ZYGOMATIC COMPLEX

FRACTURES
 SURGICAL ANATOMY
 Articulation
• Frontal - FZ Suture
• Sphenoid - ZS Suture
• Temporal - ZT Suture
• Maxillary - ZM Suture
 Floor of EYE
 Malar prominence
 CLASSIFICATON
(KNIGHT & NORTH)
 Group I Non displaced #
 Group II Arch #
 Group III Nonrotated #
 Group IV Medially rotated #
 Group V Laterally rotated #
 Group VI Complex #
 DIAGNOSIS
• History
• Trauma
• Inter Personnel violence
 Clinical Examination
 Radiographic Findings
 CLINICAL EXAMINATION
INSPECTION
 Depression-Malar Prominence
 Reduced Mouth opening
 Paresthesia of Infra Orbital Nerve/Teeth
 Eye Symptoms
• Periorbital Ecchymosis(extravasated blood is not
confined by orbital septum hence acc wherever skin
is loode)
• Sub Conjunctival Haemorrhage
• Diplopia
• Enophthalmos
• Visual Status / Eye Spec/ Documentation
 DIPLOPIA pg 40
• Caused by the interference to the action of
extra ocular muscles which may be caused by:
• Changed orbital Dimensions
• Muscle Entrapment
• Neuro Muscular Injury
• Haematoma/Oedema
• Examination:
• All Nine Dimensions (Arms Length)
• Hess Chart
 ENOPHTHALMOS
 Enoph occuring immediately after
surgery is due to increase in vol of
the orbit due to fracture of its walls.
It is made worse by herniation of fat
from the wall of the orbit via defects
usually in medial or floor or from inf
orbital fissure
 CLINICAL EXAMINATION
PALPATION
• Abnormal Mobility
• Step Defect
• Tenderness/ Crepitations
• Sites:
• Fronto zygomatic suture

• Infra orbital suture

• Crest of Zygomatic Buttress

 RADIOGRAPHS
• Waters View (Occipitomental view or
PNS view)
• (Modified PA view)
• (Head 27* angle to vertical)
• Submento vertex view (jug-handle)
• For Zygomatic archs
• CT
• Orbital floor fractures.
 TREATMENT
• INDICATIONS
• Malar depression
• Reduced Mouth opening
• Eye symptoms
• Diplopia
 TREATMENT
 Reduction
• Close
• Open
 Fixation
 Immobilization
 CLOSE REDUCTION
 Gillies Approch pg 77
• 2cm Incision
 At Bifurcation of supericial temporal vessels

 45* to upper attachment of Ear

• Temporalis fascia exposed & incised

• Bristows elevator is passed beneath the ZB which is gently lifted
back into pos.
• Fascia is sutured with catgut and skin with silk.
 Keen’s approch (intra oral)
• Incision in maxillary buccal sulcus
 Percutaneous approch
• Land marks- horizontal(Ala-tragus)-vertical (perp
from outer canthus of eye)
• Stab Incision in maxillary buccal sulcus. The point of
hook is directed under body of zygoma and pulled
back into pos.
 OPEN REDUCTION
(FIXATION & IMMOBILIZATION)
 Transosseous wiring at FZ/ IO rim
 Miniplate osteosynthesis
• Frontozygomatic suture line
• Infra orbital rim
• Crest of zygomatic buttress
 Fixation with an Antral pack in max sinus(to suport a
communited zygo frac or support a reconstituted
comm orbital floor)
 Combination of lateral n IO ring wiring may be used.
 Pin fixation
 INCISIONS
• Supra orbital incisions
• Lateral eyebrow incision
• Upper eyelid incision
• Coronal incision
• Infra orbital incisions
• Trans conjunctival incision
• Subciliary incision
• Lower eyelid incision
• Infra orbital incision
 Zygomatic Arch
Fractures
• Lateral force
• Three fracture segments
• Rarely green stick
• - Signs and symptoms
1. Depression 1-2.5cm in diameter (v shaped)
over arch
2. Reduced mouth opening
3. Impinge on coronloid process
4. Impede mand. movements
 TREATMENT
• Reduction
• Fixation - same as zygomatic, not
really nec as temp fascia attached
along upper aspect of arch effectively
immob the fragments.
• Immobilization
• Percutaneous circumferential suture/wires
• Balloon /Foleys Cather/ Gauze
 ZYGOMATIC # WITH ORBITAL
FLOOR # pg 10,51 killeys
 Called Blowout
fractures of the
orbit
 Can be an isolated
fracture
 OR with Zygomatic
bone fracture blowout fracture caused
by ball’s impact.

Figure 22-5
 ORBITAL FLOOR
CONSIDERATIONS
• Zygomatic complex fractures
• LeFort ii fractures
• Isolated blow out fractures
• Signs
• Enopthalmos
• Extra Occular muscle dysfunction
• Diplopia
• Infrorbital paresthesia
 ORBITAL FLOOR FRACTURES
INDICATIONS FOR SURGERY/
EXPLORATION
 Enopthalmos > 3 mm
 Diplopia – Not resolving within 10 days
 Herniation of peri orbital tissues into max
sinus
 Intervention / Exploration
1. Infra orbital rim incisions
2. -Caldwell-Luc operation-max sinus packing
soaked in whitehead varnish (left for 3 weeks)
3. Repositioning of frag attached to periosteum

4. Graft-silastic /Teflon / Bone /Rib, iliac

crest,calvaria
 POST OPERATIVE CARE
 Eye
• movements / visual acuity
 Incisions care
 Antibotics I/v
 Nasal decongestant
• pseudo ephedrine
 Protection
• Malar prominence/ arch
 Post operative radiographs
 COMPLICACTIONS
 EYE:-
- Corneal abrasion
- Retro bulbar haemorrhage
- Superior orbital fissure syndrome
- Traumatic hyphema
 Persistent diplopia
 Enophthalmos
 Neuro sensory Deficiencies
 Persistent malar depression /malunion
 Trismus/ankylosis of zygoma to coronoid