The level of technical complexity and the stakes involved for patients make correcting facial trauma one of the most difficult tasks for head and neck surgeons. During the session “Management of Soft Tissue and Bony Facial Trauma,” a panel of experts brought their know-how and experience to the table. Here are some of their main points.
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March 2015Zygomatic Bone
Stephen Park, MD, director of the division of facial plastic and reconstructive surgery at the University of Virginia in Charlottesville, said fixing complex (or “tripod”) fractures to the zygomatic bone is one of the most challenging repairs to get exactly right. “Once it is fractured and displaced, the reduction is not in a linear vector,” he said. “We’re not just popping the bone out in a single dimension. You usually have to move it up and out and then rotate it to get it precisely back in position and restore facial symmetry.”
Axial CT image depicting extensive facial fractures.
To get the zygomic bone three-dimensionally and anatomically correct, he said, sometimes it is necessary to expose the zygomatic arch, the zygomatic-sphenoid fracture line, or both. The arch is the only buttress that otolaryngologists can align that sets the anterior-posterior vector, he added. Also, he said, “The zygomatic-sphenoid fracture is the only fracture that courses through all three dimensions in space, and it is your guide in complex cases.”