Reduction Techniques For Zygomatic fractures. Which comes when?

Dr.Ayesha MaqsoodDr.Ayesha MaqsoodBDS, FCPSBDS, FCPS

Assistant Professor, Oral & Maxillofacial SurgeryAssistant Professor, Oral & Maxillofacial SurgeryMargalla Institute of Health Sciences & affiliated Margalla Institute of Health Sciences & affiliated hospitals,Rawalpindi.hospitals,Rawalpindi.

Zygomatic bone is responsible for the anterior and lateral projection of face

It is frequently fractured alone or with other bones of midface

Zygomatic Fractures

Zygomatic fractures cause disruption along the following articulations

Zygomaticofrontal suture Infraorbital rim Zygomaticomaxillary

buttress Zygomatic arch Zygomaticosphenoid

suture

Zygomatic Fractures

Zygoma may be fractured in a variety of

patterns,a wide variety of treatment

recommendations have evolved

From minimal reduction maneuvers

performed without fixation to complicated

types of open reduction involving multiple

exposure and fixation points

Zygomatic Fractures

Mechanism of injuryMechanism of injuryDirect blow on prominent partRelative inbending at area of impactionRelative outbending at weak areas such as

the arch,ZM suture,ZF sutureFractures are usually displaced posteriorly&

inferiorly or mediallyMore violent blow causes posterior& lateral

displacement

• Depressed malar eminenceDepressed malar eminence

• EnophthalmosEnophthalmos

• Infraorbital paresthesiaInfraorbital paresthesia

• DiplopiaDiplopia

• Inability to open the mouthInability to open the mouth

Indications for surgery

TreatmentTreatment

• as soon as possible

• Little delay Settling of periorbital edema

proper zygomatic bone examination

• Sight threatening injuries Retrobulbar

hemorrhage may require urgent surgery

Methods of ReductionMethods of Reduction• Temporal fossa (Gillies approach)

• Intra oral (Keen approach)

• Percutaneous

• Malar hook approach

• Carrol Girard screw approach

• Lateral eyebrow (Dingman approach)

Gillies Approach• 2.5 cm.incision in hair of temporal

region• Dissection upto the deep temporal

fascia• Elevator slided over the muscle

under the arch• Rowe elevator allows only the

zygoma to be lifted ,preventing pressure on temporal bone

• For medially displaced arch fractures

• For downward displaced zygoma fractures which are lifted forward

Vestibular(Keen Approach)Vestibular(Keen Approach)• Incision in the buccal sulcus

• Elevator placed under the zygomatic bone or arch

• Allows safe & direct approach to entire facial surface of midfacial skeleton

• For reduction of medially & posteriorally displaced zygomatic fractures

• The displaced segments are lifted upward and laterally

Carroll Girard ScrewCarroll Girard Screw• Incision over the cheek• Drill a small hole and insert the screw • As it is placed directly over the body of zygoma,it

provides traction in any direction• Ideally for laterally displaced arch and zygomatic

fractures

Bone HookBone Hook

• Through a stab incision on the cheek or even

through an intra oral incision

• Posterioraly displaced zygomatic fractures

Dingman ApproachDingman Approach• Lateral eyebrow incision given• For medially displaced arch• Medially and downward displaced body of

zygoma

Endoscopically assisted reduction

• Endoscopic approaches may be used to identify the arch &zygomatic fractures and they could be reduced using any technique

Conclusion• A simple arch fracture such as a medially

displaced one ,may be managed by elevation

alone because periosteal continuity will prevent

displacement.

• No technique suitable for laterally displaced

arch or zygomatic body because insufficient

periosteal continuity will not maintain reductionCont……

Conclusion• Appx. 25% of zygomatic fractures are with

minimal displacement ,which are best managed by closed reduction

• Incomplete fractures at Z.F suture are also amenable to closed reduction

• For an unstable fracture the closed redution may be used as part of open reduction

Thank youThank you