Arch Plast Surg.  2018 Jul;45(4):325-332. 10.5999/aps.2018.00311.

Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction

• Song SH
• Kwon H
• Oh SH
• Kim SJ
• Park J
• Kim SI

• KMID: 2418243
• DOI: http://doi.org/10.5999/aps.2018.00311

Abstract

BACKGROUND
Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of the extended transconjunctival approach (ETA) combined with T-bar screw reduction in minimizing scarring and complications for the treatment of ZMC fractures.
METHODS
A total of 26 patients underwent ZMC reduction through the ETA and intraoral approach. A skin incision measuring roughly 5 to 8 mm in length was placed following the lateral canthal skin crease. After releasing the inferior crus of the lateral canthal tendon for canthotomy, the medial periosteum of the lateral orbital rim was preserved for canthal reattachment. A limited subperiosteal dissection and partial relaxing incision of the orbicularis oculi were performed to expose the fracture line of the inferior orbital rim and zygomaticofrontal suture. Reduction was performed using a T-bar screw through the transconjunctivalincision and an elevator through the intraoral incision.
RESULTS
The aesthetic and functional results were excellent. Successful reduction was achieved and the skin incision was less than 8 mm in 20 cases (76.9%). Only six patients had an additional skin incision (less than 5 mm) to achieve reduction. No cases of ectropion, entropion, or excessive scarring were noted.
CONCLUSIONS
The ETA using a T-bar screw is a useful method for maximizing aesthetic results in ZMC fractures, with the advantages of minimal scarring, faster recovery, and maintenance of pretarsal fullness.

Keyword

Zygomatic fractures; Zygoma; Facial bones; Cicatrix

MeSH Terms

Cicatrix
Ectropion
Elevators and Escalators
Entropion
Facial Bones
Humans
Methods
Orbit
Periosteum
Skin
Sutures
Tendons
Zygoma*
Zygomatic Fractures