Reduction of Isolated Zygomatic Arch Fractures with Gillies Approach / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of facial bone fracture is increasing. The zygomatic bone, due to its anatomical prominence, is the second most common site of all facial bone fractures. In this study, we present the clinical experiences of zygomatic arch fracture in a tertiary hospital and introduce the Gillies approach for reduction and its outcome results. SUBJECTS AND METHOD: We collected data from retrospective chart reviews of patients who underwent surgeries from 2010 to 2017 for zygomatic arch fractures at Chungbuk National University Hospital. Data were analyzed according to age, gender, cause of trauma, location of trauma, and clinical symptoms including trismus. All surgery was performed under general anesthesia and via the use of Gillies approach. The result of surgery was evaluated by postoperative facial computed tomography. RESULTS: Sixteen patients underwent surgery for zygomatic arch fracture. The patients had the average age of 41.3 years, a male predominance of 15:1 and physical assault as the most common cause of trauma. The time lag between injury and surgical reduction was 5.5 days. The surgical outcomes were assessed “good” in 14 cases and “moderate” in one case. Patients who had trismus preoperatively were resolved of it in all cases after operation. Postoperative complications were absent. CONCLUSION: The Gillies approach proved to be a relatively easy, safe, and reliable method, and its surgical outcomes was satisfactory in our experiences.

Zygomatic Arch Fracture Reduction via Gillie's (Temporal) Approach—Report of 3 Cases

In mid-face, the zygomatic bone and arch represents the bridge between the maxilla, orbital cavity and temporal bone anterosuperior and posterior, respectively. Zygomatic arch plays a potential relation with the maxilla, petrous part of temporal bone, orbits and the multitude of structures contained within and posterior to it make the temporomandibular joint functionally. Fracture of the zygomatic arch of the bone is potentially disturb the function of the mandibular jaw while opening and closing as well as disfigure by forming depression on face even in case of undisplaced. In time and reduction of arch fracture provides the best chance to avoid facial deformity, jaw dysfunction and prevents unfavorable sequelae. We conclude that, Gillies approach for undisplaced arch fracture reduction will be considerable due to simple and effective method and cosmetically more acceptable.

The Avalibility of C-Arm in Reduction of Zygomatic Arch Fracture Intraoperatively: Case Report

The Effective Reduction Method of Unstable Zygomatic Arch Fracture with Thermo-Splint

PURPOSE: The objective of this study is to propose an effective management of unstable zygomatic arch fracture. The reduction methods of arch fracture were relatively simple but the maintenance of reduction state is very troublesome. On this, authors introduce an effective management method of unstable zygomatic arch fracture. METHODS: Authors experienced 23 cases of unstable segmental zygomatic arch fractures and used Thermo- splint in all cases. All the arch fractures were reduced through Gillies' approach under the general anesthesia. After the reduction, the most effective suspension points were marked on the covering skin of the fractured arch. A needle of heavy nonabsorbable suture material was inserted toward the marking site under the reduced zygomatic arch. And then Therm-splint was dipped in the hot water, and we got the splint pattern of patient face. Reshaped Thermo-splint was trimmed and fixated with previous suspension suture materials. More additive suspension was done if necessary. The splint was applied for in two to three weeks postoperatively. RESULTS: In all the cases, good cosmetic and functional results were observed without severe complications. There were 4 cases of incomplete reductions but they also had no specific problems. There were no facial nerve symptom and scar(stitch mark). Postoperative slight tenderness and trismus were completely subsided after removal of the splint. CONCLUSION: The Thermo-splint safely protect and maintain the postoperative reduction state. The application, maintenance and removal were easy and simple. It could be reformed to any contour of face and had enough rigidity for supporting. Above all these things, effective prevention of displacement and easy manipulation were significant merit. Authors experienced good results with Thermo-splint, and would introduce it for another method of management of zygomatic arch fracture.

Fractured zygomatic arch reduction with foley catheter

K-wire Insertion Beneath Zygomatic Arch Under the Fluoroscope for Rigid Fixation of Zygomatic Arch Fracture

The fracture of zygomatic arch is one of the common fracture of the facial bone and commonly reduced by Gillies or Dingman method However, if the reduced bone segments are unstable after reduction, they tend to be displaced by mastication or unintentional external forces. Though many techniques have been introduced for the treatment of the unstable zygomatic arch fracture, all of those techniques have their own shortcomings. We devised a new fixation method to prevent the displacement of the reduced zygomatic arch segments with 0.047 inch K-wire under the fluoroscope. After reduction of zygomatic arch using Gillies method under the fluoroscope, a thin K-ire was inserted along the undersurface of the zygomatic arch through zygoma body for rigid fixation. The inserted K-wire was removed in 4 weeks. In ten cases, good cosmetic and functional results were observed without complications such as infection, facial nerve injury, displacement of fractured segments, and operative scar during the follow up period of 3 months. However, while the pin was being inserted, patients complained discomfort on their cheeks. This technique may be an available method to prevent the displacement of the reduced zygomatic arch and to obtain the rigid fixation.

CLOSED REDUCTION OF ZYGOMATIC ARCH FRACTURE WITH EXTERNAL WIRE TRACTION UNDER FLUOROSCOPY

Recently, facial traumas are increasing due to expansion of motor vehicles and complexity of social life pattern. The zygoma bone is a prominent part of the midface and prone to be traumatized. Numerous approaches for reduction and fixation of zygomatic fractures have been described. Each reduction method has its advantages and disadvantages. The authors employed the external wire traction with fluoroscopy in cases of non-comminuted zygomatic arch fracture. The advantages of this method are a more accurate reduction under direct vision and takes a very short time. This procedure also can reduce the pain and edema after postoperation and possible under local anesthesia. With such method, we obtained satisfactory results cosmetically and functionally.