![]() ![]() Figure 21D: Right anterior oblique projection of a 3D surface shaded rendering demonstrates fractures of the right lateral ( thick black arrow) and inferior orbital rims ( black arrowheads) and right zygomatic arch ( thin black arrow). The coronal incision allows for excellent exposure of the zygomatic arch, as well as reduction and fixation of comminuted fractures. Zygomatic arch fractures can be clinically difficult to diagnose as the only signs may be a dimple palpable on the arch, which may or may not be tender. (Click here for a detailed description of the coronal approach). Orbital floor ( curved arrow) involving the infraorbital nerve canal, and a minimally displaced fracture of the lateral wall of the right maxillary sinus ( wavy arrow). General considerations The only direct exposure to the zygomatic arch is through a coronal incision. Closed treatment can be considered but it is difficult to know whether an adequate reduction has been achieved if one does not have intraoperative radiographic imaging. There is a comminuted, inferiorly displaced fracture through the right Principles In this module of AOCMF Surgery Reference we refer to closed treatment if it is limited to using a bone hook. Figure 21C: Coronal reformatted CT image demonstrates an additional fracture of the right superolateral orbital rim ( thick white arrow), just above the frontozygomatic suture. ![]() There are also nondisplaced fractures through the anterior and posterolateral walls of the right maxillary sinus ( hatched arrows). In Figure 21B, there is a comminuted fracture of the right zygomatic arch ( white arrowheads), including a more posterior fracture through the base of the zygomatic process of the temporal bone. Figure 21A demonstrates a comminuted fracture ( thin white arrow) through the right lateral orbital wall involving the sphenozygomatic suture, with posterolateral displacement of the lateral orbital rim, and a medially displaced and laterally angulated comminution fragment encroaching on the orbit. The cause is usually a direct blow to the. 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.Figures 21A and 21B: Axial noncontrast maxillofacial CT images. The zygomatic arch usually fractures at its weakest point, 1.5 cm behind the zygomaticotemporal suture. In most patients, there is little soft tissue over the zygomatic arch. Care must be taken not to injure this nerve. The temporal branch of the facial nerve runs in close proximity to the periosteum of the zygomatic arch. 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 is believed that type 4 and 5 fractures with obvious morpho-functional disorders should require surgery and the other types should be orthopedic and. 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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