DOI: 10.1097/01.PRS.0000157613.93879.FF
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PMID: 15809625
Issn Print: 0032-1052
Publication Date: 2005/04/15
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Excerpt
Some methods for closed reduction of facial bone fractures, including fractures of the zygoma and the zygomatic arch, have been reported,1–6 and various types of devices have been used for reduction.1–4,6 We report the use of hook screws (made of 18-8 stainless steel, which is frequently used for medical instruments) as devices for closed reduction of the zygoma and as auxiliary devices for frontal bone reduction (Fig. 1) in two cases.
In case 1, a 21-year-old man presented with a relatively slight dislocation of the right zygoma. In accordance with the reported transcutaneous reduction procedure,6 a bone hole was made with a drill through a stab incision at the point of intersection between a vertical line from the lateral canthus and an oblique line extending from the tragus to the medial canthus. A hook screw was screwed into the fractured segment. After the hook screw was inserted, the fractured segment was mobilized by pulling or rotating the force that was directly transmitted through it (Fig. 2, above). Repositioning was checked by intraoperative reverse Waters and zygomatic arch radiography.
Because of good immobilization of the reduced segment, additional fixation was not needed. At 3 months after the operation, there was no recurrent dislocation (Fig. 2, below).
We performed this procedure in five patients. General anesthesia was used in four patients and a maxillary nerve block was used in one patient. In the oldest patient (a 72-year-old man), the hook screw slipped out from the zygoma because of its friability and we switched to the conventional open reduction method. The other four patients had no complications or postoperative dislocations. The same procedure was used for frontal bone fractures.
In case 2, a 56-year-old man presented with a noncomminuted fracture of the anterior wall of the left frontal bone. Through an upper eyebrow incision, the dislocated segment of the frontal bone was partially exposed. During the operation, the supratrochlear and supraorbital nerves were carefully preserved. The dislocated segment was reduced and retained by pulling and rotating the inserted hook screw, and after fixation with titanium microplates, the hook screw was removed (Fig. 3, above). The postoperative course was uneventful, and good repositioning was achieved without any postoperative dysesthesia (Fig. 3, below). We performed this procedure in four cases of frontal bone fractures. All operations were performed with the patient under general anesthesia. In all cases, reduction and fixation could be performed via a small dissection area. There were two cases of slight and temporary postoperative dysesthesia of the ipsilateral forehead or parietal region.
In reductions of the zygoma, the indications for this method were limited to cases of slight dislocation without comminuted fractures, and in frontal bone reduction, a screw hook was used as an auxiliary device in the conventional open reduction. In the repair of various types of facial bone fractures, the hook screw can be easily used as both a reduction handle and a temporary bone-retaining device for microplate fixation, because it is more compact than previously reported devices, such as the corkscrew,2 heavy hook,4 and external fixator system.6 Since the hook screw is affixed directly to the bone, minimal force and dissection of the area are needed to mobilize, rotate, twitch, and control the fractured segment. With this simple and inexpensive method, the minute dissection area can reduce the incidence of postoperative dysesthesia and edema, and make bony union better by preserving the periosteal continuity.
