A method of zygomatic arch stabilization

Modified Temporal Incision for the Management of Zygomatic Arch fractures-A Retrospective Study for 7 Years

Study Design

Retrospective cross-sectional study.

Objective

The objective of this retrospective study was to evaluate the clinical outcomes of Modified temporal incision in the management of zygomatic arch fractures (ZAF).

Patients and Methods

Records of 34 patients who underwent open reduction for zygomatic arch fractures were retrieved and included in the study between 2011 and 2018. These patients were followed up at 4 weeks, 8 weeks and 12 weeks respectively. Clinical parameters such as post-operative infection, hematoma, scarring, degree of mouth opening, palpability of plates, alopecia and weakness of temporal branch of Facial nerve recorded were analyzed for complications of modified temporal incision in the management of ZAF.

Results

A thorough analysis of the clinical parameters revealed that at the end of 4 weeks scarring was present in 4 patients and temporal branch of Facial nerve weakness was present in 21 patients. None of the patients had hematoma, infection or palpability of miniplates. At the end of 8 weeks the only complication recorded was weakness of temporal branch of Facial nerve in 21 patients. By 12 weeks, all patients had complete recovery and none of the patient had weakness of temporal branch of Facial nerve.

Conclusion

The results obtained proved that the Modified temporal incision can be considered as a reliable method in the management of zygomatic arch fractures. The incision can be adopted with confidence in suitable cases of zygomatic arch fractures without any permanent morbidity.

Stabilisation of the unstable fractured zygomatic arch with a ballooned foley catheter

The zygomatic arch fracture is one of the most common facial bone fractures. Especially the isolated zygomatic arch fracture is usually repaired via Gillies' approach. But in the case of unstable zygomatic arch fracture, we need an additional step for stabilising the unstable zygomatic arch segment after repositioning the fractured segment. For the stabilising method we use the ballooned Foley catheter on the medial side of the zygomatic arch in the zygomaticotemporal fossa. This method is of assistance to the patient who has a zygomatic arch fracture with comminution or an old patient with weak and torn periosteum. In this study, we achieved a good result and we will introduce this simple method as one of alternatives of stabilising tool.

Aqua splint suture technique in isolated zygomatic arch fractures

Various methods have been used to treat zygomatic arch fractures, but no optimal modality exists for reducing these fractures and supporting the depressed bone fragments without causing esthetic problems and discomfort for life. We developed a novel aqua splint and suture technique for stabilizing isolated zygomatic arch fractures. The objective of this study is to evaluate the effect of novel aqua splint and suture technique in isolated zygomatic arch fractures. Patients with isolated zygomatic arch fractures were treated by a single surgeon in a single center from January 2000 through December 2012. Classic Gillies approach without external fixation was performed from January 2000 to December 2003, while the novel technique has been performed since 2004. 67 consecutive patients were included (Classic method, n = 32 and Novel method, n = 35). An informed consent was obtained from all patients. The novel aqua splint and suture technique was performed by the following fashion: first, we evaluated intraoperatively the bony alignment by ultrasonography and then, reduced the depressed fracture surgically using the Gillies approach. Thereafter, to stabilize the fracture and obtain the smooth facial figure, we made an aqua splint that fit the facial contour and placed monofilament nonabsorbable sutures around the fractured zygomatic arch. The novel aqua splint and suture technique showed significantly correlated with better cosmetic and functional results. In conclusion, the aqua splint suture technique is very simple, quick, safe, and effective for stabilizing repositioned zygomatic arch fractures. The aqua splint suture technique can be a good alternative procedure in isolated zygomatic arch fractures.

A New Proposal of Classification of Zygomatic Arch Fractures

PURPOSE

Among facial fractures, zygomatic arch fractures occur rather frequently. Facial fractures have recently been classified in fine detail according to computed tomographic findings. Nevertheless, there exists no classification of the zygomatic arch fracture, which has a physiognomically important place, to provide guidance for treatment. We aimed to make a detailed classification of zygomatic fractures in various shapes, which does not exist in the literature, and to form an algorithm for treatment.

PATIENTS AND METHODS

A total of 451 patients with zygomatic arch fractures treated in our clinic from 1987 through 2004 were assessed retrospectively from the treatment viewpoint together with radiological and clinical findings.

RESULTS

At the end of this assessment, arch fractures were divided into 2 groups: 1) isolated fractures in which the zygomatic arch alone broke, and 2) combined fractures in which the zygomatic arch broke together with the other facial bones. Isolated fractures were also divided into 2 subgroups as A) 2 fractures in the arch, and B) more than 2. Isolated arch fractures with more than 2 fracture lines were also classified as V-shaped fractures where fragments are partially reduced and those where fragments are displaced. As for combined fractures, they were subgrouped as A) single fracture in the arch, and B) plural. Plural fractures were further classified within their own group, also according to whether fragments were displaced or not.

CONCLUSION

In the 2 fractures and V-shaped fracture subgroups of isolated fractures, preservation of fragments in reduced position was satisfactory during the closed reduction and afterwards. As for those with more than 2 fractures of isolated arch fractures, they required open reduction and internal rigid fixation. The same treatment was used in combined zygomatic arch fractures where there were more than one displaced fractures. In addition to classification, we formed an algorithm to guide us in treatment based on our series.

Alloderm stabilization of zygomatic arch fractures

Zygomatic arch fractures, particularly when comminuted, are unstable fractures that may lose their reduction after operative manipulation. This case study describes the use of Alloderm as a postoperative stabilizing agent in two patients.

Stabilisation of the unstable fractured zygomatic arch with a Kirschner wire

Although relatively uncommon, isolated fractures of the zygomatic arch can sometimes be difficult to stabilise following reduction. We present a simple method of stabilisation using a Kirschner wire.