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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (2): 356-362. doi: 10.19723/j.issn.1671-167X.2022.02.025

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Relationship between prognosis and different surgical treatments of zygomatic defects: A retrospective study

LAN Lin,HE Yang(),AN Jin-gang,ZHANG Yi   

  1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2020-04-13 Online:2022-04-18 Published:2022-04-13
  • Contact: Yang HE E-mail:fridaydust1983@163.com
  • Supported by:
    National Key R&D Program of China(2017YFB1104103)

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Abstract:

Objective: To evaluate the effect and summarize the characteristics of different treatment methods in repairing zygomatic defect. Methods: A total of 37 patients with zygomatic defect were reviewed in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from August 2012 to August 2019. According to the anatomical scope of defect, the zygomatic defects were divided into four categories: Class 0, the defect did not involve changes in zygomatic structure or continuity, only deficiency in thickness or projection; Class Ⅰ, defect was located in the zygomatic body or involved only one process; Class Ⅱ, a single defect involved two processes; Class Ⅲa, referred to a single defect involving three processes and above; Class Ⅲb, referred to zygomatic defects associated with large maxillary defects. The etiology, defect time, defect size and characteristics of zygomatic defects, the repair and reconstruction methods, and postoperative complications were collected and analyzed. Postoperative computed tomography (CT) data were collected to evaluate the outcome of zygomatic protrusion. Chromatographic analysis was used to assess the postoperative stability. Results: Among the causes of defects, 25 cases (67.57%) were caused by trauma, and 11 cases (29.73%) were of surgical defects following tumor resection. We performed autologous bone grafts in 19 cases, 6 cases underwent vascularized tissue flap,5 cases underwent external implants alone, and 7 cases underwent vascularized tissue flap combined with external implants. After the recovery of the affected side, the average difference of the zygomatic projection between the navigation group and the non-navigation group was 0.45 mm (0.20-2.50 mm) and 1.60 mm (0.10-2.90 mm), with a significant difference (P=0.045). Two patients repaired with titanium mesh combined with anterolateral thigh flap had obvious deformation or fracture of titanium mesh; 2 patients with customized casting prosthesis had infection after surgery and fetched out the prosthesis finally. Conclusion: Autologous free grafts or alloplastic materials may be used in cases without significant structural changes. Pedicle skull flap or vascularized bone tissue flap is recommended for zygomatic bone defects with bone pillar destruction, chronic inflammation, oral and nasal communication or significant soft tissue insufficiency. Titanium mesh can be used to repair a large defect of zygomatic bone, and it is suggested to combine with vascularized bone flap transplantation.

Key words: Zygoma, Bone and bones, Reconstructive surgical procedures, Prognosis

CLC Number: 

  • R782.26

Figure 1

Classification of zygomatic defects Class 0, defects does not involve changes in the zygomatic structure, and involves in only thickness or suddenness; Class Ⅰ, defects are located in the zygomatic body or involved only one process; Class Ⅱ, a single defect involving two processes; Class Ⅲa, a single defect involving three processes and above; Class Ⅲb, zygomatic defects are associated with large maxillary defects (including Brown 3)."

Figure 2

Postoperative zygomatic protrusion was measured In ProPlan CMF 3.0, after calibration of the symmetric plane, the dif-ferences in the values of zygomatic arch protrusion on both sides were analyzed and compared."

Table 1

General information of different types of zygomatic bone defects"

Items 0 (n=1) Ⅰ (n=15) Ⅱ (n=7) Ⅲa (n=5) Ⅲb (n=9)
Gender
Male 0 14 5 4 6
Female 1 11 2 1 3
Age/years 22 44 (23-77) 41 (9-67) 31 (22-40) 36 (21-57)
Etiology
Skeletal dysplasia 1 0 0 0 0
Trauma 0 13 6 4 2
Tumor 0 2 1 1 7
CNTS
Yes 1 5 5 5 9
No 0 10 2 0 0

Figure 3

Some commonly used prosthodontic surgical methods A, cranial bone grafts repair the continuity of the zygomatic arch; B, pedicled cranial bone flap was prepared and transferred to repair the zygomatic body; C, vascularized iliac crest bone flap was used to repair the defects of right zygomatic bone caused by trauma; D, the defect of right zygomatic ma-xillary bone was repaired using preoperatively bent titanium mesh; E, after tumor resection of right zygomatic-maxillary bone, the titanium mesh was used to repair the defects of zygomatic-maxillary bone; F, Ti-mesh + anterolateral femoral flap was used to repair the defects after tumor resection of the left zygomatic maxilla."

Figure 4

Customized casting prosthesis A, the model of customized casting prosthesis of zygomatic-maxillary bone; B, under the guidance of intraoperative navigation, a customized titanium casting prosthesis was implanted into the zygomatic maxillary bone."

Figure 5

Chromatographic and CT data were used for stability evaluation A, the defects of zygomatic temporal process and zygomatic orbital process after trauma were repaired with cranial bone grafts 2 years later, and chromatographic analysis showed overall thickening of the local thickness of the zygomatic bone; B, C, the defects of zygomatic maxilla were repaired using personalized pre-curved Ti-mesh and anterolateral femoral flap after resection of adenoid cystic carcinoma, and chromatographic analysis showed obvious deformation of titanium mesh 2 years later; D, 2 years after the repair of left zygomatic maxilla with Ti-mesh and anterolateral thigh flap, CT showed fracture of the titanium mesh at the zygomatic arch and zygomatic frontal suture; E, Ti-mesh combined with iliac crest bone flap was used to repair the defect of zygomatic maxillary bone, and chromatographic analysis showed that the local thickness of the ilium was decreased one year later; F, Ti-mesh combined with fibular flap was used to repair the defect of zygomatic maxillary bone, showing no significant changes one year later."

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