Indirect approaches for reduction of the zygomatic arch :
A traumatic impact to the side of the face can sometimes result in a pure zygomatic arch fracture. In these cases, the zygomatic complex itself remains nondisplaced. In the classification of cheek bone fractures, this would be considered a Type II fracture. In this case, two open approaches can be considered for a reduction of the zygomatic arch: the temporal (Gillies) and transoral (Keen) approach. The operative details of the more commonly used indirect approach ( Gillies approach) follow:
The Gillies technique describes a temporal incision (2 cm in length), made 2.5 cm superior and anterior to the helix, within the hair-bearing portion of the scalp. A temporal incision is made and care is taken to avoid the superficial temporal artery. The dissection continues through the subcutaneous tissue and superficial temporal fascia down to the deep portion of the deep temporal fascia. The deep temporal fascia is what I commonly harvest to reline the nose during primary and revision rhinoplasty. This fascia is then incised to expose the temporalis muscle. An instrument is inserted deep to the temporalis fascia and superficial to the temporalis muscle. A blunt instrument is advanced until it is located just medial to the depressed zygomatic arch segment. A blunt dissection instrument (zygomatic elevator) is inserted just deep to the depressed zygomatic arch bone segment and an outward force is applied in order to adequately reduce the bone back into anatomic alignment. Once complete, the scalp is simply closed with staples. When using this technique, there is no need for fixation with titanium plates and screws.