Left midfacial and periorbital edema with malar depression and left enophthalmos.
Computed tomography (CT) demonstrates depressed left zygomaticomaxillary (ZM) complex fracture with comminution at the ZM buttress.
By definition, the left orbital floor is fractured in a displaced ZM complex fracture.
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.
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.
Pertinent imaging or diagnostic studies
High-resolution maxillofacial CT scan
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]).
Evaluate orbital floor defect. Coronal images are critical to this evaluation.