The role of intraoperative ultrasonography in zygomatic complex fracture repair

Intraoperative assessment of the zygomatic arch is very important in achieving adequate repositioning. The correct alignment of the zygomatic arch indicates the proper position of the zygomatic bone and ensures adequate prominence of the lateral midfacial aspect. The aim of this study was to estimate the value of ultrasonography as an intraoperative repositioning control. In a clinical study of 25 patients, ultrasonography was employed for intraoperative visualization of the zygomatic arch before and after fracture repositioning. Twelve patients presented with isolated zygomatic arch fractures and 13 with combined fractures of the zygomatic bone and arch. The ultrasonographic findings were compared to the radiological and clinical findings. Ultrasonography was able to detect all fractures and dislocations of the zygomatic arch. It was possible to assess the repositioning in 24 out of 25 cases using ultrasonography. The ultrasound images were concordant with the radiographs. Clinical assessment by palpation only succeeded in isolated zygomatic arch fractures with an m-shaped impression, whereas it remained uncertain in nearly all cases with a different dislocation pattern. Ultrasonography was rapid and easy to perform, and is recommended as an intraoperative visualizing tool in all midfacial fractures with displacement of the zygomatic arch.