Clinical Follow-up on Sagittal Fracture at the Temporal Root of the Zygomatic Arch: Does It Need Open Reduction?

Abstract

Background: The zygoma is a major portion of the midfacial contour. When deformity occurs in this area, a reduction should be conducted to correct it. If a sagittal fracture at the temporal root of the zygomatic arch occurs, this also requires reduction, but it is difficult to approach due to its anatomical location, and the possibility of fixation is also limited. Thus, the authors attempted the reduction of sagittal fracture by two- or three-point fixation and the Gillies approach without direct manipulation. The preoperative and postoperative results of the patients were evaluated. Follow-up was performed to establish a treatment guideline.

Methods: A retrospective study was done with 40 patients who had sagittal fractures at the temporal root of the zygomatic arch from March 2009 to June 2012. Only two- or three-point fixation was performed for the accompanying zygomatic-orbital-maxillary fracture. The Gillies approach was used for complex fractures of the zygomatic arch, while the temporal root of the zygomatic arch was only observed without reduction. Preoperative and postoperative computed tomography and X-ray scans were performed to examine the results.

Results: The result of the paired t-test on preoperative and postoperative bone gap differences, the depression level, and the degree of temporal protrusion showed a marked decrease in the mean difference at a 95% confidence interval. The results were acceptable.

Conclusions: In the treatment of sagittal fractures at the temporal root of the zygomatic arch, it is acceptable to use indirect reduction and non-fixation methods. This leads to a satisfactory aesthetic and functional outcome.

Keywords: Facial asymmetry; Follow-up studies; Zygomatic fractures.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1

Measurement of bone gap (A) A schematization of the preoperative computed tomography of a 63-year-old male patient. The sagittal fracture at the root of the zygomatic arch can be seen (red round). (B) Magnified view. The length of the widest portion of the sagittal fracture site was measured (red arrow).

Fig. 2

Measurement of the degree of depression After tracing the shadow of the injured zygomatic cortex, the intact side was overturned and overlapped on the affected side in order to measure the distance of the gap (red curve arrow). Then, the vertical distance was measured between the severest depression point and the lateral cortex of the intact bony shadow (red arrow in a circle).

Fig. 3

Measurement of the degree of temporal protrusion After marking the anterior edge of the affected side (point a), the vertical distances were measured on both the affected side and non-affected side (point b) from the sagittal midline (point c). The difference in the two distances (ac-bc) was calculated.

Fig. 4

A 63-year-old man with a sagittal fracture (A) Preoperative computed tomography (CT) view. Lateral displacement and outward bowing of the zygomatic arch was found, accompanied by a sagittal fracture at the zygomatic process of the temporal bone. (B) Postoperative 18 month follow-up CT scan demonstrating anatomic restoration of the comminuted arch fracture and a remarkably decreased bone gap and temporal protrusion on the sagittal fracture site. (C) Preoperative worm's eye view shows prominent bone temporal protrusion compared with the intact side. (D) After reduction, comparatively acceptable postoperative facial symmetry and a decrease in temporal protrusion were seen (postoperative 18 month view).