Penatalaksanaan Fraktur Kompleks Zygomatikomaksilaris Sinistra dengan Miniplate Osteosynthesis

Abstract

Wajah terletak lebih ke anterior secara anatomis oleh sebab itu mudah mendapatkan trauma. Os Zigoma merupakan tulang yang menonjol pada wajah dan akan menahan gaya bentur terbesar pada wajah. Tulisan ini melaporkan penatalaksanan fraktur kompleks  zigomatikomaksilaris sinistra dengan miniplate osteosynthesis.Seorang laki-laki 22 tahun dirujuk ke Bagian Bedah Mulut RSUP Dr Sardjito dengan riwayat kecelakaan lalulintas tiga minggu sebelum masuk RS. Pasien mengeluh daerah pipi kiri terasa tebal dan dirasa lebih datar dari pipi kanan. Pemeriksaan klinis terdapat parestesi nervus infraorbita sinistra, displace tulang daerah infraorbital rim sinistra, diskontinuitas regio sinus maksilaris sinistra.  Radiografis CT axial dan koronal serta CT Scan 3D tampak fraktur melibatkan infraorbital rim sinistra, fraktur sinus maksila sinistra, fraktur pada sutura zigomaticofrontalis dan pada sutura zigomatikotemporalis. Penatalaksanaannya dilakukan open reduction internal fixation (ORIF) fraktur kompleks zigomatikomaksilaris dengan miniplate osteosynthesis di bawah anestesi umum. Pasca operasi gejala parestesi berangsur- angsur berkurang, defek infraorbital rim terkoreksi dan pipi kiri tampak kembali prominen. Prognosis kasus ini dubia ad bonam. ORIF dengan miniplate osteosynthesis dapat memulihkan deformitas wajah dengan hasil malar eminensia kembali prominen dan membuat kondisi dekompresi nervus infraorbita sinistra yang mendukung proses pemulihan sensorisnya.

Management of Zygomaticomaxillaris Sinistra Complex Fractures with Osteosynthesis Miniplate. Face lies in a prominent position so that this area is often susceptible to trauma. Os zygomaticum is an area that holds the heaviest impact on facial trauma. This paper reports one case about zygomaticomaxillary complex fractures management with miniplate osteosynthesis. A 22 years old man was referred to the Department of Oral Surgery Dr Sardjito Hospital with a history of traffic accident three weeks before admission. He felt that his left cheek was thick and flatter than the right one. Clinical examination found that the left infraorbita nerve was paresthesized, the bone on the left infraorbital rim region was displaced and the left maxillary sinus region was discontinued. Radiography examination using CT axial and coronal, and 3D CT scan showed  both of the left infraorbital rim and maxillary sinus were fractured, as well as the zygomaticotemporalis suture and the zygomaticofrontalis suture. An Open Reduction Internal Fixation (ORIF) of the zygomaticomaxillary complex fractures with miniplate osteosynthesis was performed under  general  anesthesia. The  result  showed  that  the  postoperative paresthesia  symptoms  were  gradually  diminished,  the infraorbital rim defects were corrected and the prominent left cheek was recontructed. The prognosis was dubia ad bonam. It can be concluded that ORIF with miniplate osteosynthesis reconstructs the facial deformity, recovers the malar eminence prominency. The nerves decompression will favor the recovery process of the left infraorbita sensory