‘Y’ Modification of the Transconjunctival Approach for Management of Zygomatic Complex Fractures: A Prospective Analysis

Abstract

The purpose of this study was to clinically and radiologically evaluate reduction and fixation of isolated zygomatic complex (ZMC) fractures treated by Y modification of the transconjunctival approach. A prospective evaluation of ten patients was undertaken for a period of 6months using this modified approach from Jan 2012 to Jun 2013. Patients were examined preoperatively and post operatively at the end of 6months for symmetry discrepancies involving A-P globe projection, lateral canthal level, malar projection and diplopia in direct and extreme gazes. Cosmetic outcomes were assessed by clinical assessment and examination of photographs. Quality of reduction and stability of fixation was assessed by examination of postoperative images. All patients underwent a three point fixation of ZMC with reconstruction of the orbital floor using titanium mesh. Patients were post surgically followed up at regular intervals of 1, 3 and 6months. Immediate complications noted were chemosis, lid edema and lower lid retraction. Late complications included minor scleral show in two cases. All patients experienced significant improvement with excellent esthetic appearance and function. Y modification of transconjunctival approach provides excellent surgical exposure for ZMC fractures potentially avoiding the use of a second incision in the area of ZF suture. Although this technique provides good exposure and excellent esthetics, it requires more operating time and detailed knowledge of the anatomy of the lateral canthal region.