Zygomaticomaxillary ZMC Fracture Anatomy Similar to a 4

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.

Enophthalmous accentuation of the sulcus of the upper lid narrowing of the palpebral Fissur pseudoptosis of the upper lid

Radiologic Assessment Axial & coronal CT is the method of choice

Radiologic Assessment (3 D 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 TO ZYGOMATICOMAXILLARY 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)