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5Placement of additional plates

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 zygomaticomaxillary buttress.

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.