ĐIỀU TRỊ GÃY XƯƠNG GÒ MÁ CUNG TIẾP ĐẾN MUỘN CÓ SỬ DỤNG ĐƯỜNG RẠCH CORONAL: BÁO CÁO CA LÂM SÀNG

Abstract

Objective: To report a case of delayed right zygomatic-arch complex fracture (30 days post-injury) treated by open reduction through a coronal approach and fixation with titanium miniplates and screws. The patient was followed and evaluated at multiple postoperative time points (1 day, discharge, 2 weeks, 3 months, and 6 months) focusing on functional recovery, facial aesthetics, CT-based anatomical assessment, and potential postoperative complications. Case presentation: An 18-year-old female presented to Hanoi Medical University Hospital three weeks after facial trauma with a chief complaint of limited mouth opening (1 cm). Clinical examination and computed tomography confirmed a delayed-fracture of the right zygomatic-arch complex (Knight & North classification type IVa, 1961) - 30 days post-injury at the time of surgery. The patient underwent open reduction and internal fixation via a coronal incision using titanium miniplates and screws. On the first postoperative day, the patient achieved 2,5 cm of mouth opening and was able to wrinkle her right forehead. At discharge, mouth opening improved to 3 cm, forehead wrinkling was completely normal, and mild right facial swelling remained. At 2 weeks post-surgery, mouth opening reached 4 cm, with slight residual swelling. At 3 months post-surgery, the patient could open her mouth 5 cm, facial symmetry was restored, and mild hair loss was noted around the coronal incision line. At 6 months post-surgery, mouth opening reached 5,5 cm, the previously thinned hair had regrown, facial symmetry was stable, and no temporal hollowing was observed. Conclusion: The coronal approach provides a wide and clear surgical field, allowing comprehensive exposure and accurate reduction of delayed zygomatic-arch complex fractures with optimal functional and aesthetic outcomes. When meticulous techniques are applied to minimize trauma to scalp structures, postoperative aesthetic complications such as hair loss and temporal hollowing can be effectively minimized. Delayed zygomatic-arch fractures present significant challenges in restoring both anatomical structure and functional outcomes. In such fractures, depending on the fracture pattern and the patient’s clinical manifestations, the coronal approach may be considered to optimize treatment outcomes.