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Robert W. Dolan, MD; Daniel K. Smith, MD

Arch Facial Plast Surg. 2000;2:181-186.

Objective  To determine if performing a superior cantholysis eases the surgical exposure, reduction, and rigid fixation of the zygomaticofrontal suture in the open repair of zygomatic complex (ZMC) fractures.

Patients and Methods  Fifteen superior cantholysis procedures were used in 14 patients who presented with ZMC fractures requiring open reduction and internal fixation. Follow-up ranged from 6 to 18 months. Collected data included patient demographics, cause of fracture, fracture classification, associated facial injuries, methods of fracture exposure and reduction, type and location of fixation, procedure-related complications, and postoperative outcome, including adequacy of fracture reduction.

Results  Superior cantholysis opens a direct surgical route to the zygomaticofrontal suture for exposure, reduction, and rigid fixation. It also expedites exposure and assessment of the sphenozygomatic suture. No postreduction ZMC malunions or malpositions occurred during the study. There were 4 complications, none of which could be attributed to superior cantholysis. The complications related primarily to the transconjunctival and lateral canthotomy incisions.

Conclusions  Superior cantholysis eases the surgical exposure, reduction, and rigid fixation of the zygomaticofrontal suture in the open repair of ZMC fractures. The superior cantholysis added no morbidity in open ZMC fracture repair, and it simplified exposure of the lateral orbital rim, without the need for overzealous tissue retraction.

From the Department of Otorhinolaryngology, University of Oklahoma Health Science Center, Oklahoma City (Dr Dolan); and the Department of Otolaryngology–Head and Neck Surgery, Boston University School of Medicine, Boston, Mass (Dr Smith).

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