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

Previous facial injuries or fractures.

Change in vision, loss of vision, or double vision.

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  Must rule out orbital injuries before considering operative intervention.

Numbness of the cheek or upper lip signifying infraorbital nerve V₂ injury.

Change in occlusion.

ATLS protocol: Identify any potentially life-threatening conditions.

Perform a detailed examination of the face, including inspection for swelling and depression; palpation for tenderness, crepitus, or step-off; sensory and motor examinations; eye, nasal, and intraoral examinations; and examination of ears and tympanic membrane.

Signs of ZM complex fractures are malar depression (masked by soft-tissue swelling early on), subconjunctival and periorbital ecchymoses, enophthalmos and/or hypoglobus (usually masked by orbital swelling resulting in ptosis), inferior slant of the palpebral fissure, numbness in the infraorbital nerve distribution, and upper buccal sulcus ecchymoses.

High-resolution maxillofacial CT scan

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  Evaluate the five articulations of the zygoma for degree of displacement and comminution: (1) lateral orbital rim (zygomaticofrontal [ZF]); (2) inferior orbital rim; (3) ZM buttress; (4) zygomatic arch and temporal articulation; and (5) lateral orbital wall (zygomaticosphenoid [ZS]).

  
  
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  Evaluate orbital floor defect. Coronal images are critical to this evaluation.