Treatment of Zygomatic Fractures Without Inferior Orbital Rim Fixation

Abstract

Zygomatic fractures can be associated with functional and esthetic problems. Recent improvements in surgical techniques and materials have enabled stable fixation of zygmomatic fractures. Multiple-point fixation is most commonly used for internal fixation. Generally, reduction and fixation are performed through lateral brow, subciliary, temporal, or intraoral incisions (three-point fixation). Our experience indicates that postoperative scarring and sensory disturbances are caused by a subciliary incision with inferior orbital rim fixation. It is thus recommended that inferior orbital rim fixation with mini- or microplates be avoided. In patients in whom the fracture does not involve the orbital floor, reduction of the zygoma and zygomatic arch through a temporal incision is performed at this institution. Fixation of the lateral zygomaticomaxillary buttress and anterior wall of the maxilla with miniplates through an intraoral incision is also performed. If necessary, zygomaticofrontal suture fixation with a miniplate or wire is performed through a lateral brow incision. The status of inferior orbital rim reduction is confirmed by palpitation. Inferior orbital rim fixation with mini- or microplates is recommended for reduction of comminuted fractures and orbital floor fractures with herniation of internal orbit components. Patients who did not undergo inferior orbital rim fixation were free of inferior orbital rim deformity, diplopia, and postreduction rotation.

Management of Zygomatic Complex Fracture in Armed Forces

“…However, opinions vary and different combination have been documented in literature [12]. Eight cases were managed by more than two point fixation, but no extra benefits were achieved from these approaches on reduction and stabilization point of view vis-à-vis two point fixation, and one patient in this group developed complications.…”

Efficacy of two point rigid internal fixation in the management of zygomatic complex fracture

“…the frontozygomatic along with the zygomatic buttress [16], zygomatic buttress along with infraorbital [18] and frontozygomatic along with infraorbital [15]. The infraorbital rim may not be a preferred choice for mini bone plate osteosynthesis as there are no functional loads in this area, and though compact the bone at the infraorbital rim is so thin that only few threads of the screw can be anchored [19].…”

“…Also, infraorbital exploration for rigid fixation may result in lower eyelid problems e.g. ectropion and a perceptible scar [18].…”

“…8 and 9). Also the fact that the approach has an esthetic outcome as the scars is well hidden intraorally and in the eyebrow [15] also avoiding the problems of ectropion and neurological disturbance associate with infraorbital exploration [18].…”

Use of Mono Cortical Screws as an Aid to Zygomatic Complex Fracture Reduction

“…Proper reduction of the lateral wall of the orbit is important for the proper reconstruction of the orbital volume and for the anterio-posterior projection of the zygomatic bone [4]. This can be achieved effectively in our method as the operator can feel the reduction by passing a flat instrument with the fractured bone held firmly in the reduced position.…”