Methods of zygomatic bone fixation
If the fragments cannot be reduced simultaneously or maintained in the correct anatomical position, instrumental interventions are employed.
Bone suture osteosynthesis The classic method involves surgical exposure of the fracture line in the area of the zygomaticofrontal and zygomaticomaxillary sutures. Using a small burr, holes are made in the ends of the fragments, through which a polyamide thread or wire is passed. An alternative is a more modern method — using metal mini-plates secured with mini-screws. The wound is sutured tightly after fixation.
Kazanjian method This technique is indicated for unstable fragments. The physician makes an incision in the soft tissues around the lower eyelid, exposing the zygomatic bone at the infraorbital margin. A channel is then created through which a thin stainless steel wire is passed. The outer end of the wire is bent into a hook or loop shape and attached to a rod mounted in the patient's special plaster cap. This provides continuous traction of the fragment.
Shinbarev method Similar in concept to Kazanjian's method, but here the fixation of the zygomatic bone to the head plaster cast is performed using a single-toothed hook.
Reduction of the zygomatic arch
Zygomatic arch fractures are frequently accompanied by bone depression. In cases of a single fracture without significant displacement, it is sufficient to insert a single-toothed hook strictly along the lower margin of the arch at the site of depression. Reduction does not differ from working with the zygomatic bone itself, and a skin suture is applied after the manipulation.
If the displacement is significant and a standard hook does not allow the fragments to be aligned (only one fragment moves), the Bragin method is used. This requires a double-toothed hook with holes. It is passed beneath the fragments, ligatures are pulled through the holes, and they are fixed to an external splint.
The Matas-Berini method involves reduction using wire traction. With a large curved needle, the physician passes a thin wire through the thickness of the temporalis muscle tendon (m. temporalis) directly above the arch. A loop is formed from the wire, pulled outward, and the bone is repositioned.
In extreme cases, open osteosynthesis is used. An incision (about 2 cm) is made along the lower margin of the arch, the damaged ends are skeletonized (periosteum is reflected), holes are drilled in them, and a wire bone suture is applied.
Comminuted and chronic fractures
In multiple fragments of the zygomatic arch, external fixation with a special fast-curing plastic plate is used (its width is usually 1.5 cm, and the length is selected individually). Using a curved needle from the outside, a polyamide thread is passed under each fragment, and the ends are tied over the plastic splint. To prevent pressure sores, a iodoform gauze strip is mandatory placed under the plate. This structure is removed on days 8–10.
Tactics for chronic fractures (if more than a year has passed) depend on the presence of functional deficits:
- If there are no jaw function impairments and the patient is only concerned with aesthetics, facial contouring is performed.
- If lower jaw function is impaired due to displacement (limited mouth opening), zygomatic bone osteotomy or surgical resection of the coronoid process of the mandible is indicated.
Postoperative regimen and nutrition
The most important condition for successful consolidation (healing) is the complete avoidance of mechanical pressure on the reduced fragments of the zygomatic bone.
Patients with facial skeletal injuries require a special diet since normal chewing of food is impossible. In hospitals, the first jaw diet is prescribed — liquid, creamy food with high energy value (3000–4000 kcal/day). Food is often served from a feeder cup with an attached rubber tube inserted into the oral vestibule (e.g., behind the wisdom tooth).
On days 14–16 after jaw fixation (if applied), early mobilization is indicated — temporary removal of tractions during meals. This improves vascularization of the fracture zone and accelerates regeneration due to better absorption of calcium and phosphorus.
Briefly: answers to topical questions
What methods exist for fixing zygomatic bone fragments in unstable fractures?
In unstable fractures, when fragments do not maintain their position independently, several surgical fixation methods are used.
- Osteosynthesis — fixation of fragments with a wire suture, polyamide thread, or the use of on-bone metal mini-plates with mini-screws.
- Kazanjian method — formation of a channel in the bone through which a thin wire is passed; its end is bent into a loop or hook and attached to a rod in a plaster cap.
- Shinbarev method — fixation of the zygomatic bone using a single-toothed hook to a head plaster cast.
What are the clinical symptoms of a displaced zygomatic bone fracture?
Clinical symptoms of a displaced zygomatic bone fracture include visual, palpation, and neurological changes.
- Facial deformity — tissue depression due to the displacement of the bone fragment.
- «Step» sign — a palpable bone prominence in the area of the infraorbital margin, upper-outer orbital angle, temporal process, or zygomaticoalveolar crest.
- Neurological disorders — numbness and decreased pain sensitivity of the skin in the infraorbital region, upper lip, and nasal ala.
- Visual disturbances — diplopia (double vision).
- Local signs — epistaxis, hemorrhages into the tissues of the infraorbital region, conjunctiva, and chemosis.
Which radiographic projections are used to diagnose zygomatic arch fractures?
Several radiographic projections are used to diagnose zygomatic arch fractures.
- Axial projection — allows the determination of a fracture with displacement of bone fragments.
- Submentovertical projection (submento-vertex) — optimal for visualizing zygomatic arches when using a "soft" radiation mode.
- Occipitomental projection (Waters' view) — a basic projection in which zygomatic arch fractures are also usually visualized.
What is the essence of Limberg's method for zygomatic bone reduction?
The essence of Limberg's method is percutaneous reduction of the zygomatic bone using a single-toothed hook. The instrument is inserted through the skin beneath the displaced bone in a horizontal direction. The hook is then rotated by 90°, moving its tip onto the inner surface of the zygomatic bone. Afterward, the fragment is reduced by traction in the direction opposite to its displacement until a characteristic click is heard.
To memorize eponymic arch reduction methods: Bragin — Big displacement (use a double-toothed hook), Matas-Berini — Muscle (pass wire through the temporalis muscle).
Class and exam questions
What is the essence of Kazanjian's method?
Surgical passage of a wire loop through the infraorbital margin of the zygomatic bone, followed by fixation of the externally led hook to a rod on a plaster cap.
How are comminuted zygomatic arch fractures fixed?
Using an external plastic plate 1.5 cm wide, to which each fragment is pulled with polyamide threads. Iodoform gauze is placed between the skin and the plate.
What to do in case of an old fracture (more than 1 year) if jaw function is not impaired?
If the only complaint is an aesthetic defect, the patient is indicated for facial contouring without complex reconstructive bone surgery.
What else to study on this topic
- Medical and physical therapy treatment of facial injuries
- Organization of jaw diets and tube feeding methods
- Complications: acute and subacute stages of traumatic osteomyelitis
- Reduction and packing in nasal bone fractures
- Oral hygiene care during dental splinting
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Other topics in the section "Chapter 11. Non-ballistic and ballistic facial injuries. Thermal and radiation lesions of the maxillofacial region (V.V. Afanasyev)"
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