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Karl Otto Geier - One of the best experts on this subject based on the ideXlab platform.
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Bloqueio do nervo maxilar para redução de fraturas do osso zigomático e assoalho da órbita Bloqueo del nervio maxilar para reducción de fracturas del hueso zigomático y suelo de la órbita Maxillary Nerve block for zygoma and orbital floor fractures reduction
Sociedade Brasileira de Anestesiologia, 2003Co-Authors: Karl Otto GeierAbstract:JUSTIFICATIVA E OBJETIVOS: Poucos relatos existem sobre redução de fraturas da órbita zigomática e do arco zigomático sob anestesia regional. O objetivo deste estudo é verificar a qualidade do bloqueio do nervo maxilar por via extraoral, para redução de fraturas do osso zigomático e do assoalho da órbita. MÉTODO: Quinze pacientes foram submetidos à bloqueio do nervo maxilar pela técnica de Moore (abordagem infrazigomática) para redução de fraturas isoladas do arco zigomático (oito pacientes) e associadas ao assoalho da órbita (sete pacientes). Nenhum paciente recebeu medicação pré-anestésica. Após sedação e anestesia local com 2 ml de lidocaína a 1,5% com adrenalina a 1:300.000, o nervo maxilar foi abordado com 8 ml da mesma solução anestésica através de uma agulha 22G, 10 cm de comprimento de ponta romba. Foram avaliados: o tempo de bloqueio, a latência, o tempo de analgesia, a incidência de falhas, a necessidade de anestesia geral e as complicações. RESULTADOS: Os primeiros três bloqueios foram difíceis, resultando em dois bloqueios parciais e uma falha. Os restantes foram efetivos e os pacientes não referiram nenhum desconforto ou dor durante o bloqueio e a cirurgia. O tempo para a realização do bloqueio variou de 5 a 20 minutos, enquanto a latência anestésica ficou entre 3 e 10 minutos. Foram registradas 7 ocorrências de punção vascular, porém sem relatos de formação de hematomas. CONCLUSÕES: Redução de fraturas zigomáticas são factíveis sob bloqueio do nervo maxilar, quando realizadas na fossa ptérigo palatina, permitindo anestesia de seus dois ramos distais, nervo zigomático-temporal e nervo zigomático-frontal.JUSTIFICATIVA Y OBJETIVOS: Pocos relatos existen sobre reducción de fracturas de la órbita zigomática y del arco zigomático bajo anestesia regional. El objetivo de este estudio es confirmar la calidad del bloqueo del nervio maxilar por vía extraoral, para reducción de fracturas del hueso zigomático y del suelo de la órbita. MÉTODO: Quince pacientes fueron sometidos al bloqueo del nervio maxilar por la técnica de Moore (abordaje infrazigomática) para reducción de fracturas aisladas del arco zigomático (ocho pacientes) y asociadas al suelo de la órbita (siete pacientes). Ningún paciente recibió medicación pre-anestésica. Después de sedación y anestesia local con 2 ml de lidocaína a 1,5% con adrenalina a 1:300.000, el nervio maxilar fue abordado con 8 ml de la misma solución anestésica a través de una aguja 22G, 10 cm de largo de punta romba. Fueron evaluados: el tiempo de bloqueo, la latencia, el tiempo de analgesia, la incidencia de fallas, la necesidad de anestesia general y las complicaciones. RESULTADOS: Los primeros tres bloqueos fueron difíciles, resultando en dos bloqueos parciales y una falla. Los restantes fueron efectivos y los pacientes no mencionaron ninguna incomodidad o dolor durante el bloqueo y la cirugía. El tiempo para la realización del bloqueo varió de 5 a 20 minutos, en cuanto la latencia anestésica quedó entre 3 y 10 minutos. Fueron registradas 7 ocurrencias de punción vascular, sin embargo, sin relatos de formación de hematomas. CONCLUSIONES: Reducción de fracturas zigomáticas son factibles bajo bloqueo del nervio maxilar, cuando realizadas en la fosa ptérigo palatina, permitiendo anestesia de sus dos ramos distales, nervio zigomático-temporal y nervio zigomático-frontal.BACKGROUND AND OBJECTIVES: There are few reports of zygomatic orbital floor or zygomatic arch fractures reduction under regional anesthesia. This study aimed at evaluating extraoral maxillary Nerve block for zygoma and orbital floor fractures reduction. METHODS: Participated in this study 15 patients submitted to maxillary block according to Moore’s technique (lateral approach of the pterygoid plate) for reduction of isolated zygomatic arch fractures (8 patients) or orbit floor fractures associated to zygomatic arch fractures (7 patients). Patients were not premedicated. After sedation and local infiltration with 2 ml of 1.5% lidocaine and epinephrine 1:300,000 the maxillary Nerve was blocked with 8 ml of the same anesthetic solution through a 10 cm 22G, short beveled needle. The following parameters were evaluated: blockade duration, onset, analgesia duration, failures, need for general anesthesia and complications. RESULTS: The first three blocks resulted in difficult punctures with two partial blocks and one failure. Remainder blocks were effective and patients have not referred any discomfort or pain during both blockade and surgery. Blockade time varied from 5 to 20 minutes while onset varied from 3 to 10 minutes. There were 7 vascular punctures (7 patients) however without hematomas. CONCLUSIONS: Zygomatic fractures reduction is feasible under maxillary Nerve block when performed in pterygopalatine fossa inducing anesthesia in its two distal branches: zygomaticotemporal and Zygomaticofacial Nerve
Lake S Raggio - One of the best experts on this subject based on the ideXlab platform.
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zygomatic arch fracture
StatPearls, 2019Co-Authors: Jeffrey M Ergero, Lake S RaggioAbstract:The zygoma is a bone that provides vital contributions to both the structure and aesthetic of the midface and articulates with several bones of the craniofacial skeleton. The zygoma and its articulations comprise the zygomaticomaxillary complex (ZMC). Fractures of the zygomatic arch (ZA) or any of its bony articulations can cause significant functional and cosmetic morbidity. The management of the zygomatic arch and ZMC fractures should be patient-specific but range from simple observation to open reduction with internal fixation (ORIF).AnatomyThe zygoma is the most anterolateral projection of the midface. It plays a key role structurally as it absorbs and dissipates forces away from the cranial base. The zygoma also comprises a significant portion of the inferior and lateral orbital walls; thus, fracture of the zygoma warrant investigation into fractures of the orbit.The zygoma has four articulations, referred to as the ZMC complex:NOTE: Fractures of the ZMC complex may be mistakenly referred to as "tripod fractured," though the correct terminology is, in fact, "tetrapod fracture," given the four articulations of the zygoma as stated above.NeuroanatomyParesthesia of the face is a common sequela of a ZMC fracture given its proximity to sensory Nerves such as the infraorbital Nerve, the Zygomaticofacial Nerve, and the zygomaticotemporal Nerve (all branches of cranial Nerve V2). Severe ZMC fractures may also result in an ipsilateral facial palsy since the facial Nerve is intimately associated with the zygomatic arch. The facial Nerve's frontal branch emerges from the parotid gland within the parotid-masseteric fascia and crosses superficial to the zygomatic arch in the innominate fascia deep to the superficial muscular aponeurotic system (SMAS). The frontal branch then transitions to the undersurface of the temporoparietal fascia where it travels to innervate the frontalis muscle.Muscular AnatomyThe temporalis originates along the temporal line of the parietal and frontal bones and travels medially to the zygomatic arch to insert on the coronoid process of the mandible. It also has attachments to the zygoma.The masseter originates on the inferior aspect of the zygoma and zygomatic arch and inserts on the angle of the mandible.The zygomaticus major and minor are muscles of facial expression that originate on the zygoma and insert near the corner of the mouth to assist with commissure elevation.Other landmarksTubercle of Whitnall: The attachment site of the lateral canthal tendon located on the medial surface of the frontal process of the zygoma.
Jeffrey M Ergero - One of the best experts on this subject based on the ideXlab platform.
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zygomatic arch fracture
StatPearls, 2019Co-Authors: Jeffrey M Ergero, Lake S RaggioAbstract:The zygoma is a bone that provides vital contributions to both the structure and aesthetic of the midface and articulates with several bones of the craniofacial skeleton. The zygoma and its articulations comprise the zygomaticomaxillary complex (ZMC). Fractures of the zygomatic arch (ZA) or any of its bony articulations can cause significant functional and cosmetic morbidity. The management of the zygomatic arch and ZMC fractures should be patient-specific but range from simple observation to open reduction with internal fixation (ORIF).AnatomyThe zygoma is the most anterolateral projection of the midface. It plays a key role structurally as it absorbs and dissipates forces away from the cranial base. The zygoma also comprises a significant portion of the inferior and lateral orbital walls; thus, fracture of the zygoma warrant investigation into fractures of the orbit.The zygoma has four articulations, referred to as the ZMC complex:NOTE: Fractures of the ZMC complex may be mistakenly referred to as "tripod fractured," though the correct terminology is, in fact, "tetrapod fracture," given the four articulations of the zygoma as stated above.NeuroanatomyParesthesia of the face is a common sequela of a ZMC fracture given its proximity to sensory Nerves such as the infraorbital Nerve, the Zygomaticofacial Nerve, and the zygomaticotemporal Nerve (all branches of cranial Nerve V2). Severe ZMC fractures may also result in an ipsilateral facial palsy since the facial Nerve is intimately associated with the zygomatic arch. The facial Nerve's frontal branch emerges from the parotid gland within the parotid-masseteric fascia and crosses superficial to the zygomatic arch in the innominate fascia deep to the superficial muscular aponeurotic system (SMAS). The frontal branch then transitions to the undersurface of the temporoparietal fascia where it travels to innervate the frontalis muscle.Muscular AnatomyThe temporalis originates along the temporal line of the parietal and frontal bones and travels medially to the zygomatic arch to insert on the coronoid process of the mandible. It also has attachments to the zygoma.The masseter originates on the inferior aspect of the zygoma and zygomatic arch and inserts on the angle of the mandible.The zygomaticus major and minor are muscles of facial expression that originate on the zygoma and insert near the corner of the mouth to assist with commissure elevation.Other landmarksTubercle of Whitnall: The attachment site of the lateral canthal tendon located on the medial surface of the frontal process of the zygoma.
R. Shane Tubbs - One of the best experts on this subject based on the ideXlab platform.
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Bilateral Absence of the Zygomatic Nerve and Zygomaticofacial Nerve and Foramina.
Cureus, 2017Co-Authors: Shehzad Khalid, Joe Iwanaga, Marios Loukas, R. Shane TubbsAbstract:The Zygomaticofacial branch (ZFb) of the zygomatic Nerve travels along the inferolateral angle of the orbit, traverses the Zygomaticofacial foramen (ZFF) in the zygomatic bone, and then perforates the orbicularis oculi muscle to finally reach the skin of the malar area, which it innervates. The bilateral absence of the ZFb and the ZFF was found in an 80-year-old Caucasian cadaver. In addition, both zygomatic Nerves were absent. A thin Nerve arising from the lacrimal Nerve passed below it and gave rise to the lacrimal branch and a communicating branch to the lacrimal Nerve. This then entered the small bony canal, which opened at the medial aspect of the lateral wall of the orbit on the right and left sides. The bilateral absence of the ZFb of the zygomatic Nerve and its foramen appears to be uncommon but should be realized during surgery or invasive procedures over the cheek or infraorbital region. The additional absence of both zygomatic Nerves is exceptional.
In Hyuk Chung - One of the best experts on this subject based on the ideXlab platform.
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cutaneous distribution of Zygomaticofacial Nerve
Journal of Craniofacial Surgery, 2007Co-Authors: Kun Hwang, Sheng Jin, Jun Ho Park, In Hyuk ChungAbstract:The aim of this study is to elucidate the cutaneous distribution of the Zygomaticofacial Nerve (ZFN). Twenty hemifaces of 10 adult Korean cadavers were dissected. ZFN-innervated limits were rectangular and each side was 18.8 ± 4 mm and 15.8 ± 3.4 mm. The center of the rectangle was located laterally
