Cheekbone Surgery: Wire Fixation vs. Plate and Screw Fixation

 Last week, a patient came to the hospital for consultation on zygomatic bone surgery. During the consultation, the patient asked whether screw fixation or wire fixation is used for zygomatic bone fixation. Generally, it is heard that wire fixation is weak, so the patient was curious if wire fixation is acceptable for zygomatic bone surgery. As a specialist, I will explain in detail about the fixation methods for zygomatic bone surgery.

-The truth about wire fixation vs plate + screw fixation-

The choice of fixation method depends entirely on the judgment of the operating surgeon. Although each fixation method has its own characteristics, the degree of fixation varies greatly depending on how the fixation material is used. Therefore, it cannot be simply said that one fixation method is better than another. Ultimately, what matters is not which fixation method is used, but how that method is specifically applied.

Ultimately, I fix both the front and back parts of the zygomatic arch using wires. Now I will explain why I choose wire fixation and what the advantages of my wire fixation method are.

1- It does not protrude.

Plate fixation, especially fixation in front of the ear, is often felt and may even protrude. In particular, the area in front of the ear is often felt very well, but many patients dislike the hard feeling of metal. In contrast, wire fixation does not protrude even in the area in front of the ear.

Plate fixation in front of the ear - X-RAY

2. 2-Compared to plates, wire fixation is effective in preventing bulging due to its minimal protrusion.

3. The area required for fixation is significantly narrower than that of plate fixation. Especially in the broad area of the cheekbone, wide protrusion is related to bulging, which can be minimized. The images below depict the fixation of the anterior part of the cheekbone. On the left is the fixation area using a 4-hole plate and screws, while on the right is the fixation using wire, which is the method I employ. Particularly in the fixation on the right side (cheek area), minimal protrusion is desirable. This area, where the bone and skin are firmly attached, poses a risk of bulging if there is significant protrusion. When I perform fixation with wire, I can secure the area without much protrusion. In contrast, fixation using a plate on the left requires considerable protrusion in the cheek area.

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6. 3-Wire fixation is less visible on X-rays compared to plates.

7. As shown in the images below, wires are less visible on X-rays compared to plates due to their smaller volume of fixation material. Some individuals are concerned about the visibility of fixation materials on X-rays, and for this reason, they may opt for pin removal. While wires are visible on X-rays, they are much less conspicuous compared to plates.

Plate + Screw Fixation (Left), Wire Fixation (Right)

4. 4-Wire fixation is easier to remove compared to plate fixation.

5. There are cases where pin removal is required after surgery due to visibility issues on X-rays. Plate and screw fixation sometimes becomes difficult to remove after several years post-surgery. In contrast, wire fixation is relatively easier to remove even after several years compared to plate and screw fixation.

4. 5-Wire fixation encourages closer bone contact during the fixation process.

5. Wire fixation inherently involves pulling both sides of the bone together during the fixation process. In other words, wire fixation inevitably pulls both sides of the bone closer together during fixation. This process encourages closer bone contact. On the other hand, plate and screw fixation may result in less intimate bone contact as the screws may cause movement in the bone during fixation.

Positioning the wire and tightening it results in close contact between the two bone pieces.

6. 6-It has sufficient fixation strength.
7. In frontal fixation, wires typically have more fixation strength compared to thin plates and screws commonly used in preauricular fixation. It's not uncommon for preauricular fixation plates to break and separate under external force after surgery. In frontal fixation, the wire fixation I perform has a similar level of fixation strength to using a 4-hole mini plate with four screws. Since the cheekbone doesn't bear weight, a fixation strength equivalent to that of a 4-hole mini plate is generally deemed sufficient. Not all wire fixations have good fixation strength. To achieve good fixation strength, precise bone osteotomy is crucial. If the osteotomy is done crookedly, achieving close contact becomes difficult.
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9. Moreover, fixation should be applied to the exact area bearing force. If fixation is applied to a weak area of the bone, the fixation material itself might dislodge. The specific type of fixation material is also important. When fixing the cheekbones, I use different wires for the front and back. For frontal fixation, where greater force is required, I use thicker and stronger wires compared to those used for back fixation, ensuring greater fixation strength. Thus far, I have explained the wire fixation method used in my cheekbone surgeries. The fixation method I employ is based on extensive expertise accumulated through numerous surgical procedures. Since there are various nuances to fixation, it's important not to have preconceived notions about whether using certain fixation materials is good or bad.

• Plastic Surgeon Lee Jin-soo -

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• *This post contains advertisements for Faceline Plastic Surgery.
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• *Images may differ from reality depending on the shooting conditions and have been published with the individual's consent.
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• *After surgery (or procedures), side effects such as bleeding, inflammation, asymmetry, and nerve damage may occur depending on the individual, so caution is advised.