Common Approaches to the Zygoma

• Incisions: coronal incision (visualize the lateral orbital rim and zygomatic arch), periorbital incisions (transconjunctival, subciliary incisions, subtarsal; visualize the orbital rim and floor), eyebrow incisions (visualize frontozygomatic suture), gingivobuccal incision (visualize the maxillary face)

• Gillies Approach: indicated for isolated arch fractures with no comminution; incision behind the temporal hairline is carried through the superficial temporalis fascia, the superior auricular muscle, and the deep tempo-ralis fascia; approach zygoma by placing elevator below the deep temporalis fascia and above the temporalis muscle to avoid injuring the temporal branch of facial nerve (underside of superficial temporalis fascia)

• Intraoral Approach (Keen): incision at gingivobuccal sulcus, tunnel lateral to the maxilla and under the zygomatic arch

• Coronal, Hemicoronal, or Extended Pretragal Approaches: indicated for multiple complex facial fractures (eg, Le Fort III, frontal sinus); access to full length horizontal arc to repair a displaced middle arc segment

• Lateral Brow Approach: allows reduction of the zygomatic arch

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