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Temporal (Gillies) Approach to a Zygomatic Arch Fracture

This video documents the steps typically followed during open reduction of isolated, depressed zygomatic arch fractures.  The patient’s hair was shaven for clarity and for proper marking of key anatomic landmarks. Such landmarks are shown and discussed in sequence with the key surgical steps.

Marcus Couey, DDS, MD; Eric Reimer, DDS; Andrew Bhagyam, DDS; Phillip Freeman, DDS, MD; Jose M Marchena, DMD, MD

The University of Texas Health Science Center at Houston, School of Dentistry, Department of Oral & Maxillofacial Surgery

Temporal (Gillies) Approach for Open Reduction of a Zygomatic Arch Fracture
(1) Depressed fractured zygomatic arch causing a cosmetic deformity (2) Depressed fractured zygomatic arch causing mandibular hypomobility secondary to interference with the coronoid process
(1) Coexisting unstable or comminuted zygomatic body fractures requiring reconstruction of the arch to achieve proper projection and stability of the zygoma
Standard setup for midface procedures
(1) Evaluation for facial asymmetry secondary to flattening of the lateral midface (2) Evaluation for the presence of additional fractures and mobility of the zygoma (3) Assessment of mandibular mobility (mouth opening) (4) Maxillofacial CAT scan
(1) Superior temporal line of the parietal bone (2) Natural hairline (3) Frontal branch of the superficial temporal artery (4) Parietal branch of the superficial temporal artery
Advantages: (1) Clean procedure (2) Small cosmetic incision Disadvantages: (1) Indirect approach not allowing for direction fixation of fragments
(1) Scar/ alopecia at the incision site (2) Bleeding from injury to branches of the superficial temporal artery (3) Nerve injury if instrumentation is conducted in a superficial plane (4) Inadequate reduction due to fracture instability (5) Over-correction resulting in a bowed/curved arch
None
(1) Offices of the Vice President and Chief of Staff, Ben Taub Hospital (2) Offices of Corporate Communications and Media Relations, Harris Health System (3) Department of Legal Affairs, The University of Texas Health Science Center at Houston (4) Department of Oral & Maxillofacial Surgery, The University of Texas Health Science Center at Houston
Gillies HD, Pomfret Kilner T, Stone Dudley. Fracture of Malar-Zygomatic Compound with Description of a New X-ray Position. British J Surgery 14:651, 1927. Haggerty CJ, Demian N, Marchena JM*: Acute Management of Orbito-zygomatic-maxillary Fractures. In: Current Therapy In Oral and Maxillofacial Surgery (eds Bagheri SC, Bell BR, Khan AH). Elsevier-Saunders, St. Louis, 2012; 324-332.

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