Authors of section

Authors

Scott Bartlett, Michael Ehrenfeld, Gerson Mast, Adrian Sugar

Executive Editor

Edward Ellis III

General Editor

Daniel Buchbinder

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Construction of zygomatic arch

1. Introduction

When the zygomatic arch is missing in whole or in part, but the glenoid fossa is present, it should be constructed as symmetrically as possible. Mirror imaging of the normal side to the abnormal side using 3D-CT software can provide a guide to the shape and position of the graft required.

The construction of the zygomatic arch is generally carried out during childhood although the same principles apply when a patient presents as an adult.

2. Approach

The surgical approach is via a coronal or hemi-coronal/extended preauricular incision (illustrated)

This enables exposure of the posterior part of the arch extending forwards to the body of the zygomatic bone.

Hemifacial microsomia (HFM) - Construction of zygomatic arch

3. Rib graft harvest

It is generally possible to reconstruct the zygomatic arch using autogenous rib grafts. Usually one rib graft is sufficient.

Hemifacial microsomia (HFM) - Construction of zygomatic arch

4. Construction

Shaping of the graft

The rib is molded using rib benders to the required shape.

Hemifacial microsomia (HFM) - Construction of zygomatic arch

Fixation

The construct is then stabilized with two screws (eg, 1.5 mm), one anteriorly and one posteriorly. Screw fixation is generally into the body of the zygomatic bone anteriorly and the mastoid process of the temporal bone posteriorly.

Hemifacial microsomia (HFM) - Construction of zygomatic arch

5. General wound care

Apply ice packs (may be effective in a short term to minimize edema).

The sterile dressing placed over the incisions is maintained for a minimum of 48 hours. Thereafter routine wound care should be instituted.

Antibiotic prophylaxis is continued for 1-5 days depending on the nature, complexity, and duration of the surgical procedure.

Remove sutures from skin after approximately 5 days if nonresorbable sutures have been used.

Regular follow up examinations to monitor healing are required.

Avoid sun exposure and tanning to skin incisions for several months.