Epistaxis balloon catheter stabilization of zygomatic arch fractures

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.

Use of a Balloon Catheter With Intraoperative C-Arm Fluoroscan for Reduction of Zygomatic Arch Fractures

BACKGROUND AND OBJECTIVES

The purpose of this study was to evaluate the usefulness of C-arm fluoroscan with a balloon catheter in patients undergoing closed reduction of zygomatic arch fractures.

SUBJECTS AND METHODS

All patients who had zygomatic arch reduction surgery between 2006 and 2015 were identified and classified into 2 groups. Group A included those patients who underwent closed reduction of zygomatic arch fractures. Group B included those who underwent zygomatic arch reduction surgery with a C-arm fluoroscan and supporting balloon. A balloon catheter was used to stabilize the zygomatic bone after reduction. Results were scored from 1 (poor) to 3 (good) to assess surgical outcomes based on 3 criteria: alignment of the zygomatic arch on a postoperative computed tomography scan, facial asymmetry in photography, and the patient's subjective satisfaction.

RESULTS

The authors enrolled 32 patients with zygomatic arch fractures. 18 patients underwent closed reduction for zygomatic arch fractures (group A), while 14 patients underwent closed reduction with C-arm fluoroscan and balloon support (group B). The average score for group A was 2.00 for alignment, 2.56 for facial asymmetry, and 2.67 for subjective satisfaction compared with 2.64 for alignment, 2.86 for facial asymmetry, and 2.79 for subjective satisfaction in group B. There were statistically significant differences in the alignment and facial asymmetry scores between the 2 groups.

CONCLUSION

The authors suggest that C-arm fluoroscan with balloon support is a useful modality for reduction of zygomatic arch fractures that provides better surgical outcomes than conventional closed reduction surgery.

Treatment of Isolated Zygomatic Arch Fracture: Improved Outcomes with External Splinting

BACKGROUND

The various approaches to reduction and fixation of isolated displaced zygomatic arch fractures have not been well studied. The authors compared established treatment methods for zygomatic arch fractures for both aesthetic and functional outcomes.

METHODS

Consecutive patients with isolated zygomatic arch fractures with a minimum of 6 months' follow-up were studied in five groups: group 1, intraoral approach (no fixation); group 2, temporal approach (no fixation); group 3, coronal flap plate fixation; group 4, external splint fixation; and group 5, no surgery. Perioperative complications, facial contour symmetry (aesthetic outcome), improvement in mouth opening (functional outcome), and reoperations were compared.

RESULTS

Patients undergoing external splint fixation had no perioperative complications. Coronal flap plate fixation had the highest rate of perioperative complications (46 percent), with facial nerve injury (4 percent), hematoma (8 percent), and persistent hyperesthesia (8 percent). Reoperations (fat grafting or bony reconstruction) were highest with coronal flap plate fixation (23 percent) and the temporal approach (7.7 percent); external splint fixation and the intraoral approach required no reinterventions. Patients treated with external splint fixation had the largest improvement in mean interincisor mouth opening. Mean postoperative interincisor opening in decreasing order was as follows: external splint fixation (51.6 mm), coronal flap plate fixation (47.1 mm), no surgery (39.8 mm), intraoral approach (39.6 mm), and temporal approach (38.9 mm). The highest volumetric symmetry was seen in external splint fixation (97.9 percent), followed by coronal flap plate fixation (94 percent), temporal approach (76.2 percent), intraoral approach (73 percent), and no surgery (68.3 percent).

CONCLUSION

For isolated zygomatic arch fracture, patients undergoing external splint fixation had the lowest risk of perioperative complications and the greatest improvement in functional and aesthetic outcomes compared with the intraoral approach (no fixation), the temporal approach (no fixation), coronal flap plate fixation, and no surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, II.

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.

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.

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.