One-Point Fixation of Tripod Fractures of Zygoma Through a Lateral Brow Incision

The aims of this report were to analyze the cases of lateral brow incision and 1-point fixation and to introduce the criteria for application of this selective approach. Among 70 patients with tripod fractures, 14 patients (20%) underwent 1-point fixation technique through lateral brow incisions. Preoperative and postoperative displacements of the infraorbital rim were radiologically measured. Of these patients, 7 cases (50%) were type III, 6 cases (43%) were type IV, and 1 case (7%) was type V according to the Knight and North classification. Simple fracture of the infraorbital rim was seen in 10 patients (71%), and comminuted fracture was seen in 4 patients (29%). In 11 patients, zygomaticofrontal sutures were fixed with square microplates with 4 holes and 0.5 mm in thickness, and straight miniplates with 4 holes and 1.0 mm in thickness were used in 3 patients. Of 14 tripod fractures, 6 (43%) were associated with floor fractures. Seven had displacement of the infraorbital rim (range, 2.0-7.6 mm; mean, 4.6 +/- 0.8 mm), and the other 7 had no displacement of the infraorbital rim. After surgery, step deformities of the infraorbital rims were improved (range, 0.1-3.8 mm; mean, 1.4 +/- 0.5 mm). All 14 patients were satisfied with their postoperative appearance. Indications for using 1-point fixation of the tripod fracture are (1) minimal or moderate displacement of the infraorbital rim in the tripod fracture of the zygoma, (2) no ocular signs of diplopia or enophthalmos, and (3) comminuted infraorbital rim fractures where internal fixation is difficult.