Inferomedially impacted zygomatic fracture reduction by reverse vector using an intraoral approach with Kirschner wire

Abstract

Background: In inferomedially rotated zygomatic fractures sticking in the maxillary sinus, it is often difficult to achieve complete reduction only by conventional intraoral reduction. We present a new intraoral reduction technique using a Kirschner wire and its clinical outcome.

Methods: Among 39 inferomedially impacted zygomatic fractures incompletely reduced by a simple intraoral reduction trial with a bone elevator, a Kirschner wire (1.5 mm) was vertically inserted from the zygomatic body to the lateral orbital rim in 17 inferior-dominant rotation fractures and horizontally inserted to the zygomatic arch in nine medial-dominant and 13 bidirectional rotation fractures. A Kirschner wire was held with a wire holder and lifted in the superolateral or anterolateral direction for reduction. Following reduction of the zygomaticomaxillary fracture, internal fixation was performed.

Results: Fractures were completely reduced using only an intraoral approach with Kirschner wire reduction in 33 cases and through an additional lower lid or transconjunctival incision in six cases. There were no surgical complications except in one patient with undercorrection. Postoperative 6-month computed tomography scans showed complete bone union and excellent bone alignment. Four patients experienced difficulty with upper lip elevation; however, these problems spontaneously resolved after manual tissue lump massage and intralesional steroid (Triamcinolone) injection.

Conclusions: We completely reduced infraorbital rim fractures, zygomaticomaxillary buttresses, and zygomaticofrontal suture fractures in 84% of patients through an intraoral approach alone. Intraoral Kirschner wire reduction may be a useful option by which to obtain effective and powerful reduction motion of an inferomedially rotated zygomatic body.

Keywords: Rotation; Zygoma; Zygomatic fracture.

Fig. 1.. Insertion direction of intraoral K-wire

A thick Kirschner wire (K-wire) was inserted at the thick zygomatic body near the fracture line furthest from the rotation hinge. In inferior-dominant rotation fracture, (A) vertical K-wire insertion from the zygomatic body to the lateral orbital rim and (B) lifting up for superolateral reduction. In medial-dominant or bidirectional rotation fractures, (C) horizontal insertion from the zygomatic body to the zygomatic arch and (D) lifting up for anterolateral reduction.

Fig. 2.. Cases of intraoral K-wire reduction

Preoperative and postoperative 6-month computed tomography (CT) images of inferior-dominant rotation fracture (A, B), bidirectional rotation fracture (C, D), and medial-dominant rotation fracture (E, F). These zygomatic fractures were reduced through intraoral approach alone. Postoperative CT images show excellent bony alignment. K-wire, Kirschner wire.