Objective
To describe and evaluate transsinus reduction and one-point miniplate fixation of the zygomaticomaxillary buttress for the treatment of tripod malar fractures.
Design
A consecutive case series.
Setting
Private otolaryngology practice.
Patients
A consecutive sample of 17 patients presenting with isolated tripod malar fractures over a 42-month period.
Intervention
A gingivobuccal sulcus incision is made. Access into the maxillary sinus was obtained through an invariably comminuted inferior fracture line. The zygoma was reduced by applying lateral and anterior traction force to the zygomatic recess of the maxillary sinus. Miniplate fixation of the zygomaticomaxillary buttress area was then performed bridging over an area of bone loss and comminution.
Main Outcome Measures
Clinical assessment of facial symmetry by patients, physician, and roentgenographic studies.
Results
All patients presenting with no comminution of the orbital rim had complete restoration of their premorbid facial symmetry. One of the two patients presenting with comminuted orbital rim had poor results.
Conclusions
This technique is simple, limited, and successful in treating most malar fractures. The lack of comminution of the orbital rim is crucial for the stability of the reduced zygoma. A simple and clinically relevant classification of malar fractures is proposed.
(Arch Otolaryngol Head Neck Surg. 1994;120:620-625)
