Application Of Endoscope And Preoperative 3D-Printing In The Reduction And Fixation Of Fractures Of Zygoma And Zygomatic Arch

Fractures of zygoma and zygomatic arch possesses a high incidence in oral and maxillofacial bone fractures.In view of the treatment of zygomatic complex fracture,the two standard principle of function and appearance is advocated.Therefore,application of rigid internal fixation(RIF)is more and more extensive.However,about zygomatic complex fracture accompanying zygomatic arch fracture(type B),because of the difficulties in the exposure of surgical field,scalp coronal incision were principlely adopted.This incision is easy for full exposure of the fractured area and fractured area and facilitate the reduction and fixation of the fractured segments under ditect vision.However,the surgical trauma as well as the scar after operation is obvious.In recent years,with the development of endoscopy technology,nasal endoscopy is adopted in oral and maxillofacial surgery more and more extensively,which incarnates the minimally invasive conception advocates in modern medicine.In addition,3-dimensional printing(3DP)technology can accurately reconstruct the broken end of fractures according to the 3D scan image before operation.Furthermore,according to the appearance of healthy side,the mirror image can be inversely constructed,which can provide guidance for molding and locating of the titanium plate before and during the operation procedure as a simulation model.This process embodies the accurate medical treatment conception advocated by modern medicine.However,Reduction and fixation of fractures of zygoma and zygomatic arch assisted by endoscopic as well as 3D preoperative printing techniques are rare in clinical practice.Hereby,in this study,nasal endoscope and preoperative 3D-printing are applicated in the reduction and fixation of type B Fractures of zygoma and zygomatic arch,in order to realize minimally invasive and accurate idea at the same time,on the other hand,the feasibility of this surgical method is testified as well.Furthermore,by comparing with the data reported in the literatures,the advantages of this operative method in surgical effects and incidences of postoperative complications are also discussed in this study.Purpose1.To explore the feasibility of application of endoscopic technique combined with 3D pre-operative printing assist open reduction and internal fixation in treatment of B-type fractures of zygoma and zygomatic arch.2.To explore the advantages of the operative method in terms of surgical effect and incidence of postoperative complications compared with the conventional operation.Materials and methods:5 patients with type B fractures of zygoma and zygomatic arch were selected,all of whom were accompanied by fracture of zygomatic arch.The data were transformed into 3D printed fracture model and mirror image model in STL format after CT scan before operation.The surgical design of the model and the titanium plate prebending telecontrotomy were performed by using a small incision in front of the ear and a tunnel on the surface of the zygomatic arch.The reduction and rigid internal fixation of the fractures of zygoma and zygomatic arch were performed with endoscopy.Results1.5 cases of unilateral type B fractures of zygoma and zygomatic arch were collected and treated with symptomatic support after admission.Open reduction and internal fixation of fractures of zygoma and zygomatic arch were performed under general anesthesia within 3 to 5 days after trauma.2.The wound healed well without infection and facial nerve symptoms in all the 5 cases.The sutures was removed 7 days after the operation.After a month,the facial appearance recovered to symmetry,the facial collapse disappeared,and the opening mouth distance returned to normal.No significant surgical scar was found.3.Endoscopic technique combined with 3D preoperative printing assist with reduction and internal fixation can effectively relieve the clinical symptoms of patients with type B fractures of zygoma and zygomatic arch,such as facial collapse and limited opening of mouth.The incidence of postoperative complications,such as the disappearance of frontal stria and scar retention,was significantly reduced.Conclusions1.Endoscopic and preoperative printing technique was feasible to assist with reduction and internal fixation in the treatment of type B fractures of zygoma and zygomatic arch.2.The occurrence of complications such as the disappearance of the frontal stria and the scar retention after operation is obviously reduced in the new type of operation,which is more advanced than that of the conventional operation.3.It is a new operative method which is worth popularizing because of its small incision,accurate positioning,good reposition and better realization of the minimally invasive and accurate concept advocated by modern medicine.4.The operative method realized beauty demand from the adoption of tragus incision.