Trocar Application in The Treatment of Various Facial Bone Fractures

Lee, Jong Rag; Yang, Seung Don

Abstract

The treatment of facial bone fractures aims at restoring normal anatomical feature and obtaining the physiologic function by accurate fracture reduction and adequate stability. Among various facial bone fractures, displaced mandibular angle and subcondylar fractures are common injuries. Their structural problems such as increased risk of oromasticatory dysfunction and aesthetic drawbacks can be corrected by surgical treatment. In case of displaced comminuted fracture of zygoma, the zygomatic arch should be reduced and rigidly fixed, because it can be used as a key landmark for reconstruction. In case of these fractures, we performed external incision and conventional bicoronal incision to repair mandibular fractures and expose zygomatic arch. However, there are some disadvantages associated with these extensive incisions: a possible facial nerve injury, prolonged massive swelling, noticeable external scarring and increased risk of blood loss. On the other hand, the intraoral incision approach for mandibular angle, subcondyle and zygomatic arch makes possible the anatomic reduction and rigid internal fixation by using a trocar method concomitantly, which requires only an additional small skin incision over the perpendicular point of the fracture site. Additionally, this approach has several advantages, including decreased possibility of facial nerve injury, decreased blood loss, early subsidence of postoperative swelling and minimal external scarring. From March 1997 to November 1999, we used the trocar method for the treatment of various facial bone fractures of 15 males and 3 female patients (age ranged from 17 to 60 years). In this approach, operative endoscope or C-arm was used concomitantly in order to improve the limited operative visual field and to allow surgical access. The use of trocar method through the intraoral and tiny skin incisions provides the accurate reduction and rigid internal fixation. It is considered a good method to minimize the disadvantages of external approaches for the treatment of various facial bone fractures.