If the decision is made to perform an open reduction and internal fixation, one must be concerned about the plate size, and possible palpation of the plate through the skin. In most patients, there is little soft tissue over the zygomatic arch. Care must be taken not to injure this nerve. In the past, simple techniques, such as exerting pressure under the zygomatic arch and resetting the bones in their anatomic position (eg, Gilles approach), were hindered by unsatisfactory cosmetic results and persistent diplopia. The temporal branch of the facial nerve runs in close proximity to the periosteum of the zygomatic arch. Traditionally, closed-reduction techniques were the method of choice for nearly all zygomatic fractures. It is very important to restore the previous anatomy so that it matches the uninjured contralateral arch. Existing lacerations may also be used.Īlthough it is referred to as a zygomatic arch, most surgeons consider it is rather flat. Another reason for open treatment is secondary treatment of a zygomatic arch malunion where osteotomy and internal fixation are needed. It may be particularly desirable in a patient where a coronal approach has to be made for other reasons (such as for the treatment of a frontal sinus fracture or the harvest of a split calvarium bone graft). Closed reduction of zygomatic arch fractures using a Tubbs-Logan mitral valve dilator ENT Updates DOI: 10.32448/entupdates.709516 License CC BY-NC-ND Authors: Yalcin Yontar Acibadem Hospitals. There are several techniques available for reduction of zygomatic arch fractures, which include closed reduction and open reduction with fixation using metallic splints, closed reduction via Gillies or a gingivobuccal approach is preferred for minimal invasiveness, short. The coronal incision allows for excellent exposure of the zygomatic arch, as well as reduction and fixation of comminuted fractures. Background: Zygomatic arch fractures can occur either as isolated fractures or as a part of multiple facial fractures. (Click here for a detailed description of the coronal approach). This has the advantage that it allows direct visualization of the zygomatic arch for fixation. General considerations The only direct exposure to the zygomatic arch is through a coronal incision. If the decision is made to perform an open reduction and internal fixation, one must be concerned about the plate size, and possible palpation of the plate through the skin.If the surgeon considers the zygomatic arch deformity so severe that it cannot be adequately treated with a transoral (Keen) or temporal (Gillies) approach, or too unstable to be treated without fixation, an open treatment can be considered. The temporal branch of the facial nerve runs in close proximity to the periosteum of the zygomatic arch. It may be particularly desirable in a patient where a coronal approach has to be made for other reasons (such as for the treatment of a frontal sinus fracture or the harvest of a split calvarium bone graft). This has the advantage that it allows direct visualization of the zygomatic arch for fixation. If the surgeon considers the zygomatic arch deformity so severe that it cannot be adequately treated with a transoral (Keen) or temporal (Gillies) approach, or too unstable to be treated without fixation, an open treatment can be considered.
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