However, its intraoperative use for the assessment of reduction of zygomatic arch requires a special operating table and is not cost effective Fig. CT Scan is considered to be the gold standard in the diagnosis of zygomatic arch fractures. In Sonography, minimally displaced fractures are not well appreciated 5 so assessment for precise reduction is not possible. The radiographic-imaging technique creates difficulty in positioning the patient, high risk of exposure to radiation and adds significantly to operative time due to the technician and film processing delay. Digital exploration and crepitus has the disadvantage that successful reductions are often difficult to evaluate clinically because of the great amount of swelling that often accompanies these fractures. Various methods like digital palpation and crepitus, radiographic imaging, Sonography, 4 and portable CT Scan 5 are used for intraoperative assessment of reduction of zygomatic arch fractures. In the authors' experience, closed reductions without intraoperative assessment of reduction yield unpredictable results with a significant chance of relapse, which gives rise to an embarrassing situation for both surgeon and patient postoperatively. The complications of an inadequately or unreduced zygomatic fracture are very difficult to correct secondarily and are usually avoidable. Operative methods that do not allow intraoperative visualisation of the fracture fragments not only result in unsatisfactory reduction, but are also fraught with complications including persistent diplopia, orbital dystopia, malunion, and significant residual deformity. Because the fracture lines cannot be visualised directly in closed reduction, digital exploration and crepitus noise or conventional radiographic imaging are used clinically as a guide to reposition the fragments. If this showed an incorrect positioning, renewed surgery and anaesthetics were often required.įracture of the zygomatic arch is usually treated using blind methods. Up until now it has only been possible to monitor the alignment of zygomatic arch fractures postoperatively with a computed tomography (CT) examination with coronal sectioning or conventional radiography. The C-Arm can obviate the need for intraoperative radiographs that, due to technician and film processing delays, add significantly to operative time. However, digital exploration and crepitus are unreliable guides in some cases, conventional radiographic imaging during surgery often presents difficulties in positioning the patient, and the delay in printing the film increases the operative time. 2 The position of the fragment is usually confirmed by palpation and radiography during operation. Successful reductions are often difficult to evaluate clinically because of the great amount of swelling that often accompanies these fractures. Fragments are repositioned using bone elevators passed through small incisions in the temporal skin or in the mucosa of the gingival sulcus in the canine fossa. Conventionally they are conducted by a blind method, because the anatomical pathways of the facial nerve rule out any large incision. Numerous techniques have been described to reduce zygomatic arch fractures. Depressed zygomatic arch fractures may be implicated by the partial or total obstruction of the movement of the condyle and of the coronoid process of the mandible, changing the opening and closure of the mouth.
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