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In partial Fulfillment for the requirements on the Related Learning Experience
Submitted by: Costales, Butch V. NR-22
Submitted to: Prof. Pastora M. Baro RN, MAN Clinical Instructor
January 15, 2011 Date Submitted
Introduction The zygomatic bone occupies a prominent and important position in the facial skeleton. and Osaiyuwu has shown that road traffic accidents are responsible for most zygomatic complex fractures in our environment. sports and missile injuries The study of Obuekwe. falls. In addition. assaults. The zygoma has several important articulations in significant portion of the floor and lateral wall of the orbit. Department of Oral and Maxillofacial Surgery. Etiology and pattern of zygomatic complex fractures: a retrospective study. . Fractures of the zygomatic complex are among the most frequent in maxillofacial trauma. Nigeria. University of Benin Teaching Hospital. the zygoma meets the lateral skull to form the zygomatic arch. Edo State. It plays a key role in determining facial width as well as acting as a major support of the midface. Its anterior projection forms the malar eminence and is often referred to as the malar bone. Urgent enforcement of road traffic legislation is necessary to minimize zygomatic complex fractures due to road traffic accidents. The etiology of zygomatic complex fractures include road traffic accidents. The zygomatic complex is responsible for the mid-facial contour and for the protection of the orbital contents. Owotade.
its prominent location makes it prone to fracture. These are the most common. and the zygomatic arch. displaced fractures involve the inferior orbital rim and orbital floor. Lateral to each end of the arch. in spite of its sturdiness. The mechanism of injury usually involves a blow to the side of the face from a fist. Fracture in the middle of the arch causing a V fracture which could impinge on the temporalis muscle. Comminuted fractures of the body with separation at the suture lines are most often the result of high-velocity motor vehicle accidents. and the body forms the malar eminence of the face. the zygomaticomaxillary buttress. Patients usually present with pain on opening their mouth. medial. and posterior displacement of the zygoma. 2. Types Zygomatic Arch Fracture. 1. the zygomaticofrontal suture. a direct blow to the arch results in an isolated depressed fracture of the arch only. but. Direct blow to the arch can result in isolated arch fractures. In general. occasionally. More severe blows frequently result in inferior. Fractures to the zygoma are usually the result of blunt trauma.can fracture in 2-3 places along the arch. Moderate force may result in minimally or nondisplaced fractures at the suture lines. While tripod fractures are more serious and are caused by more extensive trauma. or secondary to motor vehicle accidents. The zygoma has 2 major components. the zygomatic arch and the body. . from an object.Pathophysiology The zygoma is the main buttress between the maxilla and the skull. The arch forms the the inferior and lateral orbit. However.
>Pain in cheek and jaw movement and limited mandibular movement which is due to impingement of the coronoid process of the mandible on the arch during mouth opening or impingement of the temporalis muscle. Picture: patient with blunt trauma to the zygoma. as well as the zygomatic arch. Flattening of the right malar eminence is evident. Note the disruption of both the lateral orbital rim and the orbital floor. Clinical features: >Periorbital edema and ecchymosis >Hypesthesia of the infraorbital nerve >Palpation may reveal step off >Concomitant globe injuries are common . Zygomatic Tripod Fracture Tripod fractures consist of fractures through: >Zygomatic arch >Zygomaticofrontal suture >Inferior orbital rim and floor Picture: Diagram of a tripod fracture.Clinical findings: >Palpable bony defect over the arch >Depressed cheek with tenderness on palpation.
infraorbital region & upper teeth on injured side >Visual complaints >Swelling. orbital dystopiamalposition or displacement of the bony cavity surrounding the eye sensory deficits secondary to insult of the zygomaticofacial and zygomaticotemporal branches persistent diplopia . Ecchymoses >Eyelid swelling >Inability to close mouth properly >Blood in the side of the eye on the affected side sometimes is present.a condition typified by partial loss of movement.an acquired or congenital distortion of facial parts . Edema. Complications Paresis of the orbicularis oculi and zygomaticus muscles.General Signs and Symptoms >Pain with jaw movement >Flattened cheekbone >Palpable depression at fracture site >Altered sensation underneath the eye on the affected side >Numbness of the cheek.is double vision caused by a defective function of the significant residual deformity. or impaired movement of orbicularis oculi and zygomaticus muscles extraocular muscles or a disorder of the nerves that innervate (stimulate) the muscles.
The CT scan has now essentially replaced plain films as the gold standard in both evaluation and treatment planning. Yang QF and Zhou MX suggests that key points of perioperative nursing are psychological nursing. nurses should take active hemostatic. Yongkang 321300. If physical findings and plain films are not suggestive of a zygomatic fracture. if they do suggest fracture. anti-infection measures with good postoperative care of incision. Nursing Management Perioperative nursing care of patients with zygomatic complex fracture Stomatological Department of Yongkang First People's Hospital.Diagnostic Procedures Radiographic evaluation of the fracture is mandatory and may include both plain films and a computed tomographic (CT) scan. antishock as well as. The CT scan will accurately reveal the extent of orbital involvement. a coronal and axial CT scan should be obtained. the evaluation may end here. China This study of the researchers Shi BM. Treatment . nutrition and observation of complications.In addition. However. as well as degree of displacement of the fractures. This study is vital for planning the operative approach. Zhejiang Province. including elimination of fear and pessimism.
Treatment for Zygomatic Arch Fracture: >Consult maxillofacial surgeon >Ice and analgesia >Possible open elevation Treatment for Zygomatic Arch Fracture: Nondisplaced fractures without eye involvement >Ice and analgesics >Delayed operative consideration 5-7 days . successful outcomes are the result of a planned approach that affords excellent exposure of the operative site and of the use of meticulous surgical technique.Medical Therapy If surgical correction is performed. secondary to spontaneous reduction with repair of other ZMC fracture components. direct repair and fixation are indicated. In 1999. If an aesthetic deformity is the product of an arch fracture or if trismus is present. repair of zygomatic arch fractures requires a precise reduction and definitive stabilization to ensure positive outcomes. prescribe prophylactic antimicrobial therapy if a history of endocarditis or other conditions requiring antibiotics is known. Repair of the zygomatic arch is usually performed in concert with repair of zygomaticomaxillary complex (ZMC) fracture stabilization. Turk et al found that direct repair and plating of the zygomatic arch was not indicated in more than 1500 patients. Surgical Therapy Reconstruction of the zygomatic arch following injury is necessary for restoration of malar symmetry and support for the maxilla and masticatory loads. As with all surgical procedures. More specifically.
>Tetanus Toxoid Displaced tripod fractures usually require admission for open reduction and internal fixation Patient with a left displaced zygomatic fracture. An open reduction with rigid miniplate fixation was performed .>Decongestants >Broad spectrum antibiotics since the fracture crosses into the maxillary sinus.
>CT scan. Displaced fractures involve >inferior orbital rim and orbital floor. Etiology >Road traffic accidents >Assaults >Falls >Sports and missile injuries The study of Obuekwe. infraorbital region and upper teeth on injured side >Visual Complaints >Swelling. object. Edema. >the zygomaticofrontal suture. >the zygomaticomaxillary buttress. or secondary to motor vehicle accidents. Owotade.plain films are replaced as the gold standard in evaluation and treatment planning >Zygomaticofrontal suture >Inferior orbital rim and floor . Ecchymoses >Eyelid swelling >Inability to close mouth properly >Blood in the side of the eye on the affected side sometimes is present. and Osaiyuwu has shown that road traffic accidents are responsible for most zygomatic complex fractures Pathophysiology blow to the side of the face => fist.with postoperative result shown. Complications >Paresis of the orbicularis oculi and zygomaticus muscles >Sensory deficits >Persistent Diplopia >Orbital Dystopia >Significant Residual Deformity Diagnostic Procedures >Radiographic Evaluation-mandatory may include both plain films and CT scan. and >the zygomatic arch Types Zygomatic Arch Fracture SS/Sx >Pain with jaw movement >Flattened cheekbone >Palpable depression at fracture site >Altered sensation underneath the eye on the affected side >Numbness of the cheek. Zygomatic Tripod Fracture consist of fractures through: >Zygomatic arch Lecture Outline: Introduction The Zygomatic Bone occupies a prominent and important position in the facial skeleton. Comminuted zygomatic fractures with separation at the suture lines=> results from high-velocity motor vehicle accidents.
Nurses should take >active hemostatic >antishock >anti-infection post-operative care >incision >nutrition >observation of complication Treatment Medical Therapy >Prophylactic Antimicrobial therapy Surgical Therapy >Reconstruction of Zygomatic Arch significant residual deformity orbital dystopia .>Coronal and Axial CT scan will accurately reveal the extent of orbital involvement as well as degree of displacement of the fractures Nursing management Perioperative nursing care of patients with zygomatic fractures keypoints are eliminating fear and pessimism of the client.
Paresis of the orbicularis oculi and zygomaticus muscles persistent diplopia .