Closed Isolated Zygomatic Arch Fracture Management Made Easy

Abstract

Surgical removal of osteoma in craniofacial region is suggested when it causes pain, chronic inflammation, while surgical intervention is not required in case of asymptomatic osteomas. 19 However, surgical intervention could be needed for cosmetic reasons in prominent facial regions, such as the forehead and zygomatic body. 4,20 Osteomas of these regions used to be surgically removed by direct approach. 21 However, this approach inevitably causes a visible scar and we should consider the patients' concern because they undergo surgical treatment for cosmetic reasons, not for functional reasons.Several studies reported that the endoscopic approach was evaluated safe and effective surgical choice in craniofacial region. 22 In forehead osteoma, endoscopic-assisted surgical techniques allow safe removal of lesion with excellent cosmetic outcomes. 20 Similar techniques are also useful for removal of osteoma in other craniofacial region. In 3 cases of osteoma of zygomatic body, surgical resections were performed using extraoral approach in 2 cases 11,17 and intraoral approach in 1 case. 18 If the lesion is located on the inferior part of the zygomatic bone, an intraoral approach can be an good option. However, if the lesion is on the superior part of zygomatic bone as observed in our patient, it is difficult to access properly due to the convexity of the zygoma, so an endoscopic approach is advantageous. In addition, our patient did not want a facial scar and we decided to use an endoscopic approach for surgical resection. We could achieve satisfactory results with no complications in this case. To the best of our knowledge, this is the first report of zygomatic osteoma that was endoscopically removed. The use of the endoscopic approach is appropriate to obtain good aesthetic results and prevent an accidental injury to the neurovascular structures in zygomatic area.

Three-dimensional characterization of zygomatic arch morphology and its relation to the articular eminence in a Brazilian population

“…It is tenuous, elongated and is the site where the masseter muscle has its origin. Because it is a salient bilateral structure, the ZA is susceptible to several types of traumas (Song et al, 2009), such as isolated fractures or being a part of multiple facial fractures (Valdés and Zapata, 2021;Jones and Schmalbach, 2022;Estawrow and Elbarbary, 2022).…”

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“…is tenuous, elongated and is the site where the masseter muscle has its origin. Because it is a salient bilateral structure, the ZA is susceptible to several types of traumas(Song et al, 2009), such as isolated fractures or being a part of multiple facial fractures(Valdés and Zapata, 2021;Jones and Schmalbach, 2022;Estawrow and Elbarbary, 2022).In the temporal bone, it arises from a triangular base, extends through the zygomatic process of the temporal bone to the region where the temporal and zygomatic bones communicate, the zygomaticotemporal suture, and then it crosses to articulate with the zygomatic bone through the temporal process of the zygomatic bone. Finally, the body of this last bone delimits the extension of the arch(Testut and Latarjet, 1954).Adjacent to the ZA, in its part of the zygomatic process of the temporal bone, is the articular eminence (AE), part of the skeletal structures of the temporomandibular joint (TMJ).…”

Is Gillies Temporal Incision Necessary to Successfully Reduce Zygomaticomaxillary Fracture Combined With Orbital Wall Fracture?

“…Gillies temporal approach has been widely used to reduce zygoma fractures 6–9 . Traditionally, it is the preferred method to reduce the isolated zygomatic arch fracture.…”