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BACKGROUND: Uncorrected isolated displaced zygomatic arch fractures can lead to facial contour asymmetry and functional problems with decreased mouth opening from coronoid impingement. The various approaches to reduction and various methods of fixation have not been well studied. Our objective was to compare established treatment methods for zygomatic arch fractures for both aesthetic and functional outcomes.
METHODS: Consecutive patients with isolated zygomatic arch fractures with minimum of 6 month follow-up were studied in 4 different groups: 1) Intraoral reduction/no fixation; 2) Coronal flap reduction/Plate fixation; 3) Intraoral reduction/External splint fixation; 4) No surgery (n=85). Preop and 6 month follow-up CT scans were used. 3D photography for regional malar volume in 10 patients per group were used (Coons patch and radial methods). Perioperative complications, facial contour symmetry (aesthetic outcome), mouth opening (functional outcome), relapse and reoperations were compared.
RESULTS: External splint; No fixation; and No surgery had no perioperative complications. Plate fixation group had facial nerve injury (4%), hematoma (8%), and persistent hyperesthesia (8%). Functional recovery was best for External splint > Plate fixation >> No fixation > No surgery. Preop mean mouth interincisor opening = 9-22mm for all. Postop interincisor opening: External splint: 43mm > Plate fixation:36mm >> No fixation: 28mm > No surgery:24mm. Volumetric symmetry: External splint:98%>Plate fixation: 101% >> No fixation:81%; No surgery:74%. Relapse: External splint:0%>Plate fixation: 0% >> No fixation:24%. Reoperation (fat grafting or bony reconstruction): External splint:0%>Plate fixation: 28% >> No fixation: 44%. Data for patient reported outcome measures is still being collected in these groups.
CONCLUSIONS: For isolated zygomatic arch fracture Intraoral reduction with external splint fixation provides an effective correction (no relapse or reoperation) with low risk (minimal perioperative complication) compared to Plate fixation, No fixation, or No surgery.