J Korean Med Sci.  2006 Dec;21(6):1080-1085. 10.3346/jkms.2006.21.6.1080.

Single Transconjunctival Incision and Two-point Fixation for the Treatment of Noncomminuted Zygomatic Complex Fracture

• Lee PK
• Lee JH
• Choi YS
• Oh DY
• Rhie JW
• Han KT
• Ahn ST

• KMID: 1713123
• DOI: http://doi.org/10.3346/jkms.2006.21.6.1080

Abstract

The ultimate goal in treating zygomatic complex fracture is to obtain an accurate, stable reduction while minimizing external scars and functional deformity. The present authors present our experiences with a single transconjunctival incision and two-point (inferior orbital rim and frontozygomatic suture) fixation in 53 patients with zygomatic complex fracture which were not comminuted. All patients had transconjunctival approaches with lateral canthal extensions, and six out of 53 patients also had an additional small (about less than 2 cm) gingivobuccal incision to achieve an accurate reduction. There were 3 minor complications, and the overall esthetics and functional results were satisfactory with a long term follow-up. Our method has the following advantages in the reduction of zygomatic complex fracture; It leaves only an inconspicuous lateral canthal scar. In addition, it provides excellent simultaneous visualization of the inferior orbital rim and frontozygomatic suture area. Hence, twopoint fixation through a single incision can be performed with a satisfactory stability.

Keyword

Surgical Procedures, Operative; Single Transconjunctival Incision; Zygomatic Fractures

MeSH Terms

Zygomatic Fractures/*surgery
Treatment Outcome
Surgical Procedures, Minimally Invasive/instrumentation/methods
Osteotomy/*instrumentation/*methods
Middle Aged
Male
Humans
Fracture Fixation, Internal/*instrumentation/*methods
Female
Conjunctiva/*surgery
Bone Plates
Aged, 80 and over
Aged
Adult
Adolescent

Figure

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  Fig. 1 After lateral canthal incision is made down to the periosteum of lateral orbital rim, the conjunctiva is incised 2, 3 mm below the tarsus from a point just lateral to the punctum to the lateral canthal incision site.

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  Fig. 2 By pulling the lower eyelid flap down and pulling the upper eyelid flap up, the entire lateral and inferior orbital rim can be exposed.

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  Fig. 3 Through a single transconjunctival incision, two-point fixation (inferior orbital rim and frontozygomatic suture) with four hole resorbable 2.0 mm miniplates systems (arrows) can be performed without difficulty.

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  Fig. 4 (A) Preoperative zygomatic arch view (submentovertical view) shows fracture and displacement of the left zygoma bone. (B) Postoperative zygomatic arch view.

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  Fig. 5 (A) Preoperative skull Waters view, (B) Postoperative skull Waters view, (C) Preoperative zygomatic arch view, (D) Postoperative zygomatic arch view.

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  Fig. 6 Follow up at 2 yr after the operation. There is hardly visible scarring at the lateral canthal area (arrow).

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