Simplified protocol for treatment of malar fractures. Based on a 1,220-case, eight-year experience.

A simplified protocol of approach has evolved from the treatment of approximately 1,200 malar fractures in an eight-year period in the private practice of one of us (R.S.M.) and at the Los Angeles County/University of Southern California Medical Center. The method begins with the Gillies incison for reduction and routinely uses internal wire pin fixation tailored to the mechanical requirements of the malar fracture. It advances only if necessary to brow and infraorbital incisions, direct wiring, orbital exploration, or Caldwell-Luc. Antrostomy with antral packing. Occasionally, a transcutaneous wire or small bone screw may be inserted for headcap or halo vector traction if indicated by the judgment of the surgeon. The internal wire pin protocol has produced hundreds of satisfactory reductions and fixations of malar fractures in our experience, with shortened operating time and reduced complications. It has been installed as the primary method of treatment for this type of facial fracture in a residency program that has many of these patients.