Supra-Temporalis Approach for Treating Zygomaticomaxillary Complex Fracture

Purpose: There are multiple approaches described to access the zygomaticomaxillary complex (ZMC) fractures: lateral eyebrow, upper blepharoplasty, coronal, subciliary, subtarsal, infraorbital, transconjunctival, and transoral. All these approaches have their advantages, disadvantages, and indications according to location of fracture, degree of displacement, and surgeon's experience with a specific technique. However, there is not a good approach for treating the zygomatic arch or body fracture. In this paper, the authors described a supra-temporalis approach to treat the zygomatic arch or body fracture.

Patients and methods: Eight patients with traumatically ZMC fractures who received open reduction and internal stable fixation with supra-temporalis approach were retrospectively reviewed. A minimized supra-temporalis incision and trans-temporalis fascia access was used. Blunt dissection was performed perpendicularly to the fractured zygomatic arch and body. The open reduction and internal fixation of ZMC fractures were performed. After confirming that the fracture was fixed rigidly, the incision was closed layer by layer.

Results: Using this approach, the zygomatic arch, body, frontozygomatic suture, and fracture stumps were exposed perpendicularly. No extensive incision was needed and minimal invasion was realized. Postoperative CT scan showed that the fractures been repositioned and fixed in the normal position. Facial asymmetry was reconstructed and keep in the follow-up.

Conclusions: Supra-temporalis approach gave an optimal view of the bony field, which allowed surgeons to work perpendicularly to the fracture, and facilitated the reduction of the displaced fractured stumps. It was regarded as an ideal and valuable alternative in this potentially complicated procedure.