What is the zygomatic Complex facture? How do you classify this facture? Mention its symptomatology. What are the different surgical approaches for zygomatic complex fracture? Mention its indications, advantages and disadvantages?

Zyngomaticomaxillary complex fractures (ZMC) are a group of fracture that disrupt the lateral middle third of the face which comprise of “tetrapod” as it maintains 4 points of articulation with the

• frontal bone at the zygomaticofrontal suture
• Maxillary bone at the zygomatico maxillary suture.
• Greater wing of sphenoid at the zygomatico sphenoid suture  and
• Temporal bone at zygomaticotemporal  suture.

The body and processes of the zygomatic bone make up the lateral middle third of the facial skeleton. These injuries were originally termed “tripod fractures” because of the disruption of the 3 commonly recognized articulations.

• Fronto-zygomatic
• Infra-orbital rim
• Zygomaticomaxillary buttress

Other two articulation worthy of consideration are

• zygomatic arch
• Zygomaticsphnoid.

Classification

• There is no universally accepted scheme
• There fracture are probably best classified according to their rotation about vertical and horizontal axes:
  • Vertical axis fracture: It runs between the frontozygomatic suture and the 1st molar tooth.
  • Horizontal axis is the plane of zygomatic arch.

Larsen and Thomsen:

A) Stable fracture→ no/minimal displacement, no intervention

B) Stable fracture with displacement→ Requires reduction and fixation

Fracture of zygomatic arch:

• minimum/no displacement
• V type fracture
• Communicated fracture

Rowe and killey’s classification.

Type I: no significant displacement

Type II: Fracture of zygomatic arch

Type III: Rotation around vertical axis

• Inward displacement of orbital rim
• Outward displacement of orbital rim.
• Medial displacement of frontal process.
• Lateral displacement of frontal process.

Type V: Displacement of complex en-bloc

Type VI: Displacement of orbital floor

Type VII: Displacement of orbital rim

Type VIII: Complex commuted fracture.

Symptomatology

Local s/s	orbital s/s	other s/s	Face examination (signs)
swelling	subconjunctival Haemorrhage	Alteration of sensation of cheek due to damage to zygomatico temporal.	Tenderness
Bruising	Periorbital oedema, Restricted eye movements(upward gaze if orbital floor dehiscence and blow out of orbital contents)	Limitation of mouth opening	Step deformity of the infraorbital margin
	Diplopia	epstaxis	Reduced zygomatic projection (flat face)
	Periorbital oedema

The different approaches→indication, advantages and disadvantages are following:

Approach (GDPKC)	Indication	Advantage	Disadvantage
Gillies	Medially displaced body	Elevating site distant from fixation site	Require skin incision.
	Zygomatic arch
Dingman	Medially displaced body	Uses common incision to that of frontozygomatic access.	Difficult to plate frontozygomatic suture and elevate simultaneously
			Incision may become stretched.
Poswille hook	Posteriorly displaced	Good mechanical advantage	Access point of hook is prominent on the lateral cheek prominence and may be noticeable.
		Quick only one suture required
Keen	Medially displaced	Avoid cutaneous scar	Doesn't address Frontozygomatic suture
	Arch		Elevating and plating at the site is difficult simultaneously.
			contaminating of site with oral micro organism
Coronal	Laterally displaced arch	Only approach	Extensive surgical expenses.

 

 

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