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