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Defining the Zygomaticosphenoidal Angle as a Guide to Anatomic Zygomaticomaxillary Complex Fracture Reduction.

Abstract

BACKGROUND

Alignment of the zygomaticosphenoid suture is fundamental to reduction of zygomaticomaxillary complex fractures. To prevent a rotational deformity, the correct angle of the zygoma relative to the cranial base must be restored. Clinically, this can be a challenge, especially when there is comminution of the zygomaticosphenoid suture. Defining a zygomaticosphenoidal angle would provide a reference for use with stereotactic navigation to achieve anatomic reduction.

METHODS

A single-center retrospective analysis of 100 patients was designed to determine normative zygomaticosphenoidal angle values. An angle subtended by the midline and a best-fit line through the zygomaticosphenoid suture on axial computed tomography was measured bilaterally in patients with isolated mandibular or nasal fractures. The mean of this measurement for 3 vertically adjacent cuts was calculated with position of central cut determined by the equator of the globe and trigone of the sphenoid. Multivariate regression was completed to identify changes in zygomaticosphenoidal angle with age, sex, and race.

RESULTS

The mean zygomaticosphenoidal angle was 47° (range 39°-55°). 97% of angles were within 2 standard deviations (8°) of mean. Regression analysis demonstrated no significant change in angle with age (P = 0.74) or sex (P = 0.89). For each angle, the variation across the 3 sample cuts was ≤4.5°. Patients demonstrated high fidelity in zygomaticosphenoidal angle bilaterally with mean difference of 3°.

CONCLUSION

The zygomaticosphenoidal angle is a useful reference, in conjunction with stereotactic navigation, for reduction of zygomaticomaxillary complex fractures. Contralaterally obtained patient-specific data may be used to guide unilateral repair. Normative values may serve as reference in bilateral injury.

Authors+Show Affiliations

Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31261347

Citation

De Ruiter, Brandon J., et al. "Defining the Zygomaticosphenoidal Angle as a Guide to Anatomic Zygomaticomaxillary Complex Fracture Reduction." The Journal of Craniofacial Surgery, 2019.
De Ruiter BJ, Levin A, Nash D, et al. Defining the Zygomaticosphenoidal Angle as a Guide to Anatomic Zygomaticomaxillary Complex Fracture Reduction. J Craniofac Surg. 2019.
De Ruiter, B. J., Levin, A., Nash, D., Kamel, G., Mostafa, E., Baghdasarian, D., & Davidson, E. H. (2019). Defining the Zygomaticosphenoidal Angle as a Guide to Anatomic Zygomaticomaxillary Complex Fracture Reduction. The Journal of Craniofacial Surgery, doi:10.1097/SCS.0000000000005724.
De Ruiter BJ, et al. Defining the Zygomaticosphenoidal Angle as a Guide to Anatomic Zygomaticomaxillary Complex Fracture Reduction. J Craniofac Surg. 2019 Jun 28; PubMed PMID: 31261347.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Defining the Zygomaticosphenoidal Angle as a Guide to Anatomic Zygomaticomaxillary Complex Fracture Reduction. AU - De Ruiter,Brandon J, AU - Levin,Avinoam, AU - Nash,David, AU - Kamel,George, AU - Mostafa,Evan, AU - Baghdasarian,Daniel, AU - Davidson,Edward H, Y1 - 2019/06/28/ PY - 2019/7/2/entrez PY - 2019/7/2/pubmed PY - 2019/7/2/medline JF - The Journal of craniofacial surgery JO - J Craniofac Surg N2 - BACKGROUND: Alignment of the zygomaticosphenoid suture is fundamental to reduction of zygomaticomaxillary complex fractures. To prevent a rotational deformity, the correct angle of the zygoma relative to the cranial base must be restored. Clinically, this can be a challenge, especially when there is comminution of the zygomaticosphenoid suture. Defining a zygomaticosphenoidal angle would provide a reference for use with stereotactic navigation to achieve anatomic reduction. METHODS: A single-center retrospective analysis of 100 patients was designed to determine normative zygomaticosphenoidal angle values. An angle subtended by the midline and a best-fit line through the zygomaticosphenoid suture on axial computed tomography was measured bilaterally in patients with isolated mandibular or nasal fractures. The mean of this measurement for 3 vertically adjacent cuts was calculated with position of central cut determined by the equator of the globe and trigone of the sphenoid. Multivariate regression was completed to identify changes in zygomaticosphenoidal angle with age, sex, and race. RESULTS: The mean zygomaticosphenoidal angle was 47° (range 39°-55°). 97% of angles were within 2 standard deviations (8°) of mean. Regression analysis demonstrated no significant change in angle with age (P = 0.74) or sex (P = 0.89). For each angle, the variation across the 3 sample cuts was ≤4.5°. Patients demonstrated high fidelity in zygomaticosphenoidal angle bilaterally with mean difference of 3°. CONCLUSION: The zygomaticosphenoidal angle is a useful reference, in conjunction with stereotactic navigation, for reduction of zygomaticomaxillary complex fractures. Contralaterally obtained patient-specific data may be used to guide unilateral repair. Normative values may serve as reference in bilateral injury. SN - 1536-3732 UR - https://www.unboundmedicine.com/medline/citation/31261347/Defining_the_Zygomaticosphenoidal_Angle_as_a_Guide_to_Anatomic_Zygomaticomaxillary_Complex_Fracture_Reduction L2 - http://dx.doi.org/10.1097/SCS.0000000000005724 DB - PRIME DP - Unbound Medicine ER -