Ribeiro Ribeiro André Luis, Rodrigues Tânia Maria de Souza, Alves-Junior Sérgio de Melo, Pinheiro João de Jesus Viana
Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, University Center of Pará, Belém, Brazil.
Associate Professor, Department of Periodontology, School of Dentistry, University Center of Pará, Belém, Brazil.
J Oral Maxillofac Surg. 2015 Mar;73(3):494-8. doi: 10.1016/j.joms.2014.09.028. Epub 2014 Oct 17.
Zygomatic arch reduction and fixation is a key point in the treatment of complex midface and zygomaticomaxillary fractures. High-impact frontal trauma can cause posterior displacement of zygomatic bone, with a sagittal fracture of the root of the zygomatic arch extending posteriorly to the glenoid fossa. Miniplate and screw fixation of this fracture requires a large detachment of soft tissue, thus being technically more difficult for proper fixation and increasing the risk of soft tissue damage. This report describes an operative approach for fixation of this type of fracture using an adaptation of the lag screw technique. After the initial reduction of zygomatic bone, the proximal segment of the zygomatic arch containing the sagittal fracture is anatomically reduced and a 2.0-mm titanium screw is placed with an inferior inclination of 10° to 15° into the mastoid cells of the temporal bone, thus avoiding intracranial screw placement. This technique showed excellent results in reduction and long-term stability. It facilitates the surgical procedure, decreases the risk of soft tissue damage, and can lower costs compared with conventional miniplate and screw fixation.
颧弓复位固定是治疗复杂的面中部和颧上颌骨折的关键。高冲击力的额部外伤可导致颧骨向后移位，颧弓根部矢状骨折向后延伸至关节窝。这种骨折采用微型钢板和螺钉固定需要广泛的软组织分离，因此在技术上正确固定较为困难，且增加了软组织损伤的风险。本报告描述了一种采用拉力螺钉技术改良方法来固定此类骨折的手术入路。在初步复位颧骨后，对包含矢状骨折的颧弓近端进行解剖复位，并将一枚2.0毫米钛螺钉以10°至15°的下倾角度置入颞骨的乳突气房，从而避免螺钉置入颅内。该技术在复位和长期稳定性方面显示出优异的效果。与传统的微型钢板和螺钉固定相比，它简化了手术过程，降低了软组织损伤的风险，并可降低成本。
