A Novel Method in Restoring Form and Function Following Malunited Isolated Zygomatic Arch Fractures- A Technical Note

Abstract

Isolated zygomatic arch fractures of the facial skeleton are rare. Blunt force to the cheek can result in an isolated zygomatic arch fracture, with resulting aesthetic issues such as indendations and functional impairments such as trismus. Symptomatic or visible isolated zygomatic arch fractures are commonly treated using either the Keen (intraoral) or Gillies (temporal) approaches to reduce the fracture while avoiding visible scars. Typically, the reduced fractures are not rigidly fixated but rather held in place by the native periosteal sleeve. However, cold fractures of the zygomatic arch are difficult to treat as they require a wide area of exposure for re-osteotomy and fixation. In the present technical note, we describe a novel technique to overcome this. Through a minimally invasive approach, two osteotomies were made proximally and distally to the fracture segment, and the segment was rolled 180 degrees along the sagittal axis. The medially depressed zygomatic arch is now projected laterally and was found to give adequate prominence and relieve restrictions in mouth opening. This is a novel method for reestablishing the prominence of the zygomatic arch and aiding in mandibular function following malunion of the fractured, isolated zygomatic arch.