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Year : 2020  |  Volume : 31  |  Issue : 2  |  Page : 331-333
Circum-zygomatic suspension wiring using lumbar puncture needle: A technical note

1 Department of Oral and MaxilloFacial Surgery, Sri Siddhartha Dental College and Hospital, Tumkur, Karnataka, India
2 Sri Siddhartha Academy of Higher Education, Tumkur, Karnataka, India

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Date of Submission27-Aug-2019
Date of Decision20-Feb-2020
Date of Acceptance03-Mar-2020
Date of Web Publication19-May-2020


In the treatment of mid-facial fractures circum-zygomatic suspension wiring is one of the treatment modality. Earlier zygomatic awls were used to pass wire, which used to cause conspicuous trauma. In the present case we have used 16 gauge lumbar puncture needle for the suspension wiring for Lefort 1 fracture, which is inconspicuous as compared to an awl. The needle was passed in close proximity to bone to prevent soft tissue impaction between the wire and bone as it might lead to the necrosis of soft tissue, and the wire was twisted around the maxillary arch bar. The fragments were stable and occlusion was maintained. Six weeks post-operatively the bone healing was satisfactory, and the wires and arch bar were removed.

Keywords: Circum-zygomatic suspension wiring, Lefort I fracture, lumbar puncture needle

How to cite this article:
Ashok Kumar K R, Pal S, Kumar R. Circum-zygomatic suspension wiring using lumbar puncture needle: A technical note. Indian J Dent Res 2020;31:331-3

How to cite this URL:
Ashok Kumar K R, Pal S, Kumar R. Circum-zygomatic suspension wiring using lumbar puncture needle: A technical note. Indian J Dent Res [serial online] 2020 [cited 2022 Aug 19];31:331-3. Available from:

   Introduction Top

Pan facial fractures involve the lower, middle, and upper face. Treatment is onerous, requiring an individualised treatment plan.[1] Circum-zygomatic wires are stipulated for a variety of reasons and for passing these wires in an atraumatic manner a technique is bloomed.[2] Rowe and Dingman and their co-workers had also discussed the utilisation of large-bore spinal needles, trocars, and awls as instruments to pass wires.[3]

As per review of literature none of the published studies have used a lumbar puncture needle for circum-zygomatic suspension wiring. So, in the present case we have described an atraumatic technique of circum-zygomatic wiring using a lumbar puncture needle.

   Technique Top

Erich's arch bar was placed with respect to maxilla. Skin preparation was done with betadine solution and spirit. Extra-orally superior border of zygomatic arch and posterior border of lateral orbital rim were palpated and marked with skin marker to form 90° at their junction [Figure 1]. Bilaterally extra-oral and vestibular region with respect to upper first molars were locally infiltrated with 2% lignocaine and 1:80,000 adrenaline. A 16 gauge lumbar puncture needle was inserted at the junction of the two bones and bevel of the needle was brought in contact with the superior edge of the bony arch [Figure 2]. The needle was directed anteriorly, medially and downward touching the medial surface of the arch and taken out intraorally from highest concavity of buccal vestibule with respect to upper first molar. Then a pre-stretched 26 gauge stainless steel wire of length 30 cm was inserted through the needle. One end of the wire was taken out intraorally and clamped [Figure 3].
Figure 1: Superior border of zygomatic arch (SBZA) and posterior border of lateral orbital rim (PBLOR)

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Figure 2: Insertion of Lumber Puncture Needle

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Figure 3: Technique of circum-zygomatic suspension wiring. LOR – Lateral Orbital Rim, ZA – Zygomatic Arch, SS Wire – Stainless Steel Wire, LP Needle – Lumber Puncture Needle

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The wire was railroaded through the needle until superior border of the arch was felt and passed on lateral side in close proximity to the bone. From buccal vestibule needle along with the other end of the wire were taken out with respect to upper first molar approximately 1–2 mm away from the first end.

Bilaterally ends of the wires were twisted around a hook of the arch but with respect to upper first molars [Figure 4]. Mobility of the segment was checked. The patient was instructed to have only soft and liquid diet.
Figure 4: Twisting the wire around the hook with respect upper first molars and stabilization of the maxillary segment

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There was no segmental mobility and derangement of occlusion during the post-operative period of six weeks. The suspension wire was taken out after six weeks and satisfactory healing was noted.

   Case Report Top

A 78-year-old male patient reported to our department with a chief complaint of pain and swelling in mid face region due to road traffic accident. On examination the middle one third of face had slight swelling and oedema, bilateral ecchymosis in labial and buccal mucosa, with complete mobility of maxilla and anterior open bite and periodontal status was poor.

He was advised for Orthopantomogram (OPG), high-resolution computed tomography (HRCT) and systemic blood investigations. Based on clinical and radiographic features he was diagnosed with Lefort 1 fracture and his medical history revealed that he was under medication for diabetes, hypertension and hyperthyroidism.

   Discussion Top

Earlier facial trauma was treated by external suspension wiring, which was shifted to internal suspension and wire osteo synthesis, presently replaced by mini plate synthesis.[4]

In the present case there was no structural misalignment and patient didn't give consent for open reduction and internal fixation. So considering the age of the patient and systemic condition circum-zygomatic suspension wiring was planned.

Zygomatic bone awl is commonly used for circum-zygomatic wiring and can be accomplished aseptically without the need for facial incision.[4] But repeated autoclaving and penetrating directly with its tip may result in loss of sharpness leading to greater difficulty for the operator.[5]

In an awl, the wire has to be crimped near the eye and retracted through the soft tissue to take it above the zygomatic arch, leading to trauma to surrounding soft tissue because of the thickness of the awl and crimped wire.

Lumbar puncture needle doesn't twist, thus preventing the wire crimping and ensuring minimal soft tissue injury and unwanted scar. The other advantages of lumbar puncture needle are disposability, ready availability and user friendliness. These are the principal reasons for reduction in post-operative morbidity.[5]

In the present case the needle was passed in close proximity to bone to prevent soft tissue impaction between the wire and bone as it might lead to the necrosis of soft tissue. As the patient was medically compromised and the teeth in lower arch were periodontically weakened the suspension wire was fixed to the upper arch bar without intermaxillary fixation.

   Conclusion Top

Our technique clearly demonstrates the superior effectiveness of the lumbar puncture needle, as it is sufficiently sharp, leaves smaller entry and exit wound, disposable, easily available and user-friendly.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Edward JB. A modified technique for the placement of circum-zygomatic wires. Br J Oral Surg 1965;3:205-11.  Back to cited text no. 1
Vaithilingam Y, Thomas S, Singh D, Sundraraman P, Cyriac S, Thakur G. Awl versus intravenous cannula stillete in circummandibular wiring—a prospective comparative study. Oral Maxillofac Surg 2010;15:21-5.  Back to cited text no. 2
Mooney JW, Cardo VA, Stratigos GT. Use of wire sutures for fracture fixation. Oral Surg 1972;34:21-5.  Back to cited text no. 3
Butow K-W, Eggert JH. The versatility of modern therapy in mid-facial trauma. Br J Oral Maxillofac Surg 1984;22:448-54.  Back to cited text no. 4
Thomas S, Yuvaraj V. Atraumatic placement of circummandibular wires: A technical note. Int J Oral Maxillofac Surg 2010;39:83-5.  Back to cited text no. 5

Correspondence Address:
Dr. Supriyo Pal
Sri Siddhartha Dental College and Hospital (Affiliated to Sri Siddhartha Academy of Higher Education), B. H. Road, Agalkote, Tumakuru - 527 107, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijdr.IJDR_669_19

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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