what is zygomaticomaxillary complex fracture

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What is a zygomatic complex fracture?

A zygomatic complex fracture is a fracture that involves the zygoma and its surrounding bones. The typical lines of a zygomatic complex fracture are: A fracture emanating from the inferior orbital fissure superiorly along the sphenozygomatic suture to the frontozygomatic suture where it crosses the lateral orbital rim

What is zygomaticomaxillary complex (ZMC)?

The Zygomaticomaxillary complex (ZMC) is a 3-dimensional structure which defines midface width and projection, as well as providing shape to the orbit. Zygomaticomaxillary complex (ZMC) fractures refer to the disruption of 4 buttresses in the malar eminence. There are four points of fixation of the zygoma

What are the complications of the zygomatico maxillary complex?

Fractures of the Zygomatico Maxillary complex result in cosmetic deformity as well as functional deficits such as altered vision, restricted mouth opening and paresthesia.

What are the treatment options for zygomaticomaxillary sinus fractures?

fractures of the inferior orbital rim and anterior and posterior maxillary sinus walls and/or diastasis of the zygomaticomaxillary suture If needed, closed or open reduction methods can be performed with the goal of treatment being preservation of normal facial structure, sensory function, globe position and mastication functionality.

What is the Zygomaticomaxillary complex?

The zygomaticomaxillary complex (ZMC) is a major buttress of the midfacial skeleton. The ZMC is important to structural, functional, and aesthetic appearances of the facial skeleton. A ZMC fracture is also known as a tripod, tetrapod, or quadripod fracture, trimalar fracture or malar fracture [1,2].

What is a Zygomaticomaxillary complex fracture ICD 10?

ICD-10 code S02. 4 for Fracture of malar, maxillary and zygoma bones is a medical classification as listed by WHO under the range - Injury, poisoning and certain other consequences of external causes .

How do you treat a Zygomaticomaxillary complex fracture?

Most zygomatic complex fractures can be treated solely by an intraoral approach and rigid fixation at the zygomaticomaxillary buttress. Further exposure of the zygomaticofrontal junction or inferior orbital rim is necessary for severely displaced fractures, which require additional fixation.

Do ZMC fractures require surgery?

A review of the literature reveals that 77-94% of patients with zygomaticomaxillary complex (ZMC) fractures require surgical reduction. Many authors advocate closed reduction of ZMC fractures through more limited surgical approaches. Accurate closed reduction can be achieved in many cases.

What is the major cause of maxillofacial injury?

The most common causes are sports, accidents (automobile and workplace), penetrating injuries, and violence. Symptoms may include pain, swelling, bleeding, bruising, and numbness, while fractures to the facial bones may also result in difficulty breathing, speaking or seeing.

What are the common signs and symptoms of ZMC fractures?

Patients with ZMC fractures often present with tenderness, ecchymosis and edema over the malar prominence, lateral orbit, upper and lower eyelids, loss of malar projection, and blunting of the lateral canthus relative to the unaffected side.

Are facial fractures life threatening?

Is a facial fracture a serious problem? If you suffer from a facial injury, you should seek immediate medical attention. Some fractures are minor. However, complex fractures may cause irreversible damage and can even be life-threatening.

Do you need surgery for a facial fracture?

Facial fractures, which are often caused by traumatic injuries, may require surgery to restore the function and appearance of the injured bones. Surgeons use small incisions on concealed areas of the face or in the mouth to repair and reposition the broken bones.

Do facial bone fractures heal on their own?

Often a facial fracture may be left to heal on its own. No treatment may be necessary if the broken bone stays in normal position, but injuries causing severe fractures may need to be surgically repaired.

When should a ZMC fracture be repaired?

Indications for surgical repair of zygomatic complex fractures include displacement or instability of the fracture, mechanical restriction of mandibular movement (chewing), alteration in facial contour, globe dystopia, enophthalmos, diplopia, or sensory nerve deficit.

How long does it take for zygomatic bone to heal?

Swelling and bruising can be reduced by using cold packs and sleeping propped up for the first few days. Even if you have plates and screws to hold your cheekbone in place, it still takes about six weeks for the bone to heal completely.

Is a zygomatic fracture serious?

Fractures of the ZMC or zygomatic arch can often lead to unsightly malar depression, which should be corrected to restore a normal facial contour. ZMC fractures can also cause significant functional issues, including trismus, enophthalmos and/or diplopia, and paresthesias of the infraorbital nerve.

What is a complex orbital fracture?

Complex orbital fractures are those that involve multiple orbital walls, often involve the adjacent facial skeleton (orbitofacial fractures), often with severe visual, structural and esthetic consequences.

What is a malar complex fracture?

Anatomy and Mechanism of Injury The term malar complex fracture refers to a fracture which in its classic form primarily involves the suture lines of the zygomatic bone.

What is the most commonly fractured structure of the maxillofacial complex?

In patients who require surgery, the most commonly fractured bone is the mandible (41.6–75.2%) [1, 13, 15]. The second and third most commonly fractured bones vary with the series, being the maxilla and orbit (39.8% each) in one series [1] but the malar bone (15.2%) and maxilla (6.4%) in another [15].

How do you classify a maxillofacial fracture?

Anterior type I palatal fracture involves the incisor teeth and involving the posterior teeth it is defined as type 1b palatal fracture. Type II palatal fracture is defined as sagittal fracture which is less common in adults. Type III and IV fractures are the most common palatal fractures in adults [11].

What is a zygomaticomaxillary complex fracture?

The zygomaticomaxillary complex fracture, also known as a quadripod fracture , quadramalar fracture, and formerly referred to as a tripod fracture or trimalar fracture, has four components, three of which are directly related to connections between the zygoma and the face, and the fourth being an orbital blowout. Its specific locations are the lateral orbital wall (at its superior junction with the zygomaticofrontal suture or its inferior junction with the zygomaticosphenoid suture at the sphenoid greater wing, separation of the maxilla and zygoma at the anterior maxilla (near the zygomaticomaxillary suture ), the zygomatic arch, and the orbital floor near the infraorbital canal .

What is the cause of a zygomaticomaxillary complex?

The cause is usually a direct blow to the malar eminence of the cheek during assault. 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.

What is the treatment for zygomatic fractures?

The prognosis of tripod fractures is generally good. In some cases there may be persistent post-surgical facial asymmetry, which can require further treatment.

Which bone has zygomaticomaxillary sutures?

The upper and transverse maxillary bone has the zygomaticomaxillary and zygomaticotemporal sutures, while the lateral and vertical maxillary bone has the zygomaticomaxillary and frontozygomatic sutures. The formerly used 'tripod fracture' refers to these buttresses, but did not also incorporate the posterior relationship ...

What is the loss of sensation in the cheek and upper lip due to infraorbital nerve injury?

On physical exam, the fracture appears as a loss of cheek projection with increased width of the face. 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 zygomatic arch usually fractures at its weakest point, 1.5 cm behind the zygomaticotemporal suture.

What is the mnemonic for ZMC fracture?

Specifically focusing on the ZMC fracture, the signs and symptoms can be remembered by the following mnemonic: 6P's of ZMC Fractures (a P'Fella original)

What is ZMC fracture?

A zygomaticomaxillary complex (ZMC) fracture is a fracture that involves the zygoma and its surrounding bones. They are the second most common facial fractures after nasal bones. This article details the anatomy, evaluation, and treatment.

What is ZMC in math?

The Zygomaticomaxillary complex (ZMC) is a 3-dimensional structure which defines midface width and projection, as well as providing shape to the orbit.

What is the goal of treatment for infraorbital rim fractures?

The goal of treatment is to determine the need for closed or open reduction, three-dimensional alignment and fixation, and the management of concomitant infraorbital rim and orbital floor fractures 18. The type of treatment is depedent on fracture pattern and surgical preferences.

What is the least amount of rigid fixation needed to obtain a stable bony union?

In general, the least amount of rigid fixation needed to obtain a stable bony union is applied 12.

What test confirms extraocular muscular entrapment?

Extraocular muscular entrapment: disconjugate gaze, photophobia, and nausea confirmed by a forced duction test 4.

Why is my check numb?

Numbness in check due to infra-orbital nerve damage (often cannot be corrected at surgery 1,2)

Why is ZMC fracture so complex?

The ZMC fracture is one of the most complex fractures to reduce and fix, because of its propensity to undergo displacements in all three planes of orientation, along its five articulations. Accurate reduction is challenging due to the difficulty in intra-operative assessment of reduction, inability to predict the rotation of the zygoma during reduction, and complexity involved in concomitant orbital fractures.

How to diagnose ZMC fracture?

The clinical assessment of ZMC fractures is performed by a thorough examination of the face and the eye. As the zygoma forms an integral part of the orbit (floor and lateral wall), any trauma to the ZMC may have profound impact on the integrity of the globe and vision [ 2, 22 ]. This mandates a primary ophthalmic examination prior to facial examination.

What is the ZMC?

The zygomaticomaxillary complex (ZMC) refers to the skeletal unit [ 1] formed by the zygomatic bone and maxilla (Fig. 56.1 ). These two bones are referred to as a complex, because of the structural and functional relationship between them; they articulate with each other over a wider area, and any traumatic impact on one bone generally influences the other. This duo complex also constitutes a major part of the orbit, spanning the infra-orbital rim, lateral wall, and floor. Hence the ZMC is also termed orbitozygomaticomaxillary complex [ 2 ]. Because of its multiple articulations, various names are commonly used to describe ZMC fractures such as “tripod, tetrapod, or pentapod” [ 3, 4] fractures.

Why are ZMC fractures so high?

ZMC fractures show high propensity for over or under reductions due to lack of objective intra-operative measures to assess reduction. This may be overcome with accurate preoperative planning which helps in realizing surgical objectives in a predictable manner.

What is a surgical approach for ZMC fixation?

Surgical approaches for ZMC fixation are chosen based on the fracture pattern and fixation needs. A single or multiple incision may be used for the surgical exposure of ZMC fractures [ 30, 68, 69 ].

What is fixation for ZMC fractures?

Fixation needs of ZMC fractures depend on the post-reduction stability. Classification of fracture patterns by Rowe and Williams [ 1] provides guidance on assessment of fracture stability after reduction. Any fracture classified as stable after reduction does not require fixation, while those considered unstable, mandate fixation. However, a practical method would be to apply moderate digital pressure on the malar eminence after reduction. Displacement secondary to this maneuver, requires fixation [ 59 ]. The algorithm proposed by Rodrigo and Belini et al. is also a practical guide to manage ZMC fractures which are not associated with orbital component [ 3 ]. For ZMC fractures with orbital involvement, Ellis and Perez advocate guidelines for orbital reconstruction based on CT evaluation. Most of the studies indicate increase of fixation points from 1 to 2, 3, and 4 points based on the status of intra-operative stability after reduction. Involvement of orbit leading to changes in intra-orbital volume requires orbital reconstruction [ 59 ].

What happens to the bones when a ZMC fracture is reduced?

During reduction of ZMC fractures, as the fractured bones get realigned to normal anatomical position, entrapment of surrounding soft tissue or muscles may occur between the fragments

What CT scan is used for zygomatic complex fractures?

For zygomatic complex and orbital floor fractures, preoperative CT scans in axial and coronal slices are standard. Additional sagittal or oblique parasagittal slices are often very helpful in the assessment of the orbital roof and orbital floor. 3-D reconstructions are also helpful to understand the pattern of displacement and/or rotation.

What is a zygomatic complex fracture?

A zygomatic complex fracture is a fracture that involves the zygoma and its surrounding bones. The typical lines of a zygomatic complex fracture are: A fracture emanating from the inferior orbital fissure superiorly along the sphenozygomatic suture to the frontozygomatic suture where it crosses the lateral orbital rim.

What causes numbness in the infraorbital nerve?

A fracture of the zygomaticomaxillary complex may commonly cause numbness of the infraorbital nerve distribution.

How is the extent of the orbital floor defect underestimated?

The extent of the orbital floor defect is often underestimated by examination of the preoperative views where the zygoma has been posteriorly displaced. Repositioning of the zygoma anteriorly to its proper location often results in a large orbital floor defect.

Where is the fracture of the maxilla?

A fracture emanating from the inferior orbital fissure anteriorly along the orbital plate of the maxilla, crossing the infraorbital rim and extending inferiorly along the anterior face of the maxilla underneath the zygomaticomaxillary buttress

Why do you need an eye exam?

It is especially important to make sure that the patient’s visual acuity has not been compromised, and that there is no entrapment of the extraocular muscles (EOM). If there is suspicion of entrapment a forced duction test should be considered.

Which slice is best for orbital floor fractures?

The oblique parasagittal slice is singularly the best view to assess orbital floor fractures. It is also provides an excellent postoperative assessment of the proper placement of an orbital floor plate.

in This Article

Anatomy of Zygomaticomaxillary Complex

Assessment of ZMC Fractures

Management of ZMC Fracture

References