title: Interfragmentary screw fixation of the zygomatic arch in complex midface and zygomaticomaxillary fractures.
abstract: Zygomatic arch reduction and fixation is a key point in the treatment of complex midface and zygomaticomaxillary fractures. High-impact frontal trauma can cause posterior displacement of zygomatic bone, with a sagittal fracture of the root of the zygomatic arch extending posteriorly to the glenoid fossa. Miniplate and screw fixation of this fracture requires a large detachment of soft tissue, thus being technically more difficult for proper fixation and increasing the risk of soft tissue damage. This report describes an operative approach for fixation of this type of fracture using an adaptation of the lag screw technique. After the initial reduction of zygomatic bone, the proximal segment of the zygomatic arch containing the sagittal fracture is anatomically reduced and a 2.0-mm titanium screw is placed with an inferior inclination of 10° to 15° into the mastoid cells of the temporal bone, thus avoiding intracranial screw placement. This technique showed excellent results in reduction and long-term stability. It facilitates the surgical procedure, decreases the risk of soft tissue damage, and can lower costs compared with conventional miniplate and screw fixation.
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, University Center of Pará, Belém, Brazil. Electronic address: ribeiroalr@ig.com.br.
authors.forename: André Luis
authors.initials: AL
authors.lastname: Ribeiro Ribeiro
authors.affiliation: Associate Professor, Department of Periodontology, School of Dentistry, University Center of Pará, Belém, Brazil.
authors.forename: Tânia Maria de Souza
authors.initials: TM
authors.lastname: Rodrigues
authors.affiliation: Associate Professor, Department of Oral Pathology, School of Dentistry, Federal University of Pará, Belém, Brazil.
authors.forename: Sérgio de Melo
authors.initials: Sde M
authors.lastname: Alves-Junior
authors.affiliation: Associate Professor, Department of Oral Pathology, School of Dentistry, Federal University of Pará, Belém, Brazil.
authors.forename: João de Jesus Viana
authors.initials: Jde J
authors.lastname: Pinheiro
mesh_terms: D001860:Bone Plates; D001863:Bone Screws; D005004:Ethmoid Bone / Q000293:injuries; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D008440:Maxillary Fractures / Q000601:surgery*; D009295:Nasal Bone / Q000293:injuries; D009917:Orbital Fractures / Q000601:surgery; D012189:Retrospective Studies; D012887:Skull Fractures / Q000601:surgery; D013701:Temporal Bone / Q000601:surgery; D015051:Zygomatic Fractures / Q000601:surgery*