관골상악골 복합체 골절 환자에서의 안면 비대칭에 대한 임상경험 (Clinical Experiences of Facial Asymmetries in Zygomaticomaxillary Complex Bone Fracture Patients)

서지정보

· 발행기관 : 대한성형외과학회
· 수록지 정보 : Archives of Plastic Surgery / 38권 / 2호 / 161 ~ 165페이지
· 저자명 : 강낙헌, 최상문, 김주학, 송승한, 오상하

초록

Purpose: Zygomaticomaxillary complex (ZMC) fracture is one of the most common facial injuries after facial trauma. As ZMC composes major facial buttress, it is a key element of the facial contour. So, when we treat these fractures, the operator should have a concern with the symmetry to restore normal appearance and function. But sometimes, unfavorable results may occur. The aim of this study is to analyze the unsatisfied midfacial contour after ZMC fractures reduction retrospectively and to point out the notandum.
Methods: 369 patients, treated for fractures of the ZMC were included in the study. After operation, such as open reduction and internal fixation (ORIF with titanium or absorbable materials), open reduction, and closed reduction, midfacial contour was evaluated with plain films and 3 - dimensional computed tomography. And unfavorable asymmetric midfacial contours were correcterd by secondary correction and re - evaluated. Gross photographs were obtained at outpatient clinic.
Results: Total 38 patients had got a facial asymmetry and among of them 24 patients were treated secondary revisional ORIF operations for correction of unfavorable result of after primary reduction. Two of them had received tertiary operations, three patients had got osteotomy more than after one year and six patients had got minor procedures. The etiology of asymmetry were lateral displaced simple fracture of arch (n = 2), lateral displaced comminuted fracture of arch (n = 6), comminuted arch fracture combined posterior root fracture (n = 9), and communited arch and body fracture (n = 12), severely contused soft tissue (n = 9). After the manipulations outcomes were acceptable.
Conclusion: To prevent the asymmetry in ZMC fracture reduction, complete analysis of fracture, choice of appropriate operation technique, consider soft tissue, and secure of zygoma position are important. Especially, we should be more careful about communited fracture of zygomatic body and lateral displacement, root fracture of zygomatic arch. Because they are commom causes that make facial asymmetry. To get optimal result, ensure the definite bony reduction.

영어초록

Purpose: Zygomaticomaxillary complex (ZMC) fracture is one of the most common facial injuries after facial trauma. As ZMC composes major facial buttress, it is a key element of the facial contour. So, when we treat these fractures, the operator should have a concern with the symmetry to restore normal appearance and function. But sometimes, unfavorable results may occur. The aim of this study is to analyze the unsatisfied midfacial contour after ZMC fractures reduction retrospectively and to point out the notandum.
Methods: 369 patients, treated for fractures of the ZMC were included in the study. After operation, such as open reduction and internal fixation (ORIF with titanium or absorbable materials), open reduction, and closed reduction, midfacial contour was evaluated with plain films and 3 - dimensional computed tomography. And unfavorable asymmetric midfacial contours were correcterd by secondary correction and re - evaluated. Gross photographs were obtained at outpatient clinic.
Results: Total 38 patients had got a facial asymmetry and among of them 24 patients were treated secondary revisional ORIF operations for correction of unfavorable result of after primary reduction. Two of them had received tertiary operations, three patients had got osteotomy more than after one year and six patients had got minor procedures. The etiology of asymmetry were lateral displaced simple fracture of arch (n = 2), lateral displaced comminuted fracture of arch (n = 6), comminuted arch fracture combined posterior root fracture (n = 9), and communited arch and body fracture (n = 12), severely contused soft tissue (n = 9). After the manipulations outcomes were acceptable.
Conclusion: To prevent the asymmetry in ZMC fracture reduction, complete analysis of fracture, choice of appropriate operation technique, consider soft tissue, and secure of zygoma position are important. Especially, we should be more careful about communited fracture of zygomatic body and lateral displacement, root fracture of zygomatic arch. Because they are commom causes that make facial asymmetry. To get optimal result, ensure the definite bony reduction.

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