Fractures of the zygoma. A geometric, biomechanical, and surgical analysis.

We present a four-part study of the cosmetic results of common zygomatic fracture reduction techniques: (1) a geometric analysis of an idealized paper and clay model; (2) a topographic analysis of zygomatic fractures in the dry skull; (3) a biomechanical analysis of fixation techniques in the fresh cadaver; and (4) a retrospective and prospective review of our clinical experience. The following are concluded: Alignment of the fracture at three points and fixation at two stable points provide the most accurate and satisfactory postoperative results. Masseteric contraction may cause late displacement in poorly fixed fractures. Two-point interosseous fixation at the "buttress" fracture and the frontozygomatic fracture is suitable for routine surgery. The infraorbital rim may be aligned through the gingivobuccal sulcus incision. Transcutaneous incisions may be limited to the brow incision. The transconjunctival approach is suitable for orbital floor repair.