TY - JOUR
T1 - Modified gillies approach for zygomatic arch fracture reduction in the setting of bicoronal exposure
AU - Swanson, Edward
AU - Vercler, Christian
AU - Yaremchuk, Michael J.
AU - Gordon, Chad R.
PY - 2012/5
Y1 - 2012/5
N2 - Zygomatic arch fractures are common injuries, occurring in isolation in 5% of all patients with facial fractures and in 10% of patients with any fracture to the zygomaticomaxillary complex. Isolated noncomminuted depressed zygomatic arch fractures are easily treated with the minimally invasive Gillies approach, which most often provides long-term stability. However, zygomatic arch fractures often occur in conjunction with zygomaticomaxillary complex, Le Fort, calvarial, and naso-orbitoethmoid fractures. In situations requiring a bicoronal incision to address concomitant injuries, zygomatic arch fractures are frequently treated with wide dissection and rigid fixation. Using principles obtained from isolated arch fractures, we present for the first time to our knowledge the use of a modified Gillies approach to noncomminuted zygomatic arch fractures in a case requiring a bicoronal incision. With the deep temporal fascia exposed from the reflected bicoronal flap, a 1-cm horizontal incision is made within the deep temporal fascia allowing a Gillies elevator to easily reduce the arch fracture in a plane between the deep layer of the deep temporal fascia and the temporalis muscle. This technique exploits the advantages of the traditional Gillies approach, preserving fascial attachments, avoiding neurovascular injury, and obviating the need for rigid fixation. Moreover, this method saves time and money and decreases morbidity. Our modified Gillies approach to zygomatic arch fractures in the setting of a bicoronal incision can be applied to a wide range of cases because of the frequency with which arch fractures occur with concomitant craniomaxillofacial injuries requiring wide exposure.
AB - Zygomatic arch fractures are common injuries, occurring in isolation in 5% of all patients with facial fractures and in 10% of patients with any fracture to the zygomaticomaxillary complex. Isolated noncomminuted depressed zygomatic arch fractures are easily treated with the minimally invasive Gillies approach, which most often provides long-term stability. However, zygomatic arch fractures often occur in conjunction with zygomaticomaxillary complex, Le Fort, calvarial, and naso-orbitoethmoid fractures. In situations requiring a bicoronal incision to address concomitant injuries, zygomatic arch fractures are frequently treated with wide dissection and rigid fixation. Using principles obtained from isolated arch fractures, we present for the first time to our knowledge the use of a modified Gillies approach to noncomminuted zygomatic arch fractures in a case requiring a bicoronal incision. With the deep temporal fascia exposed from the reflected bicoronal flap, a 1-cm horizontal incision is made within the deep temporal fascia allowing a Gillies elevator to easily reduce the arch fracture in a plane between the deep layer of the deep temporal fascia and the temporalis muscle. This technique exploits the advantages of the traditional Gillies approach, preserving fascial attachments, avoiding neurovascular injury, and obviating the need for rigid fixation. Moreover, this method saves time and money and decreases morbidity. Our modified Gillies approach to zygomatic arch fractures in the setting of a bicoronal incision can be applied to a wide range of cases because of the frequency with which arch fractures occur with concomitant craniomaxillofacial injuries requiring wide exposure.
KW - Craniofacial surgery
KW - Gillies approach
KW - closed zygoma reduction
KW - craniomaxillofacial trauma
KW - facial reconstruction
KW - zygomatic arch
UR - http://www.scopus.com/inward/record.url?scp=85027949498&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85027949498&partnerID=8YFLogxK
U2 - 10.1097/SCS.0b013e31824dd5c3
DO - 10.1097/SCS.0b013e31824dd5c3
M3 - Article
C2 - 22565912
AN - SCOPUS:85027949498
SN - 1049-2275
VL - 23
SP - 859
EP - 862
JO - Journal of Craniofacial Surgery
JF - Journal of Craniofacial Surgery
IS - 3
ER -