Overview
Fractures of the zygomatic complex are frequent facial injuries involving the zygomatic bone and its articulations. Proper management aims to restore anatomical structure and function while minimizing complications 1.Diagnosis
Clinical examination focusing on facial asymmetry, trismus, ecchymosis, and palpation of bony prominences 1.
Imaging: CT scan is essential for detailed assessment of fracture patterns and displacement 1.
Grading systems often categorize fractures based on involvement of specific zygomatic structures (e.g., malar, zygomatic arch, zygomaticosphenoid suture) 1.Management
First-line Treatment: Reduction under local anesthesia with intravenous sedation and analgesia, suitable for outpatient management 1.
Surgical Fixation:
- Interosseous wiring: Used in some cases but associated with higher risk of infraorbital nerve sequelae 2.
- Miniplate osteosynthesis: Recommended for unstable fractures with displacement due to better preservation of infraorbital nerve function 2.
Post-reduction Care: Includes pain management (e.g., NSAIDs for analgesia) and monitoring for complications such as infection or malocclusion 1.Special Populations
Pediatrics: Specific techniques and considerations for pediatric zygomatic complex fractures are not detailed in provided abstracts 1.
Elderly: No specific recommendations provided in the abstracts regarding elderly patients 1.
Comorbidities: Management considerations for patients with comorbidities like osteoporosis or previous facial surgeries are not addressed 1.Key Recommendations
Utilize miniplate osteosynthesis for unstable zygomatic complex fractures to minimize infraorbital nerve sequelae (Evidence: Moderate 2).
Consider outpatient reduction under local anesthesia with intravenous sedation for suitable cases to enhance patient convenience and hospital efficiency (Evidence: Expert opinion 1).
Monitor patients closely for signs of infraorbital nerve dysfunction following surgical fixation, particularly if interosseous wiring is used (Evidence: Moderate 2).References
1 Schnetler JF. A technique for reducing fractures of the zygomatic complex under local anaesthesia. The British journal of oral & maxillofacial surgery 1990. link90081-u)
2 De Man K, Bax WA. The influence of the mode of treatment of zygomatic bone fractures on the healing process of the infraorbital nerve. The British journal of oral & maxillofacial surgery 1988. link90095-2)