Zygomatic Arch Reduction (Gillies Approach)
The zygomatic arch is formed by the articulation of the temporal process of the zygoma and the zygomatic process of the temporal bone. It serves as an attachment point for the masseter and plays a significant role in maintaining facial contour. Isolated a
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Richard Siy, Jesse D. Meaike, and Larry H. Hollier
Introduction
Indications
The zygomatic arch is formed by the articulation of the temporal process of the zygoma and the zygomatic process of the temporal bone. It serves as an attachment point for the masseter and plays a significant role in maintaining facial contour. Isolated arch fractures are often the result of a direct lateral force to the arch that drives the fragments of the zygomatic arch medially [1]. Isolated zygomatic arch fractures yielding significant contour deformity or trismus are managed surgically [2]. In the Gillies approach, a temporal incision is made anterior and superior to the root of the helix and carried through to a plane just deep to the superficial layer of the deep temporal fascia. An elevator is inserted through this incision, navigated to a location medial to the zygomatic arch, and used to reduce the zygomatic arch to its anatomic position. The main complication of this procedure is facial asymmetry or contour deformity.
1. Isolated zygomatic arch fractures with significant contour deformity or trismus [2] 2. Isolated, noncomminuted, depressed zygo matic arch fractures [3]
R. Siy, M.D. • J.D. Meaike, B.S. L.H. Hollier, M.D. (*) Michael E. Debakey Department of Surgery, Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, 6701 Fannin St., CC 610.00, Houston, TX 77030, USA e-mail: [email protected]; [email protected]; [email protected]
Essential Steps Preoperative Markings 1. Identify and mark the superficial temporal artery and hairline. 2. Mark the transverse temporal incision (2 cm in length) 2.5 cm anterior and superior to the ear root within the hairline [2]. 3. Mark the frontal branch of the facial nerve (optional).
Intraoperative Details 1 . Place patient in supine position. 2. General anesthesia or monitored anesthesia care with local anesthesia. 3. Incise the skin at the marked temporal location using caution to avoid the superficial temporal artery [4]. 4. Continue the incision through the subcutaneous tissue, superficial temporal fascia, and
© Springer International Publishing Switzerland 2017 T.A. Tran et al. (eds.), Operative Dictations in Plastic and Reconstructive Surgery, DOI 10.1007/978-3-319-40631-2_62
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superficial layer of the deep temporal fascia into a plane immediately superficial to the temporal fat pad [2]. 5. Insert the elevator through the incision into this plane and advance it until it is medial to the depressed portion of the zygomatic arch [4]. 6. Apply an outward force to the elevator to reduce the fracture without using the squamous portion of the temporal bone and the overlying tissue as a fulcrum [5]. 7. Close the temporal fascia with absorbable suture material and the subcutaneous tissue and skin according to surgeon preference [5].
Postoperative Care 1 . Elevate the head of to decrease swelling [2]. 2. Document facial nerve function, particularly brow elevation. 3. Remove nonabsorbable facial sutures 4–7 days postoperation [2].
Possible Com
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