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Gillies Temporal approach

# In Gillies Temporal approach for reduction of zygomatic arch fracture, Rowes elevator is placed between:  
A. Superficial facia and temporal fascia  
B. Temporal bone and temporalis muscle  
C. Temporal fascia and Temporalis muscle
D. Skin and superficial fascia


The correct answer is C. Temporal Fascia and Temporal muscle. 

In Gillies temporal fascia for reduction of zygomatic arch fracture, elevator is placed between temporal fascia and Temporalis muscle.


The temporal fascia is attached to the zygomatic arch and the temporal muscle passes downward medial to the fascia to be
attached to the coronoid process.Between these two structures a natural anatomical space exists into which an instrument can be inserted and it can be utilized to elevate the displaced zygoma on its arch into position.

Technique: The hair is shaved from the temporal region of the scalp. The external auditory meatus is plugged with cotton to
prevent any fluid or blood getting inside.
An incision about 2 to 2.5 cm in length is made, inclined forward at an angle of 45 degrees to the zygomatic arch, well in the
temporal region. Care is taken to avoid injury to the superficial temporal vessels. The temporal fascia is exposed which can be identified as white glistening structure. The incision is taken into the fascia and the fibres of temporalis muscles will be seen. Long Bristow's periosteal elevator is passed below the fascia and above the muscle.

Once this correct plane is identified and instrument is inserted through it downward and forward, the tip of
the instrument is adjusted medially to the displaced fragment.

A thick gauze pad is kept on the lateral aspect of the skull to protect it from the pressure of elevator while reduction is going on.

The operator has to grasp the handle of the elevator with both hands and assistant has to stabilize the head of the patient. (During elevation procedure care should be taken that pressure is not exerted on the lateral surface of the skull to end up with depressed fracture of the skull).

The tip of the elevator is manipulated upward, forward and outward. The snap sound will be heard as soon as reduction procedure is complete. Wound is
closed in layers after withdrawing the elevator.

Care is taken that after surgery at least for 5 to 7 days, no pressure is exerted on the area till the bone consolidates. Patient is instructed to sleep in supine position or not to sleep on the operated side. 


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