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

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.

Keywords

Zygomatic fractures - Zygoma - Facial bones - Cicatrix

Publication History

Received: 12 April 2018

Accepted: 18 June 2018

Article published online:
03 April 2022

• REFERENCES

• 1 Chang EL, Hatton MP, Bernardino CR. et al. Simplified repair of zygomatic fractures through a transconjunctival approach. Ophthalmology 2005; 112: 1302-9
• 2 Lee PK, Lee JH, Choi YS. et al. Single transconjunctival incision and two-point fixation for the treatment of noncomminuted zygomatic complex fracture. J Korean Med Sci 2006; 21: 1080-5
• 3 Kim DW, Choi SR, Park SH. et al. Versatile use of extended transconjunctival approach for orbital reconstruction. Ann Plast Surg 2009; 62: 374-80
• 4 Uemura T, Jinnai T, Yokoyama T. et al. C-shape extended transconjunctival approach for the exposure and osteotomy of traumatic orbitozygomaticomaxillary deformities. J Craniofac Surg 2001; 12: 603-7
• 5 Martinez AY, Bradrick JP. Y modification of the transconjunctival approach for management of zygomaticomaxillary complex fractures: a technical note. J Oral Maxillofac Surg 2012; 70: 97-101
• 6 Rodriguez ED, Dorafshar AH, Manson PN. Facial fraactures. In: Neligan PC. Plastic surgery. 3rd ed. Philadelphia: Saunders Elsevier; 2013. 3. 49-88
• 7 Kaufman Y, Stal D, Cole P. et al. Orbitozygomatic fracture management. Plast Reconstr Surg 2008; 121: 1370-4
• 8 Manganello-Souza LC, Rodrigues de Freitas R. Transconjunctival approach to zygomatic and orbital floor fractures. Int J Oral Maxillofac Surg 1997; 26: 31-4
• 9 Holtmann B, Wray RC, Little AG. A randomized comparison of four incisions for orbital fractures. Plast Reconstr Surg 1981; 67: 731-7
• 10 Werther JR. Cutaneous approaches to the lower lid and orbit. J Oral Maxillofac Surg 1998; 56: 60-5
• 11 Yamamoto Y, Kawashima K, Sugihara T. et al. Surgical management of maxillectomy defects based on the concept of buttress reconstruction. Head Neck 2004; 26: 247-56
• 12 Tarabichi M. Transsinus reduction and one-point fixation of malar fractures. Arch Otolaryngol Head Neck Surg 1994; 120: 620-5
• 13 Manson PN, Ruas E, Iliff N. et al. Single eyelid incision for exposure of the zygomatic bone and orbital reconstruction. Plast Reconstr Surg 1987; 79: 120-6
• 14 Kreutziger KL, Kreutziger KL. Zygomatic fractures: reduction with the T-bar screw. South Med J 1992; 85: 1193-202
• 15 Karlan MS, Cassisi NJ. Fractures of the zygoma: a geometric, biomechanical, and surgical analysis. Arch Otolaryngol 1979; 105: 320-7
• 16 Baek JE, Chung CM, Hong IP. Reduction of zygomatic fractures using the carroll-girard T-bar screw. Arch Plast Surg 2012; 39: 556-60
• 17 Woo KI, Choi CY. High-frequency radiowave electrosurgery for persistent conjunctival chemosis following cosmetic blepharoplasty. Plast Reconstr Surg 2014; 133: 1336-42
• 18 Weinfeld AB, Burke R, Codner MA. The comprehensive management of chemosis following cosmetic lower blepharoplasty. Plast Reconstr Surg 2008; 122: 579-86
• 19 Hester Jr TR. Evolution of lower lid support following lower lid/midface rejuvenation: the pretarsal orbicularis lateral canthopexy. Clin Plast Surg 2001; 28: 639-52