Cheekbone. The temporal process of the zygomatic bone

One of the paired elements of the facial part of the skull is the malar bone. It forms the zygomatic arch, which is the boundary of the fovea of the temple.

Features of the structure

The cheek bone is a quadrangular plane element. It holds the facial (visceral) part of the skull with its brain section. In addition, it connects the maxillary bone with a wedge-shaped, temporal and frontal bone. All this creates a firm support for her.

There are three surfaces, of which the malar bone is composed. Anatomy distinguishes the buccal (lateral), temporal and orbital parts.

The first of these is convex. It is connected to the maxillary bones, frontal and temporal lobes with the help of three processes. The glabular part participates in the formation of the lateral wall of the orbit and part of its bottom. The temporal part participates in the formation of the pedicle fossa, and its plane is turned back.

The surface of the malar bone

The glabrous part is smooth, it participates in the formation of the anterior parts of the orbit, namely, part of its outer wall and the lower portion. From the outside, this surface passes into the lobo-basic process, and in front of it the infraorbital margin is confined. It also houses a special cheek-eye orifice. The glabrous surface of the frontal process contains a well-marked elevation.

The temporal surface is inward and backward. It takes part in the formation of the front wall of the fovea of the temple. On her is a cheek-and-temporal aperture. The temporal process of the zygomatic bone, which extends from its posterior angle, is connected to the zygomatic process of the temporal bone. Together they form a zygomatic arch. Between them is the so-called temporo-zygomatic suture.

Another isolated surface of the bone is the zygomatic. It is smooth, convex, with a special tubercle and a cheek-facial opening. Its upper semicircular margin is the border of the entrance to the orbit from the side and from below. Lobnovoobnovoj otrostok (it is considered its or her part) is nizhnnenaruzhny a site of the specified surface. In front of it, it is enlarged more than in the rear. The fossa of the frontal bone is connected with it. Between them is the maxillary maxillary suture. It is located on the posterior edge of the upper third of the appendix, called the frontal.

Also the zygomatic bone is fastened together with a large bone wing, called a wedge-shaped bone. Their connection forms a wedge-zygomatic suture.

Features

Due to the size of this particular element of the facial skull, its shape and angles, which are formed with the front surfaces, determine the type of build, gender, race, age.

Specialists note 2 stages of development of the zygoma: connective tissue and bone. It is noteworthy that 2-3 sites of ossification appear in the first trimester of pregnancy. They are already on the 3rd month of intrauterine development.

It is also noteworthy that through the orbital part of the bone with the help of a thin probe it is possible to get through the perforating canal into the bone in the cheek-temporal and bilo-facial orifices.

Possible injuries

In case of injury to the face, fracture of the malar bone can not be ruled out. It is characterized by deformation and westing of the corresponding region. In the lower eyelid and in the area of the zygomatic arch one can see the so-called stair. In this case, there are problems when trying to open your mouth or make lateral movements of the lower jaw. Also, fractures are accompanied by hemorrhages in the retina of the eye and loss of sensitivity, numbness in the region of the infraorbital nerve.

If the zygomatic bone has been displaced significantly, then there may be nasal bleeding from a part on the same side and visual impairment, which patients describe as the twinning of objects. But it is only possible to make a diagnosis after an X-ray examination.

Methods of treatment

If the fact of the fracture of the malar bone was confirmed in the picture, it means that it is necessary to restore its anatomical integrity. This is done by turning the wreckage into the correct position. After this, it is desirable to fix them. If there were no displacements, then the treatment is limited to drug therapy and the appointment of physiotherapy procedures.

Surgical repair

Operative intervention is required only in exceptional cases. These include situations where the malar bone of the skull has been broken, and its processes are displaced.

All surgical interventions can be divided into intraoral and extraoral. The methods of Limberg, Gillies, Dingman are fairly well known. They refer to extraoral methods.

In some cases, its integrity can be restored through a cut in the oral cavity. If the zygomatic bone is fixed with titanium mini-plates, this gives the most stable results.

After carrying out any of the types of interventions, it is important to avoid possible displacement of bone fragments. To do this, restrict mouth movement, eat liquid and soft foods, do not sleep on the damaged side of the face.

Description of extraoral methods

Limberg's method is that a single-tooth hook is inserted into the cavity through a special puncture (sometimes, however, a small cross-sectional incision is made) in the lower edge of the zygomatic arch. The integrity of the bone is restored by movement, which is done in the direction opposite to the displacement. When it is compared and set to the correct position, a characteristic click is heard. In this case, the symmetry of the face is restored. Also disappears a step that was in the lower edge of the orbit.

In order to restore the integrity of the surface and put the temporal process of the malar bone in place, the Gillies method can be used. The operating doctor makes a cut in the scalp. In doing so, it dissects the skin, subcutaneous tissue and temporal fascia. Through the incision the elevator is brought to the zygomatic arch or bone, a gauze swab is inserted under it. Then, with a special tool, which is used as a lever, the fragment is set in the correct position.

According to the method of Dingman, a retractor is inserted into the inframammary fossa through a 1.5 cm long incision. The dissection is done in the region of the lateral part of the eyebrow. In this case, after restoring the integrity of the surface of the bone, the author of the technique recommended applying a suture in the region of the lower edge of the orbit where the frontal process of the malar bone is located.

Intraoral methods

If it is necessary to remove some free-standing fragments of bones, blood clots, parts of the mucous membrane, then other methods of surgical interventions are developed. This is possible only when carrying out intraoral operations, under which the auditory maxillary sinus is made.

To restore the integrity of the bones, a cut is made in the region of the transitional fold of the alveolar process. In this case, exfoliate the periosteal-mucous flap. This is done with the help of a Retractor or Blades of Buyalsky, which are carried out under the temporal process of the malar bone.

In carrying out this operation, it is also possible to correct the fragments of the bottom of the eye sockets. For this purpose, an iodoform tampon is placed in the appropriate sinus. He must fill it tightly in order to keep the bone elements for 10-14 days in the correct position. The end of the indicated tampon is displayed in the lower nasal passage. To do this, they impose suture.

To fix the plane of the bone in the correct position it is possible with the help of titanium mini-plates or a wire seam applied in the region of the frontal process, the lower edge of the orbit, the crest called the cheek-alveolar. But the first way is considered more reliable.

Special cases

In some situations it is necessary to use implants. They are put for defects in bone tissue. Often, doctors recommend in special cases to use ceramic implants, based on hydroxyapatite, in combination with titanium plates.

With appropriate indications, decompression of the infraorbital nerve can be performed. This is done by releasing the intracanal part of it and moving it into orbit. To eliminate bone defects of the alveolar ridge, implants made of titanium nickelide can be used. This requires the restoration of the epithelial lining of the sinuses of the nose with flaps from the cheek or graft from the palate. Such tactics can reduce the risk of developing maxillary sinusitis, which can develop after an injury.

Using the outer seams, you can fix the zygomatic arch. For this, a plate made of fast-hardening plastic is sewed to it. Under it, always lay iodine gauze. It helps to avoid bed sores.