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Updated: Jun 26, 2026

A Standardized Surgical Technique for Tessier Medial Transnasal Canthopexy
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Non-Scar Fixation Technique for Zygomaticomaxillary Complex Tripod Fracture Using Upper Lid Transconjunctival

Han Gyu Cha1, Seo Koo Lee1, Joon Suk Bae1

  • 1College of Medicine, Department of Plastic and Reconstructive SurgerySoonchunhyang University Bucheon Hospital, Soonchunhyang UniversityBucheonKorea.

Archives of Plastic Surgery
|June 25, 2026
PubMed
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An upper eyelid transconjunctival incision offers a scar-free method for frontozygomatic fixation in zygomaticomaxillary complex (ZMC) fractures. This technique provides reliable fixation and adequate exposure without visible scarring or complications.

Area of Science:

  • Oral and Maxillofacial Surgery
  • Plastic and Reconstructive Surgery
  • Ophthalmology

Background:

  • Surgical approaches for zygomaticomaxillary complex (ZMC) fractures aim to reduce visible scarring and periocular complications.
  • Conventional frontozygomatic fixation methods may leave noticeable scars or cause complications.
  • An independent upper eyelid transconjunctival incision is explored as a non-cutaneous alternative.

Purpose of the Study:

  • To evaluate the efficacy and safety of an upper eyelid transconjunctival incision for frontozygomatic fixation in ZMC tripod fractures.
  • To compare outcomes between a non-scar upper eyelid transconjunctival approach and fixation through existing traumatic lacerations.

Main Methods:

  • A retrospective comparative study of 27 patients with unilateral ZMC tripod fractures.
Keywords:
fracture fixationfracture-skullorbital fracturessurgical procedureszygomatic fractures

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  • 12 patients underwent fixation via an upper eyelid transconjunctival approach; 15 used pre-existing traumatic lacerations.
  • Computed tomography and 3D photogrammetry assessed bony and soft tissue differences postoperatively.

    • Main Results:

    • Both groups showed significant postoperative improvement in bony and soft tissue alignment.
    • No clinically meaningful differences in intermalar height were observed between the non-scar and control groups.
    • No significant approach-related ophthalmic complications occurred in either group.

    Conclusions:

    • The upper eyelid transconjunctival approach is a viable, non-scarring option for frontozygomatic fixation in select ZMC tripod fractures.
    • This technique ensures adequate surgical exposure and stable fixation.
    • It offers a reliable alternative to conventional methods, minimizing aesthetic concerns.