Can My Zygomatic Fracture Protrusion/Asymmetry Be Fixed By Burring Or An Osteotomy?
Q:Dr. Eppley, I suffered a zygomatic fracture three years ago and its aftermath has caused my entire zygoma to protrude specifically on the arch bone. I think an osteotomy or removal of the bone would be the best way to create more symmetry. I was reading two posts on your website about Zygomatic Osteotomies but they mainly were about osteomizing and removing bone from the anterior cheek area in which it would be performed through an incision in the mouth. My problem is mainly my zygomatic arch and I am wondering if osteotomizing this bone would be difficult while trying to avoid facial nerves or other serious mishaps. How would this be performed and could facial plastic surgeons do this as simple as other facial surgeries or would they be not as keen in doing so? I have attached pictures for your assessment.
A: What I see in the pictures is that the depressed arch fracture is now showing the anterior edge of the temporal process of the zygomatic arch because this is the thicker and unfractured portion behind the more anteriorly depressed arch. It would require that anterior edge to be burred down to get rid of the bulge. Now that I have seen your pictures, I can answer your questions better. To reduce that posterior zygomatic arch bulge, it can not be reached from inside the mouth. It is to posterior to the temple region to do that. The best way to treat it is to osteotomize it from a temporal incision where the bone can be fractured and pushed in. This is done below the deep temporalis fascia so it is below the path of the frontal branch of the facial nerve. This type of surgery, while not complex, is not something I suspect that most facial plastic surgeons would feel comfortable doing. You need to see someone who has experience in doing these procedures and that means a plastic surgeon with craniomaxillofacial surgery experience.
Dr. Barry Eppley