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Published byMadison Cobb Modified over 9 years ago
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Zygomaticomaxillary ( ZMC ) Fracture
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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.
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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
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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
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Flattening of the Malar Prominence.
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Trismus
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Displacement of the Palpebral Fissure & Unequal pupillary Level
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Abnormal Nerve Sensibility.
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Enophthalmous accentuation of the sulcus of the upper lid narrowing of the palpebral Fissur pseudoptosis of the upper lid
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Radiologic Assessment Axial & coronal CT is the method of choice
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Radiologic Assessment (3D Reconstruction)
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Complexities in TX of ZMC FX Rotation of the fractured ZMC
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Complexities in TX of ZMC FX Concomitant undiagnosed NOE FX
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Complexities in TX of ZMC FX Lateral displacement of Malar bone
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SURGICAL APPROACHES TO ZYGOMATICOMAXILLARY COMPLEX FRACTURES
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Maxillary Vestibular Approach
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Supraorbital Eyebrow Approach
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Upper Eyelid Approach
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Lower Eyelid Approaches
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Transconjunctival Approach
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Bicoronal / Coronal Approach
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Gillies Temporal Approach
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Buccal Sulcus Approach ( Keen Technique )
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Elevation From Eyebrow Approach
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Percutaneous Approach
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Percutaneous Approach (Carroll- Girrard Bone Screw)
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