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Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction

BACKGROUND: Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of...

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Autores principales: Song, Seung Han, Kwon, Hyeokjae, Oh, Sang-Ha, Kim, Sun-Je, Park, Jaebeom, Kim, Su Il
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Plastic and Reconstructive Surgeons 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6062705/
https://www.ncbi.nlm.nih.gov/pubmed/30037192
http://dx.doi.org/10.5999/aps.2018.00311
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author Song, Seung Han
Kwon, Hyeokjae
Oh, Sang-Ha
Kim, Sun-Je
Park, Jaebeom
Kim, Su Il
author_facet Song, Seung Han
Kwon, Hyeokjae
Oh, Sang-Ha
Kim, Sun-Je
Park, Jaebeom
Kim, Su Il
author_sort Song, Seung Han
collection PubMed
description BACKGROUND: Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of the extended transconjunctival approach (ETA) combined with T-bar screw reduction in minimizing scarring and complications for the treatment of ZMC fractures. METHODS: A total of 26 patients underwent ZMC reduction through the ETA and intraoral approach. A skin incision measuring roughly 5 to 8 mm in length was placed following the lateral canthal skin crease. After releasing the inferior crus of the lateral canthal tendon for canthotomy, the medial periosteum of the lateral orbital rim was preserved for canthal reattachment. A limited subperiosteal dissection and partial relaxing incision of the orbicularis oculi were performed to expose the fracture line of the inferior orbital rim and zygomaticofrontal suture. Reduction was performed using a T-bar screw through the transconjunctivalincision and an elevator through the intraoral incision. RESULTS: The aesthetic and functional results were excellent. Successful reduction was achieved and the skin incision was less than 8 mm in 20 cases (76.9%). Only six patients had an additional skin incision (less than 5 mm) to achieve reduction. No cases of ectropion, entropion, or excessive scarring were noted. CONCLUSIONS: The ETA using a T-bar screw is a useful method for maximizing aesthetic results in ZMC fractures, with the advantages of minimal scarring, faster recovery, and maintenance of pretarsal fullness.
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spelling pubmed-60627052018-08-03 Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction Song, Seung Han Kwon, Hyeokjae Oh, Sang-Ha Kim, Sun-Je Park, Jaebeom Kim, Su Il Arch Plast Surg Original Article BACKGROUND: Zygomaticomaxillary complex (ZMC) fractures mostly occur in the form of tripod fractures. The surgical field is accessed using a combination of three classic approaches. However, the subciliary incision may have unfavorable aesthetic results. Herein, the authors report the advantages of the extended transconjunctival approach (ETA) combined with T-bar screw reduction in minimizing scarring and complications for the treatment of ZMC fractures. METHODS: A total of 26 patients underwent ZMC reduction through the ETA and intraoral approach. A skin incision measuring roughly 5 to 8 mm in length was placed following the lateral canthal skin crease. After releasing the inferior crus of the lateral canthal tendon for canthotomy, the medial periosteum of the lateral orbital rim was preserved for canthal reattachment. A limited subperiosteal dissection and partial relaxing incision of the orbicularis oculi were performed to expose the fracture line of the inferior orbital rim and zygomaticofrontal suture. Reduction was performed using a T-bar screw through the transconjunctivalincision and an elevator through the intraoral incision. RESULTS: The aesthetic and functional results were excellent. Successful reduction was achieved and the skin incision was less than 8 mm in 20 cases (76.9%). Only six patients had an additional skin incision (less than 5 mm) to achieve reduction. No cases of ectropion, entropion, or excessive scarring were noted. CONCLUSIONS: The ETA using a T-bar screw is a useful method for maximizing aesthetic results in ZMC fractures, with the advantages of minimal scarring, faster recovery, and maintenance of pretarsal fullness. Korean Society of Plastic and Reconstructive Surgeons 2018-07 2018-07-15 /pmc/articles/PMC6062705/ /pubmed/30037192 http://dx.doi.org/10.5999/aps.2018.00311 Text en Copyright © 2018 The Korean Society of Plastic and Reconstructive Surgeons This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Song, Seung Han
Kwon, Hyeokjae
Oh, Sang-Ha
Kim, Sun-Je
Park, Jaebeom
Kim, Su Il
Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction
title Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction
title_full Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction
title_fullStr Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction
title_full_unstemmed Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction
title_short Open reduction of zygoma fractures with the extended transconjunctival approach and T-bar screw reduction
title_sort open reduction of zygoma fractures with the extended transconjunctival approach and t-bar screw reduction
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6062705/
https://www.ncbi.nlm.nih.gov/pubmed/30037192
http://dx.doi.org/10.5999/aps.2018.00311
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