Bones and joints
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings in McMinn’s Concise Human Anatomy, 2017
Cranium - strictly means the skull without the mandible, but is often used to mean the upper part of the skull that encloses the brain; it is made up of paired parietal and temporal bones and of single occipital, sphenoid, ethmoid and frontal bones. The uppermost part is the cranial vault, the rest is the base of the skull. External features are considered below and internal features in Chapter 3 (Head, neck and vertebral column, p. 35). Pterion - region where parietal, frontal, sphenoid and temporal bones meet to give an H-shaped pattern of suture lines (Figs. 2.1B, 2.2B). It lies about 5 cm above the midpoint of the zygomatic arch. Underlying it on the inside is a branch of the middle meningeal artery, liable to be damaged in skull fractures of this area and cause haemorrhage, with resulting pressure on the brain. Bone can be drilled away to relieve pressure and ligate the damaged vessel. Facial skeleton - the front (anterior) part of the skull, containing the orbital and nasal cavities. The principal bones are the single mandible (lower jaw with lower teeth) and paired zygomatic bones and maxillae (forming the upper jaw with upper teeth), with the frontal bone forming the forehead. The margins of each orbit are formed by the frontal and zygomatic bones and maxilla. The zygomatic bone is often called the cheek bone. The frontal, ethmoid and sphenoid bones and the maxillae contain the paranasal air sinuses (Fig. 3.25 ).
Head and facial injuries
Ffion Davies, Colin E. Bruce, Kate Taylor-Robinson in Emergency Care of Minor Trauma in Children, 2017
Fractures of the zygoma (Figure 4.2) are also unusual in children, and usually associated with quite severe injury, or a punch. The hallmark signs of zygomatic fracture are unilateral epistaxis, swelling and bruising of the area, subconjunctival haemorrhage (the posterior border of which cannot be seen) and loss of sensation in the distribution of the infraorbital nerve (around the cheek, nose, gum and lip on the affected side). In this age group it is best to ask advice, the same day, from the OFM service.
The paranasal sinuses
Rogan J Corbridge in Essential ENT, 2011
Fractures of the zygoma (Figure 11.14a) are usually caused by direct trauma to the cheek. Soon after the injury, the depression of the cheek that results may be apparent. However, swelling of the overlying soft tissues rapidly obscures this defect, and the diagnosis should be suspected if there is bony tenderness or if a step is palpable in the bone. Numbness over the cheek indicates that the infra-orbital nerve has been damaged. Elevation of the depressed segment is achieved via an incision within the hairline.
Not only “nurture”, but also “nature”, influence the outcome of zygoma repair
Published in Journal of Plastic Surgery and Hand Surgery, 2013
Tomohisa Nagasao, Tomoki Itamiya, Yoshiaki Sakamoto, Yusuke Shimizu, Hisao Ogata, Hua Jiang, Kazuo Kishi, Tsuyoshi Kaneko
The present study aims to elucidate the relationship between preoperative deviation patterns of fractured zygomas and treatment outcomes. Forty-five randomly selected patients with tri-pod type zygoma fractures were classified into a medial rotation group and a lateral rotation group, depending on preoperative deviation patterns. A minimum of 6 months after the operation, symmetry of the cheek was evaluated by three plastic surgeons using a VAS system. The evaluated scores were compared between the two groups. Furthermore, simulation of postoperative secondary deformity was performed by applying hypothetically defined relapse forces on CAD models produced by referring to the CT data of 20 patients. The deviation values obtained by the simulation were compared between the two groups. The results demonstrate that VAS scores were higher for the lateral rotation group than for the medial rotation group and that the deviation values were higher for the medial rotation group than for the lateral rotation group. It is concluded that treatment outcomes of zygoma fractures are affected by preoperative deviation patterns. Cases with medial rotation are likely to present poorer outcomes than those with lateral rotation.
Closed reduction of zygomatic tripod fractures using a towel clip
Published in Journal of Plastic Surgery and Hand Surgery, 2017
Anı Cinpolat, Ozlenen Ozkan, Gamze Bektas, Omer Ozkan
Background: The zygomatic bone constitutes the prominence of the cheek. Fractures of the zygomatic bone are the second most treatment of zygomatic bone fractures and can be examined under two headings, open and closed reductions. This paper describes a new technique in the closed reduction of tripod fractures using a towel clip. Methods: Seventeen consecutive patients (three females, 14 males) with a mean age of 35.5 years (range = 18–66 years) with zygomatic tripod fracture were treated using the towel clip technique between December 2011 and February 2014. Results: Patients were assessed in the first and 6 months postoperatively, by physical examination and computed tomography. Preoperatively, nine patients had paresthesia in the infraorbital nerve region. Three of these cases regressed postoperatively. Persistent collapse of the zygomatic projection was present in one patient. Conclusion: Non-comminuted zygomatic tripod fractures can be easily treated percutaneously with the towel clip method in the absence of preoperative ocular problems such as diplopia, enophthalmos, or restricted eye movements. The technique is economical, fast, and safe. The possibility of persistent zygoma collapse after reduction should be kept in mind, and preoperatively the team should be warned of the possibility of progression to open reduction during surgery.
Osteochondroma of the Right Coronoid Process (Jacob Disease): A Case Report
Published in CRANIO®, 2013
Nobuko Aoki, Kazuhiko Okamura, Daisuke Niino, Osamu Iwamoto, Jingo Kusukawa
Oscar Jacob was the first to describe osteochondroma of the coronoid process, naming it “Jacob disease.”1 Jacob disease rarely occurs in the oral and maxillofacial regions. The tumor usually grows progressively, leading to a mushroom-shaped enlargement of the process, and a joint-like structure is found between the coronoid process and the inner aspect of the zygomatic arch. Most of these lesions grow like a mushroom on, and do not destroy, the coronoid process. The major symptoms include restricted mouth opening and morphological changes to the zygoma. The authors present a case report on an 18-year-old male patient with pain in the right zygoma. Interincisal maximum mouth opening was 51 mm. An intraoral coronoidectomy was performed.