Towel Clip Reduction of the Depressed Zygomatic Arch Fracture

Abstract

Since the first description of a surgical reduction of a zygoma fracture by Duverney in 1751, 1 Duverney J.G. La fracture de l’apophyse zygomatique. Traite des Maladies des Os. 1751; 1: 182 Google Scholar many varying methods of treatment have been described. Both intraoral and extraoral methods have become commonplace. The transoral approach was popularized by Keen in 1909, 2 Keen W.W. Surgery. Saunders, Philadelphia, PA1909 Google Scholar with later modifications by Goldthwaite 3 Goldthwaite R.H. Plastic repair of depressed fracture of lower orbital rim. JAMA. 1924; 82: 628 Crossref Scopus (5) Google Scholar and Quinn. 4 Quinn J.H. Lateral coronoid approach for intra-oral reduction of fractures of the zygomatic arch. J Oral Surg. 1977; 35: 321 PubMed Google Scholar These techniques offer the advantages of avoiding any skin incision, thereby avoiding any visible scaring. Additionally, they allow for minimal dissection and an excellent vector for reduction; however, they may result in increased rates of infection by introducing oral flora into the infratemporal fossa. Gilles et al 5 Gilles H.D. Kilner T.P. Stone D. Fractures of the malar-zygoma compound, with a description of a new x-ray position. Br J Surg. 1927; 14: 651 Crossref Scopus (142) Google Scholar described the temporal fossa approach in 1927, and this became a very popular method for the treatment of isolated arch fractures around the world. Similarly, Dingman and Natvig 6 Dingman R.O. Natvig P. Surgery of Facial Fractures. Saunders, Philadelphia, PA1964: 211-245 Google Scholar described the supraorbital approach as an extraoral alternative in 1964. All of these techniques have in common the use of a Rowe zygoma elevator, urethral sound, Kelly hemostat, or similar instrument placed between the arch and coronoid process to achieve reduction. Others have described several percutaneous methods meant to be less invasive. These include passing wire beneath the arch or using a towel clip to directly grasp the bone fragments and allow for lateral force to be applied. The use of a towel clip passed beneath the arch percutaneously has been described previously in a case series by Hwang and Lee, 7 Hwang K. Lee S.I. Reduction of zygomatic arch fracture using a towel clip. J Craniofac Surg. 1999; 10: 5 Google Scholar but little description of the procedure was offered. Towel Clip Reduction of the Depressed Zygomatic Arch FractureJournal of Oral and Maxillofacial SurgeryVol. 64Issue 8PreviewIt was a great pleasure to read the technique article “Towel Clip Reduction of the Depressed Zygomatic Arch Fracture” by Carter et al (J Oral Maxillofac Surg 63:1244, 2005). We would like to commend the authors for their creativity and unique method of managing patients with depressed fractures of the zygomatic arch. Nevertheless, one must be aware of the issues that may arise in the management of patients treated with this particular technique. Full-Text PDF