Department of Oral and Maxillofacial Surgery, Lanzhou University Second Hospital, Lanzhou, China.
J Craniofac Surg. 2021 May 1;32(3):1087-1089. doi: 10.1097/SCS.0000000000007463.
There are multiple approaches described to access the zygomaticomaxillary complex (ZMC) fractures: lateral eyebrow, upper blepharoplasty, coronal, subciliary, subtarsal, infraorbital, transconjunctival, and transoral. All these approaches have their advantages, disadvantages, and indications according to location of fracture, degree of displacement, and surgeon's experience with a specific technique. However, there is not a good approach for treating the zygomatic arch or body fracture. In this paper, the authors described a supra-temporalis approach to treat the zygomatic arch or body fracture.
Eight patients with traumatically ZMC fractures who received open reduction and internal stable fixation with supra-temporalis approach were retrospectively reviewed. A minimized supra-temporalis incision and trans-temporalis fascia access was used. Blunt dissection was performed perpendicularly to the fractured zygomatic arch and body. The open reduction and internal fixation of ZMC fractures were performed. After confirming that the fracture was fixed rigidly, the incision was closed layer by layer.
Using this approach, the zygomatic arch, body, frontozygomatic suture, and fracture stumps were exposed perpendicularly. No extensive incision was needed and minimal invasion was realized. Postoperative CT scan showed that the fractures been repositioned and fixed in the normal position. Facial asymmetry was reconstructed and keep in the follow-up.
Supra-temporalis approach gave an optimal view of the bony field, which allowed surgeons to work perpendicularly to the fracture, and facilitated the reduction of the displaced fractured stumps. It was regarded as an ideal and valuable alternative in this potentially complicated procedure.
有多种方法可以进入颧骨复合体（ZMC）骨折：外侧眉、上睑成形术、冠状、下睑缘、下睑板、眶下、经结膜和经口。所有这些方法都有其优点、缺点和适应证，根据骨折的位置、移位的程度以及外科医生对特定技术的经验而定。然而，对于治疗颧骨弓或体部骨折，目前还没有一种很好的方法。本文作者描述了一种经颞肌上方入路治疗颧骨弓或体部骨折的方法。
回顾性分析了 8 例接受经颞肌上方入路切开复位内固定治疗的创伤性 ZMC 骨折患者。采用最小化的颞肌上方切口和经颞肌筋膜入路。沿骨折的颧骨弓和体部垂直进行钝性解剖。进行 ZMC 骨折的切开复位和内固定。确认骨折固定牢固后，逐层关闭切口。
采用这种方法，可以垂直暴露颧骨弓、体部、额颧缝和骨折残端。不需要广泛的切口，实现了最小的侵袭。术后 CT 扫描显示骨折已复位并固定在正常位置。面部不对称得到重建，并在随访中保持。
经颞肌上方入路提供了一个最佳的骨面视野，使外科医生能够垂直于骨折处进行操作，便于复位移位的骨折残端。在这个潜在复杂的手术中，它被认为是一种理想和有价值的替代方法。
