Surgical Management of Isolated Fractures of Zygoma under Local Anaesthesia and Intra Venous Midazolam

Fractures of the zygomatic complex are the second most common fractures of the middle third of the face. The treatment should aim at optimal reduction and fixation while taking into consideration patient satisfaction in terms of pain control, type of anaesthesia and treatment cost. This study is designed to assess the anxiolytic, sedative, amnesic properties as well as safety and efficacy of use of midazolam as intravenous sedation agent in treatment of isolated zygomatic fractures. The present study was conducted at an urban institute in Amritsar , Punjab from January 2011 to june 2012. The study was undertaken in 10 patients of isolated zygomatic fracture under local anesthesia and intravenous midazolam. The parameters evaluated were : blood pressure, heart rate, respiratory rate , oxygen saturation, airway, sedation, anxiety and surgeon‟s assessment. These were recorded pre-operatively, preprocedure, peri-operative, immediately post-operative for 2 hours and late postoperative at 12 and 24 hours. The fracture was exposed using a combination of Gilles temporal incision, supra orbital incision, maxillary vestibular incision and crows foot incision. A 2 point fixation was done using 2mm stainless steel monocortical plates. The effect of midazolam was insignificant on blood pressure and respiratory rate , whereas it was statistically significant on the heart rate , oxygen saturation and anxiety. Appropriate sedation was achieved in 90% of the patients. The degree of amnesia ranged from mild to profound. Operative comfort was rated as “good” in 60% of the patients. Optimal reduction of the fracture was achieved in 70% of the patients. Midazolam as a conscious sedative agent can be very successful in treatment of fractures of the zygomatic bone in reducing patient hospitalization, patient morbidity, complications and lowering the overall cost of the patient by avoiding general anesthesia.