{"id":38,"date":"2023-09-30T11:45:04","date_gmt":"2023-09-30T10:45:04","guid":{"rendered":"https:\/\/notes.plasticsurgeryresources.xyz\/?p=38"},"modified":"2023-10-02T10:18:15","modified_gmt":"2023-10-02T09:18:15","slug":"zygomaticomaxillary-complex-fractures","status":"publish","type":"post","link":"https:\/\/notes.plasticsurgeryresources.xyz\/index.php\/2023\/09\/30\/zygomaticomaxillary-complex-fractures\/","title":{"rendered":"Zygomaticomaxillary complex fractures"},"content":{"rendered":"
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https:\/\/en.wikipedia.org\/wiki\/File:Tripod_fx_right.png<\/figcaption><\/figure><\/div>\n\n\n

Zygomaticomaxillary complex (ZMC) fractures are the second most common facial fractures after nasal bone fractures. As plastic and maxillofacial surgeons, a strong understanding of the anatomy, patterns, evaluation, and management of these injuries is imperative for achieving optimal functional and aesthetic outcomes. This blog post provides a comprehensive overview of key considerations.<\/p>\n\n\n\n

Anatomy <\/strong><\/p>\n\n\n\n

The ZMC defines midface width and projection. It is formed by the zygoma and 4 surrounding bones – frontal, maxillary, temporal, and sphenoid. It provides insertion points for the masseter, temporalis, and zygomaticus major\/minor muscles and is closely associated with the infraorbital nerve.<\/p>\n\n\n\n

Epidemiology<\/strong><\/p>\n\n\n\n

    \n
  • Account for ~40% of midface fractures<\/li>\n\n\n\n
  • Second most common facial fracture after nasal bones<\/li>\n<\/ul>\n\n\n\n

    Pathology<\/strong><\/p>\n\n\n\n

      \n
    • Direct blow to malar eminence<\/li>\n\n\n\n
    • Disrupts zygoma anchoring via 3 main fracture components<\/li>\n\n\n\n
    • Can cause trismus, infraorbital nerve injury\/numbness<\/li>\n<\/ul>\n\n\n\n

      Evaluation<\/strong><\/p>\n\n\n\n

        \n
      • History: mechanism, numbness, trismus<\/li>\n\n\n\n
      • Physical exam: 6 P’s of ZMC fractures\n
          \n
        • Periorbital swelling<\/li>\n\n\n\n
        • Pain with gaze extremes<\/li>\n\n\n\n
        • Perception: diplopia, subconjunctival hemorrhage<\/li>\n\n\n\n
        • Paresthesia in V2 distribution<\/li>\n\n\n\n
        • Projection: lack of malar prominence<\/li>\n\n\n\n
        • Protusion: enophthalmos\/exophthalmos<\/li>\n<\/ul>\n<\/li>\n\n\n\n
        • Ophthalmology assessment: orbital apex syndrome, other ocular injuries<\/li>\n\n\n\n
        • CT scan with multiplanar reconstruction: gold standard imaging<\/li>\n<\/ul>\n\n\n\n

          Classification<\/strong><\/p>\n\n\n\n

            \n
          • Zingg et al. 1992 classification:\n
              \n
            • Type A: Incomplete zygomatic fracture<\/li>\n\n\n\n
            • Type B: Complete monofragment zygomatic fracture<\/li>\n\n\n\n
            • Type C: Multifragment zygomatic fracture<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n

              Management<\/strong><\/p>\n\n\n\n

                \n
              • Goals: restoration of anatomy, function<\/li>\n\n\n\n
              • Closed reduction or open reduction\/internal fixation<\/li>\n\n\n\n
              • Rigid fixation with plates, screws to stabilize fractures<\/li>\n\n\n\n
              • Soft tissue repair for coverage, aesthetics, ocular competence<\/li>\n\n\n\n
              • Timing: emergent if severe sequelae, otherwise delayed 1-2 weeks<\/li>\n<\/ul>\n\n\n\n

                The table below provides a summary overview:<\/p>\n\n\n\n

                Characteristic<\/th>Description<\/th><\/tr><\/thead>
                Anatomy<\/td>Zygoma + 4 surrounding bones; associated muscles\/nerves<\/td><\/tr>
                Epidemiology<\/td>40% of midface fractures; 2nd most common after nasal<\/td><\/tr>
                Pathology<\/td>Direct blow to malar eminence; disrupts zygoma anchoring<\/td><\/tr>
                Evaluation<\/td>History, physical, ophthalmology assessment, CT scan<\/td><\/tr>
                Classification<\/td>Zingg: Types A, B, C based on fracture components<\/td><\/tr>
                Management<\/td>Anatomical reduction; rigid internal fixation; soft tissue repair; timing<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

                References: <\/strong><\/p>\n\n\n\n

                Ranchod, A. I. (2023, September 14). Zygomaticomaxillary complex fracture: Radiology reference article<\/em>. Radiopaedia. https:\/\/radiopaedia.org\/articles\/zygomaticomaxillary-complex-fracture-1?lang=gb<\/p>\n\n\n\n

                PlasticsFella. (2021b, December 12). Zygomaticomaxillary complex (ZMC) fractures<\/em>. thePlasticsFella. https:\/\/www.theplasticsfella.com\/zygomaticomaxillary-complex-fractures\/<\/p>\n","protected":false},"excerpt":{"rendered":"

                Zygomaticomaxillary complex (ZMC) fractures are the second most common facial fractures after nasal bone fractures. As plastic and maxillofacial surgeons, a strong understanding of the anatomy, patterns, evaluation, and management of these injuries is imperative for achieving optimal functional and aesthetic outcomes. This blog post provides a comprehensive overview of […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","footnotes":""},"categories":[27],"tags":[],"aioseo_notices":[],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/notes.plasticsurgeryresources.xyz\/index.php\/wp-json\/wp\/v2\/posts\/38"}],"collection":[{"href":"https:\/\/notes.plasticsurgeryresources.xyz\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/notes.plasticsurgeryresources.xyz\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/notes.plasticsurgeryresources.xyz\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/notes.plasticsurgeryresources.xyz\/index.php\/wp-json\/wp\/v2\/comments?post=38"}],"version-history":[{"count":4,"href":"https:\/\/notes.plasticsurgeryresources.xyz\/index.php\/wp-json\/wp\/v2\/posts\/38\/revisions"}],"predecessor-version":[{"id":51,"href":"https:\/\/notes.plasticsurgeryresources.xyz\/index.php\/wp-json\/wp\/v2\/posts\/38\/revisions\/51"}],"wp:attachment":[{"href":"https:\/\/notes.plasticsurgeryresources.xyz\/index.php\/wp-json\/wp\/v2\/media?parent=38"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/notes.plasticsurgeryresources.xyz\/index.php\/wp-json\/wp\/v2\/categories?post=38"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/notes.plasticsurgeryresources.xyz\/index.php\/wp-json\/wp\/v2\/tags?post=38"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}