Department of Plastic and Reconstructive Surgery, The-Tight Plastic Surgery Clinic.
Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul.
J Craniofac Surg. 2024;35(1):e90-e91. doi: 10.1097/SCS.0000000000009889. Epub 2023 Nov 16.
Malar reduction surgery can increase its susceptibility to fractures in case of trauma. Patients who had malar reduction surgery and sustained a zygoma fracture pose unique challenges for treatment and management. This is a case of a 28-year-old female patient who presented with a unilateral zygoma fracture following bilateral malar reduction and augmentation rhinoplasty 6 years ago. Physical examination revealed a clicking sound when opening the mouth at the right zygomatic buttress and a depressed preauricular area, suggesting arch fracture. Computed tomography imaging demonstrated a loosened screw at the right zygomatic buttress and a depressed arch fracture. She wanted to remove all plates and treat her right fractured zygoma with absorbable materials. Through the bilateral intraoral incisions, the authors removed the plates and screws and reduced the depression with the Langenbeck elevator through the same right intraoral incision without fixation. The reduction was well-maintained without complications based on postoperative plain x-rays 1 month after surgery. She reported that the pain was mostly gone and that she did not hear any abnormal sounds when opening her mouth after the surgery. In this case, if the zygomaticomaxillary buttress is minimally displaced, but the zygomatic arch fracture is significantly depressed, the authors believe that fracture reduction with only an intraoral incision would be enough to achieve an optimal outcome. If the plates and screws used in the previous malar reduction are not well maintained, it may be necessary to remove them.
颧骨降低手术后，若遭受创伤，其骨折的易感性会增加。颧骨降低手术后发生颧骨骨折的患者在治疗和管理方面具有独特的挑战。这是一位 28 岁女性患者的病例，她在 6 年前接受双侧颧骨降低和隆鼻手术后，出现单侧颧骨骨折。体格检查显示右侧颧骨支撑处张口时有弹响声，耳前区凹陷，提示弓骨骨折。计算机断层扫描成像显示右侧颧骨支撑处有松动的螺钉和凹陷的弓骨骨折。她希望取出所有的钢板，并使用可吸收材料治疗右侧骨折的颧骨。通过双侧口腔内切口，作者取出了钢板和螺钉，并通过同一右侧口腔内切口，使用朗根贝克提升器（Langenbeck elevator）将凹陷复位，无需固定。术后 1 个月的普通 X 光片显示，复位保持良好，无并发症。她报告说，手术后疼痛大多消失，张口时也没有听到任何异常声音。在这种情况下，如果颧骨上颌骨支撑处仅有轻微移位，但颧骨弓骨折明显凹陷，作者认为仅通过口腔内切口进行骨折复位就足以获得理想的效果。如果之前用于颧骨降低的钢板和螺钉固定不佳，可能需要将其取出。
