Isolated bilateral fractures of zygomatic arches: report of a case

Isolated bilateral fractures of zygomatic arches: report of a case V. Ho Depurtment

of’Oru1 and Mrrxillqfaciul

Surgery, Derbyshire Royal Infirmary, Derh)

SUMMARY. Isolated unilateral fractures of the zygomatic arch are uncommon. Isolated bilateral fractures of the zygomatic arches are even more rare. Indeed a search of the literature failed to find any previous report of this fracture pattern.

Isolated fracture of the zygomatic arch is a relatively uncommon injury which may result in limitation of mandibular movement, and a characteristic cosmetic defect if left untreated. These clinical features are the main indications for surgical reduction of the fractured arch. The following is an unusual case of isolated bilateral fractures of the zygomatic arches in a 42-year old man, following alleged assault.

included isolated bilateral zygomatic arches fractures, a fractured and displaced left condylar neck of the mandible. multiple abrasions and lacerations around the face. Past medical history was unremarkable. Plain radiographs and computerised tomogram (CT) scan confirmed the isolated bilateral fractures of the zygomatic arches (Figs l-3). Under general anaesthesia, he underwent bilateral elevation of the zygomatic arch fractures via the temporal approach, with open reduction and A/O miniplate fixation of the condylar neck fracture via the submandibular approach. Postoperative recovery was uneventful.

Case report

DISCUSSION

INTRODUCTION

A 42-year-old caucasian man presented to Derbyshire Royal Infirmary in September 1992 following an alleged assault. He gave a history of being punched on the face numerous times. He was at that time. under the influence of alcohol and had an associated head injury. His injuries

Fig. I - Occipito-mentalplain the Lygomatic

arches

and intact

X-ray, showing bilateral zygomatico-maxillary

fractures complexes.

of

In a review of the literature from 1960 to 1992 (Table 1). there were no documented cases of isolated

Figs. 2A & B - Modified submento-vertex bilateral zygomatic arch fractures.

plain X-rays.

revealing

Isolated

bilateral

fractures

of zygomatic

arches

395

eral simple elevation relying on the periosteal envelope for fixation did not prove to be a problem, the patient being extubated awake and in a slight upright supine position. Acknowledgements The author wishes to thank the Medical Illustration Infirmary.

Mr K. Jones, Department

Mr of

D. A. Mitchell and Derbyshire Royal

Further reading

Fig. 3 -CT in the transverse plane, bilateral zygomatic arch fractures.

Table 1 - Incidence bone fractures

of zygomatic

demonstrating

arch fractures

isolated

in studies

on malar

Author(s)

Incidence (‘Xi)

Population patients

Donaldson ( I96 I ) Knight & North ( 1961) Rowe & Killey ( 1968) Matsunaga et al. ( 1977) Ellis et al. (1985) Zingg et al. ( 1992)

3.0 10.0 4.2 2.5 8.4 12.0

335 I20 336 1220 2067 1025

of

Donaldson KI. Fractures of the facial skeleton: a survey of 335 patients. N Z Dent .I 1961; 57: 55-58. Ellis E 3d. el-Attar A, Moos KF. An analysis of 2,067 cases of zygomatico-orbital fracture. J Oral Maxillofac Surg 1985; 43: 417-428. Killey HC, Kay LW. Fracture of the rygomatic arch. J Dent Ass S Afr 1968: 23: 391-394. Knight JS, North JK. The classification of malar fractures. Br J Plast Surg 1961; 13: 325 339. Matsunaga RS. Simpson W. Tolfel PH. Simplitied protocol for treatment of malar fractures. Arch Otolaryngol 1977; 103: 5355538. Rowe NL. Killey HC. Fractures of the Facial Skeleton, 2nd ed. Edinburgh & London: E & S Livingstone, 1968: 896. Zingg M, Laedrach K, Chen J et al. Classification and treatment of zygomatic fractures: a review of 1,025 cases. J Oral Maxillofdc Surg 1992; 50: 778790.

The Author bilateral fractures of the zygomatic arches. Presumably, this occurence must be rare. thus stimulating further investigation of the facial fractures by CT scan. However, combined bilateral zygomaticomaxillary complex and arch fractures cases are not that uncommon. Signs and symptoms experienced in our case were similar to the unilateral arch fracture cases apart from limitation of mandibular excursion to both injured sides. Management of the fractures by bilat-

V. Ho MBChB, BAO, MDS, FRACDS, MFHom, Dip Derm Registrar Department of Oral and Maxillofdcial Derbyshire Royal Infirmary Derby DE1 2QY Correspondence Close. Southgate,

Lit AC,

Surgery

and requests for offprints London Nl4 5QR.

Paper received 6 September Accepted 20 January 1994

1993

to V. Ho, 2 Isabella