Purpose:
A fractured zygoma frequently results in an aesthetically displeasing postero-medially displaced malar prominence. Open reduction and internal fixation (ORIF) may accurately realign the facial skeleton but often leads to undesirable sequelae related to open access (visible scars, eyelid malposition) and hardware placement (pain, palpability). Repair using the closed Gillies approach, however, is predictably less accurate as direct visual confirmation of zygoma position is impossible. Our objectives were to develop a novel technique of zygoma fracture repair using a small well-hidden temporal scalp incision and intra-operative c-arm guidance. This method should be accurate in realigning the fracture interfaces without the disadvantages of wide-open access.
Methods:
The project consisted of three main phases. First, using a model skull, the relative positions of the C-Arm required to adequately delineate the fronto-zygomatic, infra-orbital, and zygomatico-temporal buttresses as well as zygoma projection were described. Second, using the defined c-arm settings, 10 cadaver skull moderate energy zygoma fractures were repositioned using a Bristowe elevator inserted through a temporal hairline incision. Accuracy of realignment was confirmed using CT imaging. Third, the optimal operating room set-up and repair sequence were defined.
Results:
The angulations of the c-arm, with respect to the Frankfort Horizontal and the sagittal planes, required to image the fronto-zygomatic, infra-orbital, and zygomatico-temporal buttresses as well as zygoma projection were -350 and 150, -150 and 00, -900 and 00, -1250 and 00, respectively. CT images of post-repair cadaver skulls showed near anatomic restoration of zygoma position in 9 out of 10 cases. No visible cutaneous incisions were utilized. Fracture stability was apparent in all cases.
Conclusions:
We have developed a novel technique of zygoma fracture repair through one small incision using intra-operative c-arm imaging. This method has the accuracy of ORIF but without the risks related to open access or hardware placement. In addition, the short operating time required makes this technique ideal for clinical use in moderate energy zygoma injuries.