Factors Affecting Quality of Life in Zygomatic Fractures: An Original Research.

Introduction: Zygoma is one of the facial bones that are impacted in the accidents. Hence, we aim to evaluate the patient's profiles in the fracture associated with zygomatic bone. Materials and
Methods: We conducted a prospective clinical study with 60 subjects who were divided equally into cases (30) and controls (30); controls were general population and the cases underwent surgery of zygomatic complex fracture. Health-related quality of life (HRQoL) was assessed by the means of the questionnaire. The values were compared for the significance keeping P < 0.05 as significant.
Results: The preoperative 15D score was lesser for cases than controls. Soon after surgery, it was statistically least and after a month, the mean score surpassed the controls. Infraorbital sensory loss was seen even after 6 months. Conclusions: As expected, the HRQoL decreases only to improve after the surgery. However, the infra-orbital nerve sensory loss may continue for over 6 months after the zygomatic complex fracture. Copyright:

INTRODUCTION

The zygoma is very close to the vital organs including the brain and the eye. It also provides attachments for the facial muscles.[12345] The zygoma is very close to the vital organs including the brain and the eye. The zygomatico-orbital fractures are one of the most common facial fractures. The infra-orbital nerve that is crucial for the sensory supply of the face is often injured in the fractures of the zygoma. To treat the zygomatic fractures, the surgical methods are usually followed unlike mandibular fractures where conservative methods are also followed. As with any other surgical procedure, the complications of the Zygoma are also the same. After the surgery, the both physical and the psychological aspects are impacted. Health-related quality of life (HRQoL) is estimated for the other fractures that include the facial fractures also. However, there is less literature about the HRQoL for the zygoma fracture's surgery.[678] Hence, we aim to evaluate the patient's profiles in the fracture associated with zygomatic bone.

MATERIALS AND METHODS

We conducted a prospective clinical study with 60 subjects who were divided equally into cases (30) and controls (30); controls were general population and the cases underwent surgery of zygomatic complex fracture. We included mlae patients who were aged 18–35 and had no other medical conditions. The institutional ethics clearance and the patient consent were taken for the study. The follow-up was done for the cases for over 6 months. 15D instrument that is a self answered questionnaire was used to assess the HRQoL of the subjects. These include “mobility, vision, hearing, breathing, sleeping, eating, speech, excretion, usual activities, mental function, discomfort and symptoms, depression, distress, vitality, and sexual activity.” They were scored accordingly on preoperative day, postoperative, 1st, 2nd, 7th, 30th, 90th days and the last readings were noted at the end of the 6th month. Comparisons were done to assess the changes keeping the P < 0.05 as significant.

RESULTS

We observed that on the day after surgery, the 15 parameters were significantly lower in the cases than the controls (P = 0.001) [Figure 1]. There was a significant difference between the groups even after 6 months for most of the parameters except vision, eating, speech, and sexual life Figure 2. There was a significant difference only on the 1st postoperative day and 6th month after surgery between the groups. The HRQoL score was lowest on the 1st postoperative day than the controls, however, it was more than the controls after the 6th month [Figure 3]. MORE than half of the cases showed good facial sensation recovery by the end of 3rd month. Comparison of the recovery for the facial sensation is shown in Figure 4.

Figure 1

Comparison between the groups at the end of the 1st postoperative day

Figure 2

Comparison between the groups at the end of 6th month

Figure 3

Comparison between the groups for the various time periods

Figure 4

Comparison of the recovery for the facial sensation among the case

DISCUSSION

In this study, we evaluated the 15 D HRQoL between those with and without the zygoma fracture surgery that was age and gender matched. We observed that the preoperative 15D score was lesser for cases than controls. Soon after surgery, it was statistically least and after a month, the mean score surpassed the controls. The lower scores at the early stages of the surgery can be expected as the patients underwent surgery and during the recovery period, the various parameters slowly improved.[9] However, the infraorbital sensory loss was seen even after 6 months. Similar to our findings in the study of Ugboko et al.,[10] they also found that the infraorbital nerve paresthesia continued for longer periods among those who underwent the zygoma surgery. In their study, they also noted trismus and eye problems that continued.

In the patients who had the zygoma surgery along with the physical symptoms, the psychological symptoms were also seen in our study. Similar observations were seen in the studies of the Kaukola et al.,[6] Sintonen[7] where they also observed a mental impact after the fracture and the surgery of the facial bones. There were few limitations in our study like various methods of the zygoma surgery were performed, we restricted the follow-up for only 6 months and we considered only male subjects to avoid bias. Further studies with larger samples are suggested.

CONCLUSIONS

We can conclude that the HRQoL decreases only to improve after the surgery by the end of 1st month. However, the infra-orbital nerve sensory loss may continue for over 6 months after the zygomatic complex fracture.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.