Coronal approach to zygomaticomaxillary complex fractures.

OBJECTIVE: Trauma of the zygomaticomaxillary complex constitutes 45% of all midface fractures. In the author's medical unit, the proportion is 40% of all fractures of the facial skeleton. Most zygomaticomaxillary complex fractures can be treated via local incisions, however; multiple, comminuted and late fractures require wide exposure of the fragments in order to adequately reposition them and to apply rigid fixation.

PATIENTS AND METHODS: Thirty-one cases of comminuted or multiple fractures of the zygomaticomaxillary complex were treated with open reduction and rigid fixation by a coronal approach and analyzed for indications and postoperative complications. Twenty three patients had a hemi coronal approach and eight had a bicoronal approach.

RESULTS: Among the early complications noted were one case of hemorrhage, no infections, and two patients experienced paresthesia/ anesthesia in the supra orbital region, two patients in the temporal/parietal region, six patients experienced facial nerve weakness related to nerve retraction and moderate surgical edema was observed in three patients. Late complications included two cases of alopecia/baldness along the incision, one case of persistent paresthesia in the operative area. As far as the esthetics in relation to the incision was concerned, all patients were extremely satisfied.

CONCLUSIONS: The results of this study suggest that a coronal approach will facilitate accurate reduction and fixation of fragments and will allow good cosmetic result with minimal or no complications. The coronal incisions should be the first choice in case of comminuted, multiple and late zygomaticomaxillary complex fractures. However, indications for the use of coronal incisions must be strictly applied.