Background:
Zygomatic arch (ZA) fractures are among the most common facial fractures. Open reduction is typically performed “blind” via a Gillies or Keen approach which typically makes precise post-reduction confirmation dependent on computed tomography (CT) scan. This requires an extensive amount of hospital resources that are not available in all practice settings. Thus, there exists a need for an efficient, low-cost imaging paradigm to employ in these practice settings and minimize the effects of healthcare resource disparities that have been demonstrated to negatively impact patient outcomes.
Methods:
All consecutive patients undergoing open reduction for ZA fractures utilizing intraoperative ultrasound at a single resource-limited public hospital were reviewed. Patients were operated on by two plastic surgeons. A standard Gillies approach was used in all cases and intraoperative ultrasonography was performed to confirm reduction. Relevant patient data were collected and analyzed.
Results:
Two patients were included in our study at time of chart review. Patient 1 was a 43-year-old man who was assaulted and sustained a right comminuted zygomatic arch fracture without concomitant trauma. He was taken to the operating room (OR) on post-injury day four where his ZA fracture was reduced in 54 minutes. Patient 2 was a 35-year-old man who was hit by a train and sustained a left comminuted ZA fracture in addition to traumatic subarachnoid hemorrhage. The patient was taken to the OR on post-injury day five where his ZA fracture was reduced in 56 minutes. Intraoperative and postoperative CT was not utilized in either patient for reduction confirmation. To date, both patients endorse positive postoperative satisfaction with their results.
Conclusions:
Intraoperative ultrasound is a safe and effective tool for quickly confirming reduction of ZA fractures in a resource-limited practice while negating the need for additional radiation. Further investigations to standardize the technique and approach will be useful for optimizing this useful intraoperative adjunct.
Figure 1. Intraoperative ultrasound (A) pre and (B) post reduction demonstrating the zygomatic arch (red arrows) and the displaced fractured segment (yellow arrow) in appropriate aligment.
