Closed fracture of zygomatic arch8/5/2023 ![]() ![]() ^ Swanson, E Vercler, C Yaremchuk, MJ Gordon, CR (May 2012)."Zygomaticomaxillary complex fractures and their association with naso-orbito-ethmoid fractures: a 5-year review". ^ Buchanan, EP Hopper, RA Suver, DW Hayes, AG Gruss, JS Birgfeld, CB (December 2012)."Spectrum of critical imaging findings in complex facial skeletal trauma". ^ Winegar, BA Murillo, H Tantiwongkosi, B (2013).Otolaryngologic Clinics of North America. ^ Fraioli, RE Branstetter BF, 4th Deleyiannis, FW (February 2008).In some cases there may be persistent post-surgical facial asymmetry, which can require further treatment. The prognosis of tripod fractures is generally good. ![]() Gillie's approach is used for depressed zygomatic fractures. įractures with displacement require surgery consisting of fracture reduction with miniplates, microplates and screws. Failure to correct can result in rotational deformity and increase the volume of the orbit, causing the eye to sink inwards. Specific attention is given to the position of the malar eminence and reduction of orbital volume by realigning the zygoma and sphenoid. The purpose of fixation is to restore the normal appearance of the face. Open reduction and internal fixation is reserved for cases that are severely angulated or comminuted. Non-displaced or minimally displaced fractures may be treated conservatively. Concomitant NOE fractures predict a higher incidence of post operative deformity. There is an association of ZMC fractures with naso-orbito-ethmoidal fractures (NOE) on the same side as the injury. The formerly used 'tripod fracture' refers to these buttresses, but did not also incorporate the posterior relationship of the zygoma to the sphenoid bone at the zygomaticosphenoid suture. 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. These complexes are referred to as the zygomaticomaxillary complex. The paired zygomas each have two attachments to the cranium, and two attachments to the maxilla, making up the orbital floors and lateral walls. The cause is usually a direct blow to the malar eminence of the cheek during assault. The zygomatic arch usually fractures at its weakest point, 1.5 cm behind the zygomaticotemporal suture. Facial bruising, periorbital ecchymosis, soft tissue gas, swelling, trismus, altered mastication, diplopia, and ophthalmoplegia are other indirect features of the injury. In most cases, there is 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. 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. 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 the orbital floor. Right zygomaticomaxillary complex fracture with disruption of the lateral orbital wall, orbital floor, zygomatic arch and maxillary sinus. ![]()
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