Treatment of Sagittal Fracture of the Zygomatic Arch Root Assisted by Surgical Navigation Technology

Abstract

Sagittal fracture at the temporal root of the zygomatic arch often occurs as a part of zygomaticomaxillary fractures. The authors described the application of computer-assisted navigation in the lag screw insertion for the fixation of sagittal fracture at the temporal root of zygomatic arch. Using the presurgical planning of the computer-assisted navigation system, the trajectory of lag screw insertion was designed, and the insertion depth was calculated. In the presurgical planning, the trajectory of screw insertion was placed with an anterior inclination of 10° to 15° (mean: 12.24°), and the screw insertion depth was 9.0 to 12.0 mm (mean: 10.65 mm). In the operation, the screw insertion in the fixation of the sagittal fracture was performed under the guidance of navigation system according to the presurgical planning. The postoperative CT scan showed exact reduction and fixation of the sagittal fracture in all cases. Computer-assisted navigation is a useful tool for the lag screw insertion in the precise fixation of sagittal fracture at the temporal root of the zygomatic arch in complex zygomaticomaxillary fractures.

Evaluation Of Clinical Features And Treatment Of Zygomatic Bone Fractures: A 10-Year Retrospective Study

“…Contrary to our results, some authors report an increased incidence of non-displaced zygomatic bone fractures [12], while others report a higher incidence of comminuted fractures [13,14]. Biomechanically, displacement in the case of zygomatic bone fractures is primary, being directly proportional to the kinetic energy resulting from the impact, the type of the wounding agent and its direction of action [9][10][11]. Secondary displacement, following traction of the masseter muscle insertions, occurs rarely, having a reduced biomechanically importance [3].…”

“…This result is con rmed in the literature by a number of authors [9][10][11]. It can be explained by the presence of the cortical bone which is better represented at this level, and also by the fact that the temporo-zygomatic arch can fracture through an indirect exion mechanism, secondary to direct fracturing and primary inferomedial displacement of the zygomatic bone [10,11]. In this context, secondary to a low-kinetic energy trauma, the temporo-zygomatic arch fracture is not synchronous with the anterior suture lines or is incomplete [8].…”

“…In our study, all incomplete fracture lines were found in the temporo-zygomatic arch, either in association with complete anterior tripod fractures of the zygomatic bone or isolated. This result is con rmed in the literature by a number of authors [9][10][11]. It can be explained by the presence of the cortical bone which is better represented at this level, and also by the fact that the temporo-zygomatic arch can fracture through an indirect exion mechanism, secondary to direct fracturing and primary inferomedial displacement of the zygomatic bone [10,11].…”

“…In this context, secondary to a low-kinetic energy trauma, the temporo-zygomatic arch fracture is not synchronous with the anterior suture lines or is incomplete [8]. Isolated temporo-zygomatic arch fractures are rare, their reported percentage in the literature ranging between 0.5 and 14% [3][4][5][9][10][11]. A solitary temporozygomaic arch fracture, requires a lateral and perpendicular to the viscerocranium impact direction [10].…”

“…A solitary temporozygomaic arch fracture, requires a lateral and perpendicular to the viscerocranium impact direction [10]. Given that the direction of action of wounding agents on the face is most frequently anterior or anterolateral, there are small chances that fractures will occur solely at this level [9][10][11].…”