The zygomatic-sphenoid fracture line in malar reduction: A cadaver study

Objective: To demonstrate the persistent malar displacement and distraction of the zygomatic-sphenoid fracture line that is possible after alignment of the frontozygomatic and infraorbital rim fractures of a displaced malar fracture. Design: Nonblinded cadaver study. Subjects: Three fresh cadaver heads and 1 representative clinical example. Intervention: The cadaver heads were subjected to blunt trauma to the malar eminence. Reduction of the malar unit was performed either with attention to the frontozygomatic and infraorbital rim fractures alone or with concomitant inspection of the zygomatic-sphenoid fracture line. The representative case was repaired with a transconjunctival approach for inspection of the zygomatic-sphenoid fracture line. Results: Persistent malar asymmetry is possible after the reduction of displaced malar fractures when only the frontozygomatic and infraorbital rim buttresses are used for reference. In each case in our study, the zygomatic- sphenoid fracture line remained distracted. Alignment of the zygomatic- sphenoid fracture restored premorbid malar position. Conclusion: Inspection of the zygomatic-sphenoid fracture line can contribute significantly to the precise 3-dimensional reduction of displaced malar fractures.