Authors of section

Author

Boaz Arzi

Executive Editor

Amy Kapatkin

General Editor

Frank Verstraete

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Plate fixation

1. Principles

Restoring normal anatomical contour is crucial to avoid long-term complications such as loss of reduction, facial asymmetry and general dysfunction.

2. Approach

Patient positioning

For this procedure, one of the following two patient positions are used:

The lateral extraoral approach to the zygomatic arch allows for the best exposure.

lateral approach to the zygomatic arch

If only the rostral part of the zygomatic arch is fractured, an intraoral approach may be attempted.

intraoral approach to the maxilla

3. Irrigation of the fracture

Irrigation of the fractured area is advised to remove any foreign material and debris.

plate fixation

4. Reduction

The dislocated segment is elevated or distracted using one or two periosteal elevators and/or bone-holding forceps until the appropriate anatomic alignment is reached.

plate fixation

5. Fixation

Plate selection and preparation

An appropriate size, low-profile, titanium 2mm non-locking miniplate is contoured using specially designed miniplate bending pliers, and adapted to the desired anatomical site. This allows for accurate repositioning and reconstruction of the zygomatic arch. The length of the plate should allow for at least two screws on each side of the fracture. Three screws per fracture fragment (six cortices) are ideal.

plate fixation

Plate application

The plate is applied spanning the fracture margins. More than one plate is rarely required.

plate fixation

Note: Care should be taken with placement of the rostral screws to avoid the roots of the maxillary molar and fourth premolar teeth.

plate fixation

The length of the screws is determined by using CT measurements of the bone thickness and a depth gauge.

plate fixation

The plate is secured to the bone with at least two non-locking, self-tapping titanium screws in each segment of the fracture.

midface zygomatic arch simple

6. Closure

The soft tissues are closed routinely in two layers. A Stent bandage is secured in place for 72 hours in order to minimize postoperative swelling and emphysema.

7. Aftercare

The dog should be kept on soft food for one or two weeks after surgery.

Intraoperative intravenous administration and then oral antibiotics for one to two weeks is recommended. Antibiotics used should have an excellent oral cavity penetration and spectrum. Example: ampicillin at 20 mg/kg intravenous antibiotics followed by oral antibiotics amoxicillin/clavulanic acid at 15-20 mg/kg orally twice daily.

Pain medication, such as opioids and non-steroidal anti-inflammatory medications, are used for 7-14 days.

If the fracture involved the oral cavity, oral rinse with 0.05-0.12% chlorhexidine gluconate solution is recommended (not for maxillomandibular fixation).

Recheck is recommended in 10-14 days and at three and six months post-surgery.

If there are any signs of complications (i.e. purulent nasal discharge), CT and rhinoscopy are indicated.

Implant removal

Typically, titanium miniplates and screws are osseointegrated. If there is no implant failure or infection, there is no need for implant removal.