• Lijuan Yang, Chunming Liu, Wenmei Hua, Weidong Liu, Xiguang Wang, Kai Wang, Zhanle Zhang, Meifang Li, and Hainan Duan.
• Department of Stomatology, Langfang Fourth Peoples' Hospital, Bazhou Hebei 065700, PR China. ylj7198@163.com
• Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Oct 1;27(10):1181-4.

ObjectiveTo explore the procedure and effectiveness of sequential reduction and fixation for zygomatic complex fractures.MethodsBetween March 2004 and February 2012, 32 patients with zygomatic complex fractures were treated. There were 28 males and 4 females with a median age of 29 years (range, 17-55 years). Fractures were caused by traffic accident in 29 cases and by tumble in 3 cases. The time between injury and admission was 1-12 days (mean, 3 days) in 28 fresh fractures and 22-60 days (mean, 40 days) in 4 old fractures. All patients were diagnosed by clinical symptom and CT scan. Coronal scalp incision, lower eyelid aesthetic incision, and intraoral incision were used to expose the zygomatic bone segments. The sequence of fractures reduction and fixation was horizontal first, and then longitudinal. In horizontal orientation, reduction and simultaneous fixation started from the root of the zygoma, to zygomatic arch, body of the zygoma, and inferior orbital rim in turn. Longitudinally, fracture reduction of zygomatico-frontal suture and orbital posterolateral walls was done first, followed by fracture reduction of zygomaticomaxillary buttress.ResultsPrimary healing of incision was obtained in all 32 cases, without complications of maxillary sinus fistula and infection. Eighteen patients were followed up 6 months to 6 years with a median time of 32 months. All the patients gained satisfactory results with normal zygomatic contour and symmetric midface. All patients restored normal mouth opening. No eye and vision damage occurred. Frontal disappearance and brow ptosis were observed in 2 cases. Hair loss (2-3 mm) was seen at the site of coronal scalp incision, without scar hyperplasia; there was no obvious scar at lower eyelid. CT and X-ray films showed bony healing at 6 months after operation.ConclusionSequential reduction and fixation is accord with the mechanical characters of complicated zygomatic fractures. It is very easy to achieve anatomic reduction of the bone segments and facial symmetry.

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