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.

Operative Results in Orbital Floor Fracture Associated with Malar Tripod Fracture

17 patients underwent operations in malar tripod fracture combined with orbital floor fracture from January 1995 to June 1998. Age distribution was from 16 to 62. Sexual distribution was 15 males and 2 females. 11 cases were due to slip or all down. All orbital floors were reconstructed with silastic sheet through subciliary incision. In case of type I and type II, one-point fixation was performed with miniplate and screws on zygomaticomaxillary suture, In type III and IV, two-point fixation was done with miniplate and screws on zygomaticomaxillary and zygomaticofroptal suture by Gillies' approach and lateral eyebrow incision. Among 9 patients with preoperative diplopia, 5 patients improved within 1 week, 2 patients within 1 month. Among 3 patients with severe preoperative diplopia, 2 patients remained with mild diplopia, but no interference with daily work was encountered. In postoperative apperance and X-ray findings, excellent results were noted in 4 cases(24%), good cases in 10 cases (59%), fair cases in 3 cases (18%), but no poor case was found. 5 cases with Preoperative mouth opening limitation improved during postoperative period. In patients with malar tripod fracture with orbital floor fracture, it can serve as a good surgical method that bony fragment reduction by Gillies' approach and fixation with miniplate and screws.

A long term follow up of reduced isolated zygomatic arch fracture by Gillies' approach

Many methods have been developed for the reduction of the isolated zygomatic arch fracture. Even though the reduction of isolated zygomatic arch fracture can be made well according to the various methods, the Gillies' method has been selected as the 1st choice. But long term follow-up study of this method was not reported. So long term follow up of zygomatic arch fracture was performed in 35 patients who were treated by Gillies' method. Authors divided isolated zygomatic arch fractures into three classes (Type A : a simple fracture with one fracture line and one greenstick fracture, TyPe B : medially depressed fracture with three fracture lines, Type C : a medially depressed fracture segment with two fracture lines) and followed up the reduced isolated zygomatic arch fracture cases using Gillies' method by radiographes and interview. The depression of lesion site was estimated by comparing with tracing the zygomatic arch shadow of normal side. The results were as follows: 1. The mean follow up time was 33.4 month. 2. The isolated zygomatic fractures were classified by three group. A: a simple fracture (16 cases) B: the central fracture point was a medially depressed fracture (14 cases) C: fracture with a medially depressed segment (5 cases) 3. The mean depression of lesion site was 2.3 mm. (Type A: 2.0 mm, Type B: 3.2 mm, Type C: 2.4 mm and difference between A and B was significant statistically (p < 0.037)). 4. The mean depression of zygomatic arch fracture was 2.1 mm in excellent group, 2.4 mm in good group and 5.2 mm in poor group and difference between excellent and poor, and between good and poor group were statistically significant (p < 0.0001). 5. On result of subjective satisfaction, number of excellent case was 17(48.6%), it of good case was 15(42.9%) and it of poor case was 3(8.6%) (Type A: 9, 7, 0, Type B: 5, 7, 2 and Type C: 3, 1, 1 excellent, good and poor in sequence). 6. The mean depression of overcorrection group(17, 8, 1 excellent good and poor in sequence) and nonovercorrection group(2, 5 and 2 in excellent, good and poor in sequence) was 2.26 and 3.6 mm in each other(p < 0.004). After reviewing all of results, it is concluded that Gillies' method is acceptable as the 1st choice for the reduction method of an isolated zygomatic arch.

A long term follow up of reduced isolated zygomatic arch fracture by Gillies' approach

Many methods have been developed for the reduction of the isolated zygomatic arch fracture. Even though the reduction of isolated zygomatic arch fracture can be made well according to the various methods, the Gillies' method has been selected as the 1st choice. But long term follow-up study of this method was not reported. So long term follow up of zygomatic arch fracture was performed in 35 patients who were treated by Gillies' method. Authors divided isolated zygomatic arch fractures into three classes (Type A : a simple fracture with one fracture line and one greenstick fracture, TyPe B : medially depressed fracture with three fracture lines, Type C : a medially depressed fracture segment with two fracture lines) and followed up the reduced isolated zygomatic arch fracture cases using Gillies' method by radiographes and interview. The depression of lesion site was estimated by comparing with tracing the zygomatic arch shadow of normal side. The results were as follows: 1. The mean follow up time was 33.4 month. 2. The isolated zygomatic fractures were classified by three group. A: a simple fracture (16 cases) B: the central fracture point was a medially depressed fracture (14 cases) C: fracture with a medially depressed segment (5 cases) 3. The mean depression of lesion site was 2.3 mm. (Type A: 2.0 mm, Type B: 3.2 mm, Type C: 2.4 mm and difference between A and B was significant statistically (p < 0.037)). 4. The mean depression of zygomatic arch fracture was 2.1 mm in excellent group, 2.4 mm in good group and 5.2 mm in poor group and difference between excellent and poor, and between good and poor group were statistically significant (p < 0.0001). 5. On result of subjective satisfaction, number of excellent case was 17(48.6%), it of good case was 15(42.9%) and it of poor case was 3(8.6%) (Type A: 9, 7, 0, Type B: 5, 7, 2 and Type C: 3, 1, 1 excellent, good and poor in sequence). 6. The mean depression of overcorrection group(17, 8, 1 excellent good and poor in sequence) and nonovercorrection group(2, 5 and 2 in excellent, good and poor in sequence) was 2.26 and 3.6 mm in each other(p < 0.004). After reviewing all of results, it is concluded that Gillies' method is acceptable as the 1st choice for the reduction method of an isolated zygomatic arch.