floor of the nasal cavity and is most easily carried out using power tools. The pterygoid plates are best separated from the maxilla with a curved osteotome and subsequently dissected free from the muscles. Osteotomies are made medially through the ethmoid cells and then frontal process of the maxilla, the latter after dividing the lacrimal sac. The maxilla is separate from the skull above by osteotomies through the frontal process of the maxilla. Laterally the osteotomy is made through the body of the zygoma. In tumours that are laterally placed, and in which the zygoma needs to be included in the resection then the osteotomy is best made in the lateral orbital wall below Whitnall’s tubercle and through the zygomatic arch (Figure 7.15).
Approaches to the Nasopharynx and Eustachian Tube
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
The patient is intubated and placed in a supine position and draped. A Weber–Ferguson–Longmire incision is made, extending laterally onto the zygoma (Figure 109.4a). The vertical incision limb goes through the upper lip and is continued between the central incisors and onto the hard palate. After reaching the border of the hard and soft palate the incision is curved laterally to run behind the maxillary tuberosity. The facial incision is made through the subcutaneous, muscular and periosteal layers. Gentle, minimal elevation of these tissues exposes the planned osteotomy line (Figure 109.4b). The osteotomy is started by separating the zygoma from the maxilla, moving medially along the infraorbital rim until the frontal process is divided from the anterior maxillary wall. Then the medial maxillary wall is separated from the midline nasal complex in an antero-posterior fashion. The posterior wall is released without direct vision using an osteotome inserted through the antrum. The palatal bone is incised and a midline osteotomy fashioned. Finally, the pterygoid plates are separated from maxillary tuberosity by using a curved osteotome (Figure 109.4c). The entire maxilla can be swung laterally attached to the cheek flap and the masseter muscle (Figure 109.4d). The epipharynx is widely exposed including the cartilaginous Eustachian tubes of both sides, thus allowing en bloc resection of confined pathologies in this region.
Open Globe Injuries with Concurrent Orbital Fractures – Clinical Settings and Factors Predicting Outcomes
Published in Seminars in Ophthalmology, 2023
Tarjani Vivek Dave, Prapti Praful Chheda, Anthony Vipin Das, Vivek Pravin Dave
This was a retrospective, consecutive, non-comparative interventional case series. The study was conducted at a tertiary eye care center in southern India in accordance with the tenets of the Declaration of Helsinki and with appropriate institutional review board approval. All eyes presented to our centers from January 2014 to January 2021 with concurrent open globe injuries with orbital fractures that underwent management were included. The cases were defined as globe rupture, penetrating injury, intraocular foreign body (IOFB), and perforating injury as per the BETTS classification.11 The patient or the parents or guardians of the patient filled out a standard consent form for electronic data privacy at the time of registration. None of the identifiable parameters of the patient were used for analysis of the data. The clinical data of each patient who underwent a comprehensive ophthalmic examination was entered into a browser-based electronic medical records system (eyeSmart EMR) by uniformly trained ophthalmic personnel and supervised by an ophthalmologist using a standardized template.12 Data recorded included age, gender, mode of injury, zone of injury, classification of the injury, presenting visual acuity, surgery performed, associated corneal involvement, lens rupture, vitreous hemorrhage and retinal detachment, type and extent of orbital fractures, involvement of the orbital rim and involvement of the zygoma were noted. All cases were followed up till they were lost to follow up. Only those cases with a minimum follow-up of 3 months were included in the study.
A case of silent sinus syndrome following a history of multiple facial traumas
Published in Clinical and Experimental Optometry, 2021
A 67‐year‐old Caucasian male reported a two‐month history of painless sudden‐onset diplopia and progressive left facial paraesthesia. He reported a history of multiple facial injuries; the most recent was blunt trauma from a fist five months earlier. He denied prior surgical intervention. Two months after the assault and one month prior to the onset of symptoms, he underwent an unremarkable routine eye examination. The patient denied history of sinus disease or other symptoms. He exhibited facial asymmetry with 4-mm left enophthalmos and 5-mm left hypoglobus, left infraorbital nerve paraesthesia, and restricted movement on upgaze. Best‐corrected visual acuity was 6/6. CT scan of the orbit with contrast was obtained due to suspicion for orbital floor fractures with extraocular muscle entrapment. Imaging revealed chronic fractures of the left zygoma, lateral orbital walls, and anterior maxillary walls. There was evidence of bony remodelling of the left maxillary sinus walls and complete opacification and reduction in volume of the left maxillary sinus. Inferior bowing of the orbital floor and inferior rectus muscle was also observed (Figures 1 and 2). There was no acute fracture of the orbital floor and no extraocular muscle entrapment. He was diagnosed with SSS.
Advanced osteoradionecrosis of the maxilla: a 15-year, single-institution experience of surgical management
Published in Acta Oto-Laryngologica, 2020
Zimeng Li, Shangping Liu, Shang Xie, Xiaofeng Shan, Lei Zhang, Zhigang Cai
Nevertheless, when maxillary ORN involved multiple bones, the first choice of surgery was more likely to be segmental osteotomy plus flap reconstruction (p = .023). Among the seven cases with multiple bone lesions, three involved the zygomatic bone. The main blood supply of the zygoma is via the maxillary artery, and it can be affected by the operation on maxilla, which may be one of the main causes of zygomatic ORN [13]. Due to the prominent position, it can no longer form effective soft tissue coverage once the zygoma is exposed, which was considered that they had poor soft tissue condition. Therefore, we chose segmental osteotomy and flap repair as the surgical method for all patients with zygomatic exposure. On the other hand, the maxilla is adjacent to the skull base, with many major nerves and blood vessels around it. If maxillary ORN progresses, the skull base can be easily affected, which may lead to central nervous infection or even fatal bleeding [18]. Therefore, it is necessary to perform flap surgery when the important positions (pterygomandibular space, skull base, etc.) are affected by maxillary ORN.