Management of Maxillofacial Trauma_Zygomatic complex fractures

Posted by e-Medical PPT Thursday, September 1, 2011
Zygomatic complex and arch fracture
The malar bone represent a strong bone on fragile supports, and it is for this reason that, though the body of the bone is rarely broken, the four processes- frontal, orbital, maxillary and zygomatic are frequent sites of fracture.

Signs and symptoms
Periorbital ecchymosis and edema
Flattening of the malar prominence
Flattening over the zygomatic arch
Pain and tenderness on palpation
Ecchymosis of the maxillary buccal sulcus
Deformity at the zygomatic buttress of the maxilla
Deformity at the orbital margin
Trismus
Abnormal nerve sensibility
Epistaxis
Subconjunctival ecchymosis
Crepitation from air emphysema
Displacement of palpebral fissure (pseudoptosis)
Unequal pupillary levels
Diplopia
enophthalmos

Radiographical evaluation
Occipitomental view
(Posterioanterior oblique)
(water’s view)
submentovertex - Recommended for isolated zygomatic arch fracture

Nasal-orbital ethmoid injuries
Clinical examination:
Obliterating swelling
Canthus detachment
Lacrimal apparatus damage
Deformity of nasal bridge
CSF leak

Radiographical examination:
Occipitomental views
Lateral skull views
CT and 3D CT

Fracture classification
Type I
Unilateral or bilateral, involves only one portion of the medial orbital rim with the attached canthal tendon
Type II
Unilateral or bilateral, may be large segments of comminuted type and the canthus remains  attached to the large central segment
Type III
Unilateral or bilateral, comminution involves the central segment of the attached tendon results in avulsion of medial canthus.

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