Zygoma resection

Considerations

• • Pathology

  • 1992: Intraosseous hemangioma of the zygomatic bone. A case report

  • 2001: Intraosseous Hemangioma of the Zygoma: CT and MR Findings

  • 2010: Zygomatic intraosseous haemangioma: reconstruction with an alloplastic prosthesis based on a 3-D model

  • 2011: Case report: Periorbital intraosseous hemangiomas

  • 2012: Cavernous hemangioma--uncommon presentation in zygomatic bone

  • Approaches 

    • Direct

      • Coronal

        • Pros

          • option for temporal or preauricular extension

          • excellent exposure of the zygomatic arch

          • allows reconstruction of the width and AP projection of the midface

      • Cons - often outweigh the pros 

        • • significant scar alopecia 

          • temporal hollowing

          • possible risk of injury to the temporal branch of the facial nerve

    • Indirect

      • Temporal (Gillies)

      • Modified temporal

        • 2010: A Modified Temporal Incision: An Alternative Approach to the Zygomatic Arch

        • 2012: Modified Gillies approach for zygomatic arch fracture reduction in the setting of bicoronal exposure

      • Transoral (Keen), i.e. lateral maxillary vestibular incision

        • 1999: Upper buccal sulcus approach to management of fractures of the zygomatic complex: a retrospective study of 50 cases

      • Lower eyelid - transcutaneous

      • Lower eyelid transconjunctival

      • Superolateral orbital rim

      • Midface degloving

      • Weber-Ferguson 

      • Lateral rhinotomy 

  • Reconstruction

  • 2010: Reconstruction of the maxilla and midface: introducing a new classification

    • Goals: Restore...

      • orbital volume,

      • width,

      • AP projection,

      • and height of the midface

    • 3-point vs 4-point fixation

      • 1st plate: frontozygomatic

      • 2nd plate: orbital rim (3-point) vs zygomatic arch (4-point)

      • 3rd plage: zygomaticomaxillary buttress (3-point) vs orbital rim (4-point)

    • 4th plate: zygomaticomaxillary buttress

• 2009: Resection of a large, central hemangioma with reconstruction using a radial forearm flap combined with zygomatic and pterygoid implants

• 2015: Selective laser melted titanium implants: a new technique for the reconstruction of extensive zygomatic complex defects

Preparation

Procedure

Sample operative report

Post-op

Pearls & Pitfalls

High-Yield

Links

• YouTube (2:31) - Gillies temporal approach to reduce zygomatic fracture

• YouTube (4:58) - Gilles lift for fractured Zygomatic arch

• YouTube (6:47) - Preauricular approach to TMJ for Eminectomy

• YouTube (10:53) - Coronal flap

• AO Foundation - Approaches to the zygomatic arch

• AO Foundation - Approaches to ZMC including lid and orbit

• AO Foundation - Coronal approach to zygomatic arch

• AO Foundation - 3-point fixation of the ZMC

• AO Foundation - 4-point fixation of the ZMC

• eMedicine - ZMC fractures

• OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY - TOTAL MAXILLECTOMY, ORBITAL EXENTERATION