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Zygomaticomaxillary( ZMC )Fracture
Anatomy• Similar to a 4- sided pyramid• It has Temporal, Orbital,
Maxillary & Frontal processes• The Zygoma is the origin to
major portion of the masseter muscle
• The malar bone represents a strong bone on fragile supports, and it is for this reason that, though the body of the bone is rarely broken, the four processes—frontal, orbital, maxillary, and zygomatic—are frequent sites of fracture.
Anatomy
• Usually 4 fx lines exist:• Anteromedial in the floor of
the orbit• Superolateral in the lateral
orbital wall• Inferior to the maxillary
buttress• in the zygomatic arch
Diagnosis
Clinical• Perform a neurologic & ophthalmic
evaluation first• Signs & symptoms:• Periorbital Ecchymosis and Edema• Flattening of the Malar Prominence• Ecchymosis of the Maxillary Buccal Sulcus• Deformity at the Zygomatic Buttress of the
Maxilla• Deformity of the Orbital Margin• Trismus• Abnormal Nerve Sensibility• Subconjunctival Ecchymoses• Displacement of the Palpebral Fissure.• Diplopia• Enophthalmos
Radiographic
Flattening of the Malar Prominence.
Trismus
Displacement of the Palpebral Fissure & Unequal pupillary Level
Abnormal Nerve Sensibility.
Enophthalmousaccentuationof the sulcus of the upper lidnarrowing of the palpebralFissurpseudoptosis of the upper lid
Radiologic Assessment
Axial & coronal CT is the method of choice
Radiologic Assessment(3D Reconstruction)
Complexities in TX of ZMC FX
• Rotation of the fractured ZMC
Complexities in TX of ZMC FX
• Concomitant undiagnosed NOE FX
Complexities in TX of ZMC FX
• Lateral displacement of Malar bone
SURGICAL APPROACHES TOZYGOMATICOMAXILLARY
COMPLEX FRACTURES
Maxillary Vestibular Approach
Supraorbital Eyebrow Approach
Upper Eyelid Approach
Lower Eyelid Approaches
Transconjunctival Approach
Bicoronal / Coronal Approach
Gillies Temporal Approach
Buccal Sulcus Approach( Keen Technique )
Elevation From Eyebrow Approach
Percutaneous Approach
Percutaneous Approach(Carroll- Girrard Bone Screw)