Case 2 Zygomatic Fractures



Vinay Rao and Albert S. Woo

Case 2 Zygomatic Fractures

Case 2 (a, b) A 34-year-old male presents to the emergency department complaining of right cheek pain, numbness, and swelling after an assault.



2.1 Description




  • Right mid-facial and periorbital edema with malar depression and mild right hypoglobus, with presumed enophthalmos



  • Computed tomography (CT) demonstrates comminuted, displaced right zygomaticomaxillary complex (ZMC) fracture, and fracture of coronoid process of mandible



  • By definition, the right orbital floor is fractured in a displaced zygomatic injury



2.2 Work-Up



2.2.1 History




  • Mechanism of injury: Helpful in determining angle of force and severity of injury



  • Change in vision, loss of vision, or diplopia




    • Must rule out orbital injury prior to operative intervention



  • Trismus can occur with medial displacement of the zygomatic arch impinging on the temporalis muscle



  • Relevant medical history (previous facial injuries or fractures), surgical history (previous facial surgeries), and social history (alcohol, smoking, drug use)



2.2.2 Physical Examination




  • Signs of ZMC fractures are malar depression (masked by soft tissue swelling early on), periorbital ecchymoses, enophthalmos, and/or hypoglobus (usually masked by orbital swelling), inferior slant of the palpebral fissure, and tenderness at infraorbital rim and along zygomaticofrontal (ZF) suture



  • Numbness of the cheek, nose, upper lip, and teeth: Typical of V2 distribution



  • Associated eye examination: Look for visual changes, diplopia, or extra-ocular muscle entrapment



2.2.3 Pertinent Imaging or Diagnostic Studies




  • b” High resolution maxillofacial CT scan




    • Evaluate the five articulations of the zygoma: (1) lateral orbital rim (zygomaticofrontal), (2) inferior orbital rim, (3) zygomaticomaxillary buttress, (4) zygomatic arch, and (5) lateral orbital wall (zygomaticosphenoid)



    • Evaluate orbital floor defect on coronal cut images



2.3 Patient Counseling




  • Older patients, in particular, may consider nonoperative management despite displaced fractures. Surgeons must help weigh risks against benefits of surgery.



  • Patients must be informed of possible development of enophthalmos/hypoglobus, malar asymmetry/depression, or appreciable bony step-offs. These clinical examination findings may become more prominent as facial swelling subsides.



  • With operative management, adverse events/complications must be discussed, including asymmetric malar positioning, development of possible entropion/ectropion and a remote possibility of vision loss.

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 2 Zygomatic Fractures
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