A 3-cm incision placed 4 cm superior to the zygomatic arch and posterior to the temporal hairline can be fashioned to allow direct access to the arch. This approach (ie, Gillies approach) allows accurate fracture reduction via a bimanual technique. After creating a skin incision, the dissection is carried down through the superficial temporal fascia and the temporalis muscle fascia (deep temporal fascia). A plane is carried forward, superior to the temporalis muscle to the zygomatic arch.
Once this conduit is created, a periosteal elevator is positioned beneath the zygoma. Lateral traction is placed on the elevator while the surgeon's free hand palpates the fracture site during reduction. Once hemostasis is ensured, the fascia and skin are closed in the usual fashion. Take care to close the wound with all layers reanastomosed to their respective anatomic partners. Advantages of the Gillies approach include a scar camouflaged by the patient's hair; accurate, bimanual fracture reduction; and a remote chance of injury to the temporal branch of cranial nerve VII.
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