• Archives of Craniofacial Surgery
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• v.15 no.2
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• pp.59-62
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• 2014

Background: The zygoma is the most prominent portion of the face. Almost all simple zygomatic arch fractures are treated in a closed fashion with a Dingman elevator. However, the open approach should be considered for unstable zygomatic arch fractures. The coronal approach for a zygomatic arch fracture has complications. In this study, we introduce our method to reduce a special type of unstable zygomatic fracture. Methods: We retrospectively reviewed zygomatic arch view and facial bone computed tomography scans of 424 patients who visited the Wonju Severance Christian Hospital from 2007 to 2010 with zygomaticomaxillary fractures, among whom 15 patients met the inclusion criteria. Results: We used a Dingman elevator and K-wire simultaneously to manage this type of zygomatic arch fracture. Simple medial rotation force usually collapses the posterior fractured segment, and the fracture becomes unstable. Thus, the posterior fracture segment must be concurrently elevated with a Dingman elevator through Keen's approach with rotation force applied through the K-wire. All fractures were reduced without any instability using this method. Conclusion: We were able to reduce unstable and difficult zygomatic arch fractures without an open incision or any external fixation device.

• Archives of Craniofacial Surgery
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• v.23 no.3
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• pp.111-118
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• 2022

Background: Although the zygomatic arch is an important structure determining facial prominence and width, no consensus exists regarding the classification of isolated zygomatic arch fractures, and the literature on this topic is scarce. To date, five papers have subdivided zygomatic arch fractures; however, only one of those proposed classifications includes the injury vector, although the injury vector is one of the most important factors to consider in fracture cases. Furthermore, the only classification that does include the injury vector is too complicated to be suitable for daily practice. In addition, the existing classifications are clinically limited because they do not consider greenstick fractures, nondisplaced fractures, or coronoid impingement. In the present study, we present a rearrangement of the previously published classifications and propose a modified classification of isolated zygomatic arch fractures that maximizes the advantages and overcomes the disadvantages of previous classification systems. Methods: The classification criteria for isolated zygomatic arch fractures described in five previous studies were analyzed, rearranged, and supplemented to generate a modified classification. The medical records, radiographs, and facial bone computed tomography findings of 134 patients with isolated zygomatic arch fractures who visited our hospital between January 2010 and December 2019 were also retrospectively analyzed. Results: We analyzed major classification criteria (displacement, the force vector of the injury, V-shaped fracture, and coronoid impingement) for isolated zygomatic arch fracture from the five previous studies and developed a modified classification by subdividing zygomatic arch fractures. We applied the modified classification to cases of isolated zygomatic arch fracture at our hospital. The surgery rate and injury severity differed significantly from fracture types I to VI. Conclusion: Using our modified classification, we could determine that both the injury force and the injury vector meaningfully influenced the surgery rate and the severity of the injuries.

• Archives of Plastic Surgery
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• v.34 no.6
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• pp.813-817
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• 2007

Purpose: The zygomatic arch is a key element which composes the facial contour. In many cases of zygomatic arch fracture, it is difficult to fix rigidly the fractured segments. If reduced bone segments were not fixed rigidly, they are proven to be displaced by mastication or unintentional external forces. So, unfixed zygomatic arch fracture after reduction may require a external device of prevention of collapse. We introduce a new protector which stabilizing the fractured segments to prevent for collapse of the reduced zygomatic arch fracture. Methods: After reduction of zygomatic arch with blind approach(Gillies', Dingman or Keen's approach), bone segments was pulled with percutaneous traction suture in medial aspect of zygomatic arch. Then, the suture was fixed with Aqua $splint^{(R)}$, externally. And intraoperative and postoperative X-ray was done. The splint was removed on 14 days after the operation. Results: 5 patients were treated with this method. 4 patients of total patients had no collapse in zygomatic arch. There was minimal collapse in one patient. Postoperative complications such as facial nerve injury, mouth opening difficulty, contour deformity, infection, scar were not observed. Conclusion: In comparison with other techniques, this technique has several advantages which are simple and easy method, short operation time, no scar, less soft tissue injury, and facilitated removal of splint. Therefore, Aqua $splint^{(R)}$ would be a good alternative to prevent for collapse in unstable zygomatic arch fractures

• Archives of Craniofacial Surgery
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• v.17 no.4
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• pp.198-201
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• 2016

Background: Zygomatic arch is a bony arch constituting the lateral midface, which consists of 25% of all midface fractures. There are a number of ways to evaluate the extent of zygomatic arch fracture. Some authors have reported successful treatment outcomes using ultrasound (U/S). To add to the previous methods, we have considered ways to accurately display the location of the fracture line while using U/S with 23 gauge needle marking. We introduce our method, which provided satisfactory results for reduction using a portable U/S, and it can evaluate the fracture line simultaneously when reduction of an isolated zygomatic arch fracture is necessary, and needle marking, which can easily point out the fracture line on U/S. Methods: We studied 21 patients with an isolated zygomatic arch fracture who underwent closed reduction using U/S and needle marking between 2013 and 2015. Results: We achieved satisfactory results in all our cases with respect to reduction by using the Dingman elevator after performing a temporal approach incision, while confirming relative positioning between needle marking and zygomatic fracture at the same time, after insertion of a 23 gauge needle in the skin above the zygomatic arch fracture line parallel to it. Conclusion: We treated 21 patients with an isolated zygomatic arch fracture using U/S and the needle marking method, which provided satisfactory results because the extent of reduction of the fracture could be evaluated in real-time during the operation and exposure to radiation was reduced.

• Archives of Plastic Surgery
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• v.40 no.5
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• pp.546-552
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• 2013

Background The zygoma is a major portion of the midfacial contour. When deformity occurs in this area, a reduction should be conducted to correct it. If a sagittal fracture at the temporal root of the zygomatic arch occurs, this also requires reduction, but it is difficult to approach due to its anatomical location, and the possibility of fixation is also limited. Thus, the authors attempted the reduction of sagittal fracture by two- or three-point fixation and the Gillies approach without direct manipulation. The preoperative and postoperative results of the patients were evaluated. Follow-up was performed to establish a treatment guideline. Methods A retrospective study was done with 40 patients who had sagittal fractures at the temporal root of the zygomatic arch from March 2009 to June 2012. Only two- or three-point fixation was performed for the accompanying zygomatic-orbital-maxillary fracture. The Gillies approach was used for complex fractures of the zygomatic arch, while the temporal root of the zygomatic arch was only observed without reduction. Preoperative and postoperative computed tomography and X-ray scans were performed to examine the results. Results The result of the paired t-test on preoperative and postoperative bone gap differences, the depression level, and the degree of temporal protrusion showed a marked decrease in the mean difference at a 95% confidence interval. The results were acceptable. Conclusions In the treatment of sagittal fractures at the temporal root of the zygomatic arch, it is acceptable to use indirect reduction and non-fixation methods. This leads to a satisfactory aesthetic and functional outcome.

• The Journal of the Korean dental association
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• v.17 no.1 s.116
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• pp.25-28
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• 1979

An instance of difficulty in mouth opening as around 2mm due to impingement of fractured coronoid process and zygomatic arch in 30-year-old man who had met with a traffic accident was observed and surgical operation was done. After removal of the fractured coronoid process and elevation of the depressed malunited zygomatic arch, the patient could open mouth by now about 30mm.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.465-470
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• 2008

Purpose: Reduction malarplasty is a popular aesthetic surgery for contouring wide and prominent zygoma. However a few patients complain postoperative results and want to revise the midfacial contour. We analyzed the etiology of unfavorable results and treated unsatisfied midfacial contours after reduction malarplasty. Methods: Total 53 patients were performed secondary operation for correction of unfavorable results after primary reduction malarplasty from elsewhere. Midfacial contour was evaluated with plain films and three-dimensional computed tomography. Unfavorable midfacial contours were corrected by secondary malarplasty. Flaring of zygomatic arch was reduced with infracturing technique and prominent zygomatic body was reduced with shaving. Drooped or displaced zygoma complex has been suspended to higher position and fixed with interosseous wiring. As adjuvant procedure, autologous fat injection has been performed in the region of depressed zygomatic body region. Results: The etiology of unfavorable midfacial contour after reduction malarplasty was classified into 7 categories: undercorrection of zygomatic arch(n=8), undercorrection of zygomatic arch and undercorrection of zygomatic body(n=6), undercorrection of zygomatic arch and overcorrection of zygomatic body(n=28), overcorrection of zygomatic body(n=3), simple asymmetry(n=4), malunion(n=2) or nonunion(n=2). Slim and balanced malar contour was achieved with treatment. And most of the patients were satisfied with the results of the surgery. Conclusion: To prevent the unfavorable results after reduction malarplasty, complete analysis of facial contour, choice of appropriate operation technique, precise osteotomy under direct vision, and security of zygoma position are important.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.287-294
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• 2011

Purpose: Reduction malarplasty is one of the common aesthetic procedures performed in the Orient. We have analyzed effective operative methods according to the pivot point for the osteotomy and reposition of the zygoma for reduction malarplasty after confirming the shapes of the individual zygomas. Methods: Thirty-six patients had been received malarplasty over the last 10 years. The average follow-up period was 16 months. We categorized the patients into three groups according to their prominent appearance features. Group I had a prominently protruded zygomatic body, group II had a prominently protruded zygomatic arch, and group III had a prominently protruded body and zygomatic arch. In the group I, two parallel oblique osteotomies on the body, the middle portion was removed, and with the zygomatic arch as the pivot point, the body was repositioned inwards. In the group II, the zygomatic body and arch osteotomy is performed, with the body as the pivot point, and the arch is depressed medially. In the group III, using the two aforementioned methods, the zygoma was repositioned medially. In each case, postoperative complications and patients satisfaction over the surgery were surveyed. Results: Each group had 25, 5 and 12 patients respectively. No significant complications were found except for one patient who experienced a non-union of zygomatic bone. In the case of group I, four patients underwent a secondary operation. Conclusion: Reduction malarplasty is popular as an effective facial contouring surgery. In order to obtain more effective results,however, the zygomatic shape should be identified, and appropriately repositioned by different operative technique according to pivot points.

• Archives of Plastic Surgery
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• v.37 no.1
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• pp.91-94
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• 2010

Purpose: The purpose of this study is to describe the usefulness of intraoperative mobile CT scans in the reduction of zygomatic arch fracture. Method: Two patients with zygomatic arch fractures were selected who were indications of closed reduction by Gilles' approach. After the reduction was done in the operating room with zygomatic arch elevator, intraoperative CT scan was done to check the extent of reduction. Additional reduction was performed according to the obtained images from the intraoperative mobile CT scan. Examination of the preoperative CT, intraoperative CT after the reduction, and postoperative plain X-ray films were done for documentation and analysis. Results: Reduction was carried out successfully to the patients without any complications. Both patients were satisfied with the postoperative cosmetic and functional outcome. Revisional surgery was not necessary during the 6 months follow up. Conclusion: The advantage of this method is that it is easier to obtain three dimensional relationships of the fracture site. Furthermore, the operator is less exposed to radiation hazards compared to other methods that obtain intraoperative images such as the C-arm. In conclusion, intraoperative mobile CT scan can be a useful surgical aid in the reduction of zygomatic arch fractures.

• Archives of Plastic Surgery
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• v.35 no.1
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• pp.110-115
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• 2008

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.