![]() ![]() They found that the average facial incision length was shorter than that associated with traditional methods, which often require multiple incisions. They compared their outcomes (reduction and esthetic) with those of patients who underwent open reduction and internal fixation (ORIF) techniques. 15 treated 23 patients with zygomaticomaxillary complex fractures using a closed reduction method with Steinmann-pin fixation. They concluded that it is a desirable approach for undisplaced zygomatic fractures due to its simple, effective, and cosmetically acceptable results. In 2014, Patil and Patil 14 used Gillies temporal approach in three cases of left ZMC fracture. Percutaneous insertion of a “Caroll-Girard” screw is a less traditional technique to pull the zygomatic bone into an undislocated position, and to reposition it 11. A small incision is made 2 cm laterally to the temporal canthus, and the hook is inserted through the skin under the zygomatic bone, where it is then repositioned 13. The second approach is performed percutaneously with a bone hook. The fascia of the temporalis muscle is incised to insert an elevator below the zygomatic arch. According to Gillies, the first approach consists of reaching the zygomatic bone through a small temporal incision 8. For the closed reduction of the zygomatic bone, two transcutaneous approaches are recommended. Closed reduction procedures are less labor-intensive, but still provide appropriate decompression of the infraorbital nerve. A closed reduction of zygomatic fractures is contraindicated if surgical correction of the orbital floor is required 11. The two biggest problems encountered are an uncertain repositioning of the fracture gaps, and an inappropriate postoperative stability of the repositioned zygomatic body. The reduction and fixation of fracture fragments should be performed as early as possible to avoid any functional and cosmetic deformities. The elements of the facial buttress are listed in Table 1 4. These bones are enclosed by the thicker bones of the facial buttress, providing strength and stability. The ability to withstand the forces of a blow to the midface comes via a strong attachment of the frontal, maxillary, zygomatic, and sphenoid bones to one another. Accurate positioning of the fractured bone (posterior to the skull base and anterior to the midface) should be performed in order to repair the fragments. Zygomatic fractures require appropriate treatment because inadequate skeletal healing can cause reduced malar projection, resulting in facial cosmetic deformities. This makes early diagnosis and management important. The most important functional defect encountered is reduced mouth opening due to impingement on the coronoid process 3. Zygomatic fractures should be treated early because they can cause both functional and cosmetic defects. Zygomatic fractures can also lead to disarticulation from the suture line along the four articulation surfaces (i.e., the zygomaticomaxillary complex, the zygomatic complex proper, and the orbitozygomatic complex). Due to its unique bony architecture, it can withstand blows of significant impact without being fractured. The zygoma is most vulnerable to fracture beyond the dorsum of the nose 2. Any break in continuity or dislocation of this bone disrupts ocular and mandibular functions, and may cause cosmetic defects. The malar bone plays a unique role in maintaining facial contours and the underlying bony architecture 1. ![]()
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