Traumatic arch injury: indications and an endoscopic method of repair.

The unique strategic position of the zygomatic arch makes it an important surgical landmark in facial fracture repair. Because of the numerous negative sequelae associated with the traditional coronal approach to the arch, it has frequently been omitted as a point of reduction and fixation. Endoscope-assisted repair allows accurate zygomatic arch restoration without the setbacks of coronal access. The indications for arch repair include markedly displaced isolated arch fractures, complex zygoma fractures with arch comminution, and Le Fort III level fractures. In complex zygoma fractures, the arch helps accurately restore midface projection and width and serves as an additional stable anchor point. In Le Fort III fractures, restoration and fixation of the arch are essential components of the repair necessary to stabilize the maxillary dentition to the cranial base. Endoscopic arch repair is a novel, technically challenging procedure that requires a different set of surgical skills and considerable training. Implementation of appropriate teaching programs and further advances in instrument development will overcome the steep learning curve associated with this technique and encourage its use.