1 Principles top
Closed treatment of fractures of the zygomatic complex refers to the management of fractures of the zygomatic complex where, either prior to or following the reduction of the zygoma, the patient does not have a significant orbital defect.
This technique is contraindicated if there is a fracture displacement at the zygomaticofrontal suture.
In rare situations a surgeon may have a simple noncomminuted zygomatic-complex fracture which, with closed manipulation, snaps into a perfect reduction and then appears to be very stable. A surgeon may choose to omit fixation under those special circumstances.
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.
One goal is to restore the proper orbital volume and to restore the proper width, AP projection, and height of the midface. Proper reduction of the zygoma addresses the issues of the AP projection of the 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 following the reduction of the zygoma to make sure that the patient does not have entrapment of the soft tissues. Pre- and postoperative ophthalmologic examinations should be considered in all patients who have sustained periorbital trauma.
Unless a surgeon has access to intraoperative imaging, it is nearly impossible to determine that a correct anatomical reduction has been achieved using the closed technique. For this reason we discourage the use of this technique by surgeons with little experience.
2 Zygoma reduction methods topenlarge
Illustration shows reduction of zygomatic-complex fracture using a percutaneous technique and a hook.
Screw and traction
In this illustration a percutaneous screw is inserted into the zygomatic bone. This allows fracture reduction using the screw and a holding instrument.
Threaded reduction tool
In this illustration a threaded reduction tool (Carroll-Girard screw) is inserted percutaneously into the zygoma and used for reduction.