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)