Placement of fourth plate
Looking through the maxillary vestibular approach, the fracture of the
zygomaticomaxillary buttress is aligned. A larger L-shaped plate is ideal for
the fixation of this fracture. This is the most difficult plate to properly
adapt in a zygoma fracture. It is important that the leg of the L-plate be
placed on the most lateral portion of the lateral maxillary buttress, where the
bone is fairly thick.
It is similarly important that the foot of the L-plate is placed along the
alveolar bone in a manner that the screws will not be placed into the dental
roots. A common problem with this third plate is failure to properly adapt the
L-plate, resulting in screw placement into the thin wall of the anterior
maxillary sinus. It is not uncommon for the lateral maxillary buttress to be
comminuted. In this instance using a longer L-plate with multiple screw holes
may be ideal.
We recommend that lower profile plates are used at the zygomaticofrontal
suture and the infraorbital rim. A stronger plate is recommended for the
In the illustration we can see that there is a comminuted segment of the
lateral column. This is a common presentation in this kind of fracture.