Ocular Injuries in Patients with Zygomaticomaxillary Complex (ZMC) Fractures at a Tertiary Care Hospital in Lahore
DOI:
https://doi.org/10.36283/ziun-pjmd14-2/031Keywords:
Zygomatic Bone, Ocular Injury, Fractures Zygomatic, Zygomas, Cheek Bone, Eye InjuriesAbstract
Background: Ocular injuries are commonly linked with zygomatic-maxillary fractures, yet they can be easily overlooked. This study aimed to assess the severity of ocular injuries (impact on visual acuity) and potential risks associated with patients with ZMC fractures.
Methods: This retrospective observational study was conducted at the Department of Oral & Maxillofacial Surgery, King Edward Medical University/Mayo Hospital Lahore, from January 2023 to December 2023, which analyzed the records of 73 patients with zygomaticomaxillary complex fractures having ophthalmic consultations. Non-Probability Purposive sampling technique used. Data on age, gender, injury mechanism, zygomaticomaxillary fracture type, and associated ophthalmic injuries were extracted and analyzed using SPSS 21. Descriptive statistics, including frequency, percentage, and mean ± standard deviation, was calculated. Inferential statistics, such as chi-square tests (for categorical variables) and independent samples t-tests (for continuous variables), were used to identify significant associations. A p-value < 0.05 was considered statistically significant.
Results: The Maximum patients in this study were of the age range 21-30with a Mean age 28.42 ± 7.516. Road traffic accidents were the main cause of trauma comprising 52(71.2%). Mostly patients had inward and posterior displacement type of fracture (38.4%). Periorbital ecchymosis was seen in 59(80.8%) patients, subconjunctival hemorrhage in 54(74%), Diplopia in 30(41.1%), Enophthalmos in 16(21.9%), and Exophthalmos in 5(6.8%) patients while one patient lost his vision after zygoma fracture in this study.
Conclusion: ZMC fractures often involve ocular complications; thorough eye evaluation is crucial in facial trauma cases to identify and treat associated injuries.
References
Kambalimath DH, Kambalimath HV, MVV S, V AK, TG R, Deepak RM. Retrospective analysis of management of zygomatic complex fractures. The Traumaxilla. 2023 Dec;5(1-3):20-6. doi.org/10.1177/26323273231172739
Vijayan K, Sundaresh D, Ramanujam L. Ocular trauma in mid face fractures-an interdisciplinary approach. Clinical and Experimental Ocular Trauma and Infection. 2021 April;3(1):2-9. https://dergipark.org.tr/en/pub/ceoti/issue/61851/881866
Christensen DN, Wagner WD, Maar DJ, Shostrom V, Untrauer J, Chundury RV, Geelan-Hansen K. Orbital wall fractures and ocular injury: impact on management. Facial Plastic Surgery & Aesthetic Medicine. 2023 Feb 1;25(1):22-6. doi.org/10.1089/fpsam.2021.0226
Singh I, Shetty P, Fernandes TB, Singh A. Ocular Outcomes of Maxillofacial Trauma–A Decennary Descriptive Study. Journal of Craniofacial Surgery. 2022 Jan 1;33(1):e81-4. DOI: 10.1097/SCS.0000000000008026
Septa D, Newaskar VP, Agrawal D, Tibra S. Etiology, incidence and patterns of mid-face fractures and associated ocular injuries. Journal of maxillofacial and oral surgery. 2014 Jun;13:115-9. doi.org/10.1007/s12663-012-0452-9
Jain SM, Gehlot N, Arunkumar KV, Prasad P, Mehta P, Paul TR, Dupare A, Cvns CS, Rahman S. Ophthalmic complications in maxillofacial trauma: a prospective study. Cureus. 2022 Aug;14(8). doi: 10.7759/cureus.27608
Ai-Ourainy IA, Dutton GN, Stassen LF, Moos KF, Ei-Attar A. The characteristics of midfacial fractures and the association with ocular injury: a prospective study. British journal of oral and maxillofacial surgery. 1991 Oct 1;29(5):291-301. doi.org/10.1016/0266-4356(91)90114-K
Roochi MM, Abbasi AJ, Zahedipour H, Hajiani N. The incidence of common complications, including ectropion and entropion, in transconjunctival and subciliary approaches for treatment of ZMC fractures. Journal of Dentistry. 2021 Jun;22(2):76. doi: 10.30476/dentjods.2020.84853.1101
Jamal BT, Pfahler SM, Lane KA, Bilyk JR, Pribitkin EA, Diecidue RJ, Taub DI. Ophthalmic injuries in patients with zygomaticomaxillary complex fractures requiring surgical repair. Journal of oral and maxillofacial surgery. 2009 May 1;67(5):986-9. doi.org/10.1016/j.joms.2008.12.035
Natarajan S, Baviskar PS, Gandevivala A, Gupta H, Vichare SN. Traumatic optic neuropathy in orbital wall fractures-diagnostic parameters and treatment outcomes: A prospective observational study. Journal of Stomatology, Oral and Maxillofacial Surgery. 2022 Apr 1;123(2):171-6. doi.org/10.1016/j.jormas.2021.06.010.
Kolomvos N, Giannoulis G, Papadogeorgakis N. Blindness following trauma of midfacial fractures: a retrospective study of clinical cases and review of literature. Res Rep Oral Maxillofac Surg. 2020 May;4:035. doi: 10.23937/2643-3907/1710035
Dhillon J, Nassrallah G, Nithianandan H, Gaffar J, Kondoff M, Ross M, Deschênes J. Significance of subconjunctival hemorrhage in predicting ocular pathology for patients with orbital fracture. Canadian Journal of Ophthalmology. 2023 Aug 1;58(4):295-301. doi.org/10.1016/j.jcjo.2022.02.003.
Blumer M, Rostetter C, Johner JP, Ebner JJ, Wiedemeier D, Rücker M, Gander T. Associated ophthalmic injuries in patients with fractures of the midface. Craniomaxillofacial Trauma & Reconstruction. 2020 Sep;13(3):168-73. doi.org/10.1177/1943387520922056
Ansari MH. Blindness after facial fractures: a 19-year retrospective study. Journal of oral and maxillofacial surgery. 2005 Feb 1;63(2):229-37. doi.org/10.1016/j.joms.2004.05.221
Brucoli M, Boffano P, Broccardo E, Benech A, Corre P, Bertin H, Pechalova P, Pavlov N, Petrov P, Tamme T, Kopchak A. The “European zygomatic fracture” research project: the epidemiological results from a multicenter European collaboration. Journal of Cranio-Maxillofacial Surgery. 2019 Apr 1;47(4):616-21. doi.org/10.1016/j.jcms.2019.01.026.
Dubron K, Verbist M, Shaheen E, Dormaar TJ, Jacobs R, Politis C. Incidence, aetiology, and associated fracture patterns of infraorbital nerve injuries following zygomaticomaxillary complex fractures: a retrospective analysis of 272 patients. Craniomaxillofacial Trauma & Reconstruction. 2022 Jun;15(2):139-46. doi.org/10.1177/19433875211022569
Singh P, Patil PM. Ophthalmologic Injuries Associated with Maxillofacial Trauma-A Retrospective 13 Year Analysis. Biomedical Journal of Scientific & Technical Research. 2020 Dec;32(3):25031-6. DOI: 10.26717/BJSTR.2020.32.005256.
Malik AH, Shah AA, Ahmad I, Shah BA. Ocular injuries in patients of zygomatico-complex (ZMC) fractures. Journal of maxillofacial and oral surgery. 2017 Jun;16:243-7. doi.org/10.1007/s12663-016-0907-5
Martina NR, Manalu EP, Ramadhania A, Simbolon BP. Teamwork Approach in Management of Zygomaticomaxillary Complex (ZMC) Fracture with Globe Rupture: A Case Report. Jurnal Plastik Rekonstruksi. 2022 Jun 7;9(1):1-6. doi.org/10.14228/jprjournal.v9i1.326.
Riaz N, Chatha AA, Warraich RA, Hanif S, Chinar KA, Khan SR. Ophthalmic injuries in orbito-zygomatic fractures. J Coll Physicians Surg Pak. 2014 Sep 1;24(9):649-52. https://pubmed.ncbi.nlm.nih.gov/25233969/
Umarane S, Kale T, Tenagi A, Manavadaria Y, Motimath Sr AS. A clinical study of the evaluation and assessment of the etiology and patterns of ocular injuries in midfacial trauma in a tertiary care hospital. Cureus. 2020 Sep;12(9). doi: 10.7759/cureus.10216.
Terrill SB, You H, Eiseman H, Rauser ME. Review of ocular injuries in patients with orbital wall fractures: a 5-year retrospective analysis. Clinical ophthalmology. 2020 Sep 24:2837-42. doi.org/10.2147/OPTH.S274567.
Saleem Q, Qasim T, Shaikh TH, Habiba U, Irshad F, Bajwa HA. Association of Infraorbital Nerve Injury with Zygomaticomaxillary Complex Fractures at a Tertiary Care Hospital, Karachi. Pakistan Journal of Medicine and Dentistry. 2024 Apr 16;13(2):48-54. doi.org/10.36283/PJMD13-2/008.
Senarak W, Yongvikul A, Ku JK, Kim JY, Huh JK. Effect of orbital volume in unilateral orbital fracture on indirect traumatic optic neuropathy. International Ophthalmology. 2023 Apr;43(4):1121-6. doi.org/10.1007/s10792-022-02509-w.
Rajkumar GC, Ashwin DP, Singh R, Prashanth R, Rudresh KB. Ocular injuries associated with midface fractures: a 5 year survey. Journal of maxillofacial and oral surgery. 2015 Dec;14:925-9. doi.org/10.1007/s12663-015-0778-1.
Shim WS, Jung HJ. Management of Orbital Blowout Fractures: ENT Surgeon's Perspective. Journal of Rhinology. 2019 Nov 30;26(2):65-74. doi.org/10.18787/jr.2019.26.2.65.
Bradley D, Leung B, Saxena S, Dungarwalla M, Chapireau D, Fan K. Surgical management of zygomatic complex fractures in a major trauma centre. Plastic and Aesthetic Research. 2019 May 24;6. DOI: 10.20517/2347-9264.2019.06
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