Intra-oral reduction of zygomatic fractures

Zygomatico-maxillary complex fractures present a challenging diagnostic and reconstructive task to the surgeon. Gillie's temporal approach has been a commonly used technique for zygomatic arch reduction, but surgeons have been commonly using a buccal sulcus approach for the reduction of zygomatic arch fractures as well as for combined zygomatico-maxillary complex fractures. This article outlines the use of Rowe's elevator (modification of Bristow's elevator) intra-orally to reduce zygomatic arch fractures and, if required, simultaneously plate the zygoma through the same approach. A retrospective analysis of 379 patients treated with this technique in the last 10 years has been presented along with a comprehensive treatment protocol including a description of its advantages over the Gillie's approach. Based on the inclusion criteria, the study group consisted of 327 patients. In 281 patients, the zygomatic complex was fractured, whereas 46 patients presented with a solitary zygomatic arch fracture. Two hundred and three cases were successfully treated with the buccal sulcus approach, whereas 124 cases required both the buccal sulcus and the extra-oral lateral orbital approaches. The described approach has advantages over Gillie's temporal approach by being simple, faster and cost-effective, can be performed under local anesthesia, and is more esthetic as it does not leave any scars.