Davos Courses

Executive Editor: Edward Ellis III, Kazuo Shimozato General Editor: Daniel Buchbinder

Authors: Carl-Peter Cornelius, Nils Gellrich, Søren Hillerup, Kenji Kusumoto, Warren Schubert

Midface - Isolated zygomatic arch fracture

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Glossary

General considerations

The decision to perform closed versus open treatment is based on thorough clinical and radiographic (CT) evaluation.

The challenge of closed reduction is that it is difficult to ensure that stable reduction has been achieved.

Closed treatment
Main indication Skill Equipment
Displaced fracture amenable for minimally invasive reduction techniques. Some specialized surgical experience Basic equipment only

The challenge of closed reduction is that it is difficult to ensure that stable reduction has been achieved.

Further indications

  • the fracture segments impinge on the coronoid process of the mandible
  • to correct facial deformity (depression)

Advantage

  • Closed treatment is the least invasive form of operative management

Disadvantages

  • No direct visualization of fracture site and the reduction
  • Risk of injury to soft tissues, due to poor placement of bone hook
Open reduction without fixation
Main indication Skill Equipment
Displaced fractures resulting in impingement of the coronoid process and/or facial deformities. Some specialized surgical experience Simple surgical and imaging resources

Contraindication

  • Unstable reduction

Advantages

  • Simple and fast operation
  • No external scar
  • Allows for direct digital palpation of the reduction

Disadvantages

  • Blind reduction
  • Limited stability of the reduction
Open reduction with fixation
Main indication Skill Equipment
Displaced unstable fractures resulting in impingement of the coronoid process and/or facial deformities requiring reduction and fixation. Some specialized surgical experience Simple surgical and imaging resources

Advantage

  • Allows reduction and fixation under direct visualization

Disadvantages

  • Visible scar
  • Time consuming
  • Risk of temporal hollowing
  • Risk of injury to temporal branch of the facial nerve
CAS: Intraoperative imaging in closed treatment
Main indication Skill Equipment
Whenever post reduction control imaging is available. Some specialized surgical experience Full specialized surgical and imaging resources

Whenever an intraoperative CT scanner is available, an intraoperative scan should be obtained for intraoperative evaluation of the reduction.

*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2009-12-03