The placement of screws above the zygomaticofrontal suture

The use of plates in the zygomaticofrontal (ZF) region for stabilization of zygoma fractures necessitates use of screw holes. This anatomic study was done to assess where these holes can be safely placed. A study of 20 adult skulls showed that when drilling perpendicular to the bone above the ZF suture, the cranial cavity can be entered as low as 12 mm above it (average, 15 mm). Therefore, when drilling more than 12 mm over the ZF suture, the surgeon should angle the drill at an acute angle to the forehead to prevent cranial encroachment. In addition there is great variability of depth of bone around the ZF suture. When drilling perpendicularly on the frontal bone in the first centimeter above the ZF suture, the orbital cavity will always be entered.