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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
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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
(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 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)