Objective To explore the procedure and effectiveness of sequential reduction and fixation for zygomatic complex fractures. Methods Between March 2004 and February 2012, 32 patients with zygomatic complex fractures were treated. There were 28 males and 4 females with a median age of 29 years (range, 17-55 years). Fractures were caused by traffic accident in 29 cases and by tumble in 3 cases. The time between injury and admission was 1-12 days (mean, 3 days) in 28 fresh fractures and 22-60 days (mean, 40 days) in 4 old fractures. All patients were diagnosed by clinical symptom and CT scan. Coronal scalp incision, lower eyelid aesthetic incision, and intraoral incision were used to expose the zygomatic bone segments. The sequence of fractures reduction and fixation was horizontal first, and then longitudinal. In horizontal orientation, reduction and simultaneous fixation started from the root of the zygoma, to zygomatic arch, body of the zygoma, and inferior orbital rim in turn. Longitudinally, fracture reduction of zygomatico-frontal suture and orbital posterolateral walls was done first, followed by fracture reduction of zygomaticomaxillary buttress. Results Primary healing of incision was obtained in all 32 cases, without complications of maxillary sinus fistula and infection. Eighteen patients were followed up 6 months to 6 years with a median time of 32 months. All the patients gained satisfactory results with normal zygomatic contour and symmetric midface. All patients restored normal mouth opening. No eye and vision damage occurred. Frontal disappearance and brow ptosis were observed in 2 cases. Hair loss (2-3 mm) was seen at the site of coronal scalp incision, without scar hyperplasia; there was no obvious scar at lower eyelid. CT and X-ray films showed bony healing at 6 months after operation. Conclusion Sequential reduction and fixation is accord with the mechanical characters of complicated zygomatic fractures. It is very easy to achieve anatomic reduction of the bone segments and facial symmetry.
ObjectiveTo observe the effect of interventional thrombolytic therapy for central retinal artery occlusion (CRAO) with ipsilateral internal carotid artery occlusion via supratrochlear artery retrogradely or external carotid artery anterogradely.MethodsNine CRAO patients (9 eyes) were enrolled in this study, including 5 males and 4 females. The mean age was (45.2±18.1) years. The mean onset duration was 24 hours. There were 4 eyes with vision of no light perception, 3 eyes with light perception and 2 eyes with hand movement. Fundus fluorescein angiography (FFA) examination showed that the retinal artery was filled with delayed fluorescence. The peak of fluorescence was seen in the anterior part of the artery, and some of the eyes showed retrograde filling. The arm-retinal circulation time (A-Rct) was ≥35 s in 4 eyes, ≥35 s - ＜25 s in 5 eyes. The filling time of retinal artery and its branches (FT) was ≥15 s in 2 eyes, ≥12 s - ＜15 s in 3 eyes, ≥9 s - ＜12 s in 4 eyes. All the patients received the treatment of interventional thrombolytic therapy via supratrochlear artery retrogradely (8 eyes) or external carotid artery anterogradely (1 eye) according to the indications and contraindications of thrombolytic therapy in acute cerebral infraction patients. Urokinase (0.4 million U in total) was intermittently injected into the arteries. After artery thrombolysis, the changes of digital subtraction angiography (DSA), filling time of retinal artery and its branches on FFA within 24 hours and the visual acuity were observed. According to the A-Rct and FT on FFA, the therapeutic effects on retinal circulation were defined as effective markedly (A-Rct≤15 s, FT≤2 s) , effective (A-Rct was improved but in the range of 16 - 20 s, FT was in 3 - 8 s) and no effect (A-Rct was improved but ≥21 s, FT≥9 s). The related local or systemic complications were recorded.ResultsAfter the injection of urokinase into the catheter, the ophthalmic artery and its branches were increased in 6 eyes (66.7%), and the development of the eye ring was significantly more than that of the eyes before thrombolysis. The circulation time in ophthalmic artery was speeded up for 2 s before thrombolysis in 3 eyes, 3 s in 3 eyes, and 4 s in 2 eyes. Within 24 hours after thrombolysis treatment, the A-Rct was significantly decreased than that of before interventional therapy. The retinal circulation was effective markedly in 4 eyes (44.4%), effective in 4 eyes (44.4%) and no effect in 1 eyes (11.2%) . The vision was improved 3 lines in 4 eyes (44.4%), 2 lines in 3 eyes (33.3%), 1 line in 1 eye (11.2%) and no change in 1 eye (11.2%). There were no abnormal eye movements, vitreous hemorrhage and incision hematoma, intracranial hemorrhage, cerebral embolism, and other local and systemic adverse effectives during the follow-up.ConclusionsThe interventional thrombolytic therapy via supratrochlear artery retrogradely or external carotid artery anterogradely for CRAO with the ipsilateral internal carotid artery occlusion can improve retinal circulation and vision. There are no related local or systemic complications.