顴骨骨折(Zygoma fracture)

Fracture of Zygoma

1. Symptoms

• Enophthalmos(眼球內陷): avoid compressing infraorbital nerve
• Malar asymmetry: Palpable bony defect over the arch
• Diplopia
• Trismus: Pain in cheek and jaw movement
• Impingement on coronoid process
• Flame sign: Intraoral hematoma, ecchymosis
• Epistaxis
• Inferior displacement of globe
• Inferior displacement of lateral canthus
• Infra-orbital never injury: numbness

2. Diagnosis: CT scan

3. Classification

Group 1. No significant displacement.
Group 2. Arch fractures.
Group 3. Unrotated body fractures.
Group 4. Medially rotated body fractures.
Group 5. Laterally rotated body fractures.
Group 6. Include all cases with fracture lines cross the main fragment.

4. Five places to align the zygoma

1) zygomatico‐maxillary buttress
2) lateral wall of the orbit
3) infraorbital rim
4) zygomatic arch
5) zygomatico‐frontal suture

5. Treatment

1) Isolated arch fracture Gillies approach
2) Displaced zygomatic fracture: ORIF(open reduction internal fixation)
3) Comminuted zygomatic fracture: ORIF,bone grafting , correction of enophthalmos

Approach

• the temporal (Gillies) approach
• the transoral (Keen) approach.

ORIF

Open Treatment without Orbital Repair
Simple fracture: 1‐point fixation with a plate may be adequate (Upper buccal sulcus approach)

Open Treatment with Orbital Repair
Upper buccal sulcus approach+ Lower eyelid incision and Transconjunctival approach