In most cases, there is loss of sensation in the cheek and upper lip due to infraorbital nerve injury. Facial bruising, periorbital ecchymosis, soft tissue gas, swelling, trismus , altered mastication , diplopia , and ophthalmoplegia are other indirect features of the injury. The paired zygomas each have two attachments to the cranium, and two attachments to the maxilla , making up the orbital floors and lateral walls. These complexes are referred to as the zygomaticomaxillary complex.
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Management Non-surgical interventions If the zygoma is not significantly displaced and there is no optic nerve impingement, extraocular muscle entrapment or ruptured globe, medical treatment for pain management may be sufficient. Surgical intervention is not taken unless a functional or aesthetic impairment is deemed unacceptable, such as in the case of reduced mouth-opening and cheek prominence depression. Contraindications to ZMC surgical intervention include medical instability and globe injuries.
Surgical interventions When surgical intervention is indicated, the best results are obtained with timely open ZMC fracture reduction with bone screw-secured miniature metal plate s fixation. Sub-labial or buccal sulcus incisions allow for a surgical approach to precisely realign and stabilize the maxillary buttress.
Unless there is concern for orbital content entrapment in the ZMC fracture, orbital floor exploration is not always necessary. When orbital floor exploration is indicated, transmaxillary endoscopic evaluation can be employed to assess the integrity of the orbital floor. However, care must be taken to protect the globe and intraocular contents during any periocular surgery. When there is orbital floor involvement, a single surgery including addressing this defect can minimize the need for a second surgery.
Complications In general, the long-term prognosis after ZMC fracture surgical repair is very good, particularly in non-displaced fractures and fractures displaced at an isolated buttress. The rate of secondary correction for the following are greater in comminuted fractures: ZMC malreduction, secondary orbital floor reconstruction, and functional correction of diplopia via correction of the EOM.
Postoperative infection rates are extremely low, and these infections nearly always resolve with oral antibiotics and local wound care. References Le Fort R. Rev Chir Paris ;, , , , — Plast Reconstr Surg ;—7. Criteria for selective management of the orbital rim and floor in zygomatic complex and midface fractures. Arch Otolaryngol Head Neck Surg.
Winegar, B. PMID Batista, A. Braz Oral Res, Balakrishnan K. Management of tripod fractures zygomaticomaxillary complex 1 point and 2 point fixations: A 5-year review.
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