![]() It is difficult to plate the zygomatic arch without performing a coronal or preauricular exposure. It should be noted that using this 3-point fixation technique we have chosen not to plate the zygomatic arch. ![]() Reconstruction of the lateral wall of the orbit with mesh, even when comminuted, is not necessary due to the bone support of the temporalis muscle. In this situation the surgeon has to place higher emphasis in the reduction of other sites. When the lateral wall is comminuted, the lateral wall is not so reliable as a landmark in determining the proper reduction of the zygoma. A larger plate (commonly an L-shaped plate) is recommended for the zygomaticomaxillary buttress. A smaller plate is recommended for the infraorbital rim. ![]() It is easier to visualize whether a proper reduction of the lateral orbital wall is achieved by placing the plate on the infraorbital rim as the second plate after the zygomaticofrontal suture plate. Note: Check the proper alignment of the repositioned zygomatic complex along the lateral wall of the orbit (sphenozygomatic junction) before performing the fixation at the other points. It is debated whether the second site for fixation should be the orbital rim or the zygomaticomaxillary buttress. Reconstruction of the orbital floor should be performed after the zygoma has been reduced and stabilized. In a fracture of this nature, the reduction and fixation of the zygoma should be performed first. In a zygomatic fracture that requires orbital floor reconstruction, after exposing the zygoma and orbital floor, the zygoma should be disimpacted prior to dissecting herniated orbital soft tissues from the maxillary sinus.
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