Endoscopically assisted zygomatic fracture reduction and osteosynthesis revisited.

In comminuted fractures of the zygoma open reduction of the malar arch is essential for correct anatomic repair. Avoiding exposure of this landmark may result in severe functional and aesthetic impairment. Exposure of the malar arch necessitated traditionally a coronal incision. However, recently several authors reported good results in malar fracture repair with minimal incisions and endoscopic assistance. To establish this technique a cadaver study was performed. Different approaches to the malar arch, fracture reduction and internal fixation were evaluated. After establishment of a satisfactory technique 12 patients with comminution of the zygoma were treated with endoscopic assistance. Repositioning of the fragments was excellent in nine cases, minimal remaining dislocation was seen in two cases and in one case revision was necessary. Postoperatively the frontal branch of the facial nerve was intact in all patients. Scarring was minimal. In three patients plating of the malar arch on a side table resulted in arch necrosis and resorption in the long-term follow-up. Operating time was remarkably longer than in conventional procedures due to the difficult technique.