Autogenous Costal Cartilage Grafting With Titanium Mesh Fixation for Comminuted Bilateral Zygomatic Arch Fractures: An Autobiographical Case Report.

Abstract

Bilateral zygomatic arch fractures are uncommon but may result in significant midfacial deformity and functional impairment, particularly when fractures are comminuted and structural continuity is compromised. This report describes the surgical management of a 49-year-old male who sustained severe facial trauma following a mountain-climbing accident, resulting in comminuted bilateral zygomatic arch fractures and marked midfacial disfigurement. Due to the complexity of the injury and loss of structural support, autogenous costal cartilage grafting combined with titanium mesh fixation was selected for reconstruction. Under general anesthesia, bilateral preauricular and infraorbital approaches were used to expose the fracture sites. Autogenous costal cartilage was harvested from the left costal cartilage (typically sixth-eighth rib), contoured according to the anatomical requirements of both zygomatic arches, and positioned to restore midfacial contour. Titanium mesh and screws were applied to achieve rigid fixation and maintain structural stability. Short-term follow-up of three months demonstrated satisfactory healing without complications. Facial symmetry and midfacial projection were successfully restored, and the patient reported high satisfaction with the surgical results. The patient described in this report is also one of the authors, and this dual role is disclosed for ethical transparency. This case highlights autogenous costal cartilage grafting with titanium mesh fixation as a viable reconstructive option in complex bilateral zygomatic arch fractures when conventional reduction and fixation may be insufficient.