Reduction of Acute Zygomatic Arch Fractures With Intraoperative Ultrasound: An Underutilized Technique for Resource Scarce Settings.

Background: Zygomatic arch (ZA) fractures are a common facial fracture, and reduction is typically performed blind via a Gillies or Keen approach. Postoperative confirmation of reduction thus requires advanced imaging, which may not be readily available in all settings. Thus, there exists a need for an effective, low-cost imaging paradigm to employ in these clinical scenarios. Herein, we introduce the ultrasonic arch reduction (USA Reduction) for ZA fractures.

Methods: All consecutive patients with ZA fractures undergoing a USA Reduction at a single public hospital were reviewed. Patients were operated on by two plastic surgeons. A standard Gillies approach was used in all cases in conjunction with real-time intraoperative ultrasound. All relevant patient data were collected and analyzed.

Results: Two patients were included in our study. Patient 1 was a 43-year-old man who was assaulted and sustained a right comminuted zygomatic arch fracture without concomitant trauma. Patient 2 was a 35-year-old man who was hit by a train and sustained a left comminuted ZA fracture in addition to traumatic subarachnoid hemorrhage. Both fractures were successfully reduced under ultrasound guidance in under 1 hour of operating room (OR) time without necessitating the use of postoperative CT. To date, both patients endorse positive postoperative satisfaction with their results.

Conclusions: Intraoperative ultrasound is a safe and effective tool for confirming reduction of ZA fractures in a resource-limited practice while obviating the need for additional radiation. Further investigations to standardize the technique and approach will be useful to optimize this intraoperative adjunct.