Reduction of Zygomatic Arch Isolated Fracture Using Ultra Sound and Needle Marking

Abstract

BackgroundZygomatic arch is a bony arch constituting the lateral midface, which consists of 25% of all midface fractures. There are a number of ways to evaluate the extent of zygomatic arch fracture. Some authors have reported successful treatment outcomes using ultrasound (U/S). To add to the previous methods, we have considered ways to accurately display the location of the fracture line while using U/S with 23 gauge needle marking. We introduce our method, which provided satisfactory results for reduction using a portable U/S, and it can evaluate the fracture line simultaneously when reduction of an isolated zygomatic arch fracture is necessary, and needle marking, which can easily point out the fracture line on U/S.MethodsWe studied 21 patients with an isolated zygomatic arch fracture who underwent closed reduction using U/S and needle marking between 2013 and 2015.ResultsWe achieved satisfactory results in all our cases with respect to reduction by using the Dingman elevator after performing a temporal approach incision, while confirming relative positioning between needle marking and zygomatic fracture at the same time, after insertion of a 23 gauge needle in the skin above the zygomatic arch fracture line parallel to it.ConclusionWe treated 21 patients with an isolated zygomatic arch fracture using U/S and the needle marking method, which provided satisfactory results because the extent of reduction of the fracture could be evaluated in real-time during the operation and exposure to radiation was reduced.

Closed reduction with minimal accesses for treating isolated zygomatic arch fractures: Case Series

“…The traditional closed reduction for IZAF can be achieved with digital palpation alone. However, this technique requires considerable skills on the surgeon's part to reduce an uneven and curved bone properly (Kim et al, 2016;Xie et al, 2009). Twelve different surgeons carried out a study of closed reduction with percutaneous transfacial Kirschner wire fixation (CRWF), most of them being junior surgeons with limited experience regarding the CRWF technique.…”

“…The submentovertex is the radiographic view indicated to analyze the zygomatic arch symmetry. Computed tomography should be carefully considered for IZAF assessment because of its high radiation exposure and high cost (Kim et al, 2016;Korkmaz et al, 2016).…”

Three-dimensional intraoperative computed tomography imaging for zygomatic fracture repair

“…Zygoma fractures can impact clinical outcomes and can compromise functional ability and esthetic facial appearance. In their comprehensive study, Kim et al 7 compared soft tissue differences over repaired zygoma fractures using cephalometric points measured in cone-beam CT scans. They found soft tissue asymmetry that was directly related to the amount of hard tissue dislocated after surgery.…”

“…In the present study, the O-Arm system was a highly successful approach for visualization and could minimize the need for revision interventions following the initial ZMC and ZA corrective surgeries. Plain radiographs of the skull, such as the Waters view, the submentovertex view, and lateral radiographs to evaluate intraoperatively ZMC and ZA fracture reconstruction are used frequently 6,7 . However, the resolution of these images and the superimpositions with adjacent bony structures, especially in the region of the orbital walls, can result in inadequate surgi-cal results.…”

“…The multiaxis structures of both ZMC and orbitozygomatic region fractures pose challenges to surgeons in assessment and proper reduction. Postoperative plain radiographs of the skull, such as Waters and submentovertex views, are used traditionally to evaluate reduction of bony segments following ZMC fracture repair 6 , 7 .…”