![]() If a plate is used, we recommend placing only one screw on each side of the fracture, allowing the zygoma to swing into its proper position for reduction. The first step should be the placement of a plate or wire at the frontozygomatic suture. Reconstruction of the orbital floor should be performed after the zygoma has been reduced and fixated. In a fracture of this nature, the reduction and fixation of the zygoma, including the zygomatic arch, orbital rim, and zygomaticomaxillary buttress should be performed first. Pre- and postoperative ophthalmologic exams should be considered in all patients who have sustained periorbital trauma. A forced duction test should be performed before and after the reduction of the zygoma to make sure that the patient does not have entrapment of the soft tissues. It is possible that the periorbital contents may have been affected by the reduction of the zygomatic-complex fracture. Accurate positioning of the zygomatic arch addresses the AP dimension and width of the midface. It should be noted that the zygomatic arch is not a true arch and is often relatively straight in its central portion.Ī goal is to restore the proper orbital volume and to restore the proper projections in all three dimensions. The zygomatic arch can be useful in achieving the proper width of the midface and AP projection of the zygoma. It is difficult to use the lateral orbital wall as a landmark if the fractures of the lateral orbital wall are comminuted. In order to achieve proper reduction of the lateral orbital wall the greater wing of the sphenoid and the zygoma must be properly aligned. Correct anatomical reduction is required to reproduce the original structure of the zygomaticomaxillary complex and the proper alignment of the orbital walls.
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