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General considerations

Correct anatomical reduction is required to reproduce the original structure of the zygomaticomaxillary complex and the proper alignment of the orbital walls. In order to achieve proper reduction of the lateral orbital wall the greater wing of the sphenoid and the zygoma must be properly aligned. It is difficult to use the lateral orbital wall as a landmark if the fractures of the lateral orbital wall are comminuted.

The zygomatic arch can be useful in achieving the proper width of the midface and AP projection of the zygoma. It should be noted that the zygomatic arch is not a true arch and is often relatively straight in its central portion.

A goal is to restore the proper orbital volume and to restore the proper projections in all three dimensions. Accurate positioning of the zygomatic arch addresses the AP dimension and width of the midface.

It is possible that the periorbital contents may have been affected by the reduction of the zygomatic-complex fracture. A forced duction test should be performed before and after the reduction of the zygoma to make sure that the patient does not have entrapment of the soft tissues. Pre- and postoperative ophthalmologic exams should be considered in all patients who have sustained periorbital trauma.