This document discusses reduction techniques for zygomatic bone fractures. It begins by describing the anatomy of the zygomatic bone and common types of zygomatic fractures. It then outlines various surgical approaches that can be used for open reduction of zygomatic fractures, including the temporal fossa, intraoral, percutaneous, malar hook, Carroll Girard screw, and lateral eyebrow approaches. Indications for surgery include depressed malar eminence, enophthalmos, infraorbital paresthesia, and inability to open the mouth. The conclusion recommends that technique choice depends on the location and degree of displacement of the fracture.

1. Reduction Techniques For
Zygomatic fractures. Which
comes when?
Dr.Ayesha MaqsoodDr.Ayesha Maqsood
BDS, FCPSBDS, FCPS
Assistant Professor, Oral & Maxillofacial SurgeryAssistant Professor, Oral & Maxillofacial Surgery
Margalla Institute of Health Sciences & affiliatedMargalla Institute of Health Sciences & affiliated
hospitals,Rawalpindi.hospitals,Rawalpindi.

2.  Zygomatic bone is
responsible for the
anterior and lateral
projection of face
 It is frequently
fractured alone or
with other bones of
midface
Zygomatic Fractures

3.  Zygomatic fractures cause
disruption along the
following articulations
 Zygomaticofrontal suture
 Infraorbital rim
 Zygomaticomaxillary
buttress
 Zygomatic arch
 Zygomaticosphenoid
suture
Zygomatic Fractures

4. Zygoma may be fractured in a variety of
patterns,a wide variety of treatment
recommendations have evolved
From minimal reduction maneuvers
performed without fixation to complicated
types of open reduction involving multiple
exposure and fixation points
Zygomatic Fractures

5. Mechanism of injuryMechanism of injury
Direct blow on prominent part
Relative inbending at area of impaction
Relative outbending at weak areas such as
the arch,ZM suture,ZF suture
Fractures are usually displaced posteriorly&
inferiorly or medially
More violent blow causes posterior& lateral
displacement

6. • Depressed malar eminenceDepressed malar eminence
• EnophthalmosEnophthalmos
• Infraorbital paresthesiaInfraorbital paresthesia
• DiplopiaDiplopia
• Inability to open the mouthInability to open the mouth
Indications for
surgery

7. TreatmentTreatment
• as soon as possible
• Little delay  Settling of periorbital edema
 proper zygomatic bone examination
• Sight threatening injuries  Retrobulbar
hemorrhage may require urgent surgery

9. Methods ofMethods of
ReductionReduction
• Temporal fossa (Gillies approach)
• Intra oral (Keen approach)
• Percutaneous
•Malar hook approach
•Carrol Girard screw approach
• Lateral eyebrow (Dingman approach)

10. Gillies Approach
• 2.5 cm.incision in hair of temporal
region
• Dissection upto the deep temporal
fascia
• Elevator slided over the muscle
under the arch
• Rowe elevator allows only the
zygoma to be lifted ,preventing
pressure on temporal bone
• For medially displaced arch
fractures
• For downward displaced zygoma
fractures which are lifted forward

11. Vestibular(Keen Approach)Vestibular(Keen Approach)
• Incision in the buccal sulcus
• Elevator placed under the
zygomatic bone or arch
• Allows safe & direct approach to
entire facial surface of midfacial
skeleton
• For reduction of medially &
posteriorally displaced zygomatic
fractures
• The displaced segments are lifted
upward and laterally

12. Carroll Girard ScrewCarroll Girard Screw
• Incision over the cheek
• Drill a small hole and insert the screw
• As it is placed directly over the body of zygoma,it
provides traction in any direction
• Ideally for laterally displaced arch and zygomatic
fractures

13. Bone HookBone Hook
• Through a stab incision on the cheek or even
through an intra oral incision
• Posterioraly displaced zygomatic fractures

14. Dingman ApproachDingman Approach
• Lateral eyebrow incision given
• For medially displaced arch
• Medially and downward displaced body of
zygoma

15. Endoscopically assisted
reduction
• Endoscopic approaches may be used
to identify the arch &zygomatic
fractures and they could be reduced
using any technique

16. Conclusion
• A simple arch fracture such as a medially
displaced one ,may be managed by elevation
alone because periosteal continuity will prevent
displacement.
• No technique suitable for laterally displaced
arch or zygomatic body because insufficient
periosteal continuity will not maintain reduction
Cont……

17. Conclusion
• Appx. 25% of zygomatic fractures are with
minimal displacement ,which are best
managed by closed reduction
• Incomplete fractures at Z.F suture are also
amenable to closed reduction
• For an unstable fracture the closed redution
may be used as part of open reduction

18. Thank youThank you