Professional Documents
Culture Documents
Clinical,
Surgical, Zygomatic
AMIL JAMES
Correlation
of the
are
Clinical
Limitation ofJaw
and
Movement
Radiographic
and Flattening
Findings
of Cheek
of radiographic
facial trauma are no different describes the specific clinical each displaced bony fragment
fracture. Limitation of jaw
in this respect. This paper findings associated with of the zygomatic complex
and flattening of the
The
like
temporal
of bone
process
extending
of the anterior of
zygoma
posteriorly
(fig.
from
1 ), a flat
the
wingof
blade
body
the covers
forms lower
the portion
part the
of
the
arch fossa.
which The
movement
cheek are produced by depressed fractures of the ternporal process or zygomatic arch; unilateral epistaxis is a result of fractures of the zygomatic process of the maxilla or the floor of the orbit; paresthesia or anesthesia of the cheek results from fractures of the infraorbital process or orbital floor; unequal pupil heights is associated with fracture of the frontal process; and decreased extraocular muscle function with diplopia is caused by fractures of the orbital process, frontal process. or orbital floor. The clinical and radiographic findings are correlated with surgical management.
posterior process,
from
the temporal
These
processes
fuse
at the zygomaticotemporal suture. The coronoid of the mandible with its attached temporalis muscle lies and within forth the temporal fossa under the zygomatic and the closed. body of the can tendon, closing one-third zygoma
and must pass freely back arch when the mouth is is depressed on the coronoid inward. process the or
process
impinge
Introduction Trauma to the zygomatic or of its malar bone of the bone and injury face itself and their can
produce
acteristically, rarely
multiple
the fractured;
fractures
body instead,
and
the weaker
clinical
zygomatic
findings.
Charis
complex fracture [4]. Flattening the cheek may also be present. from Acutely which the underlying this may bony be obscured this support
of the lateral contour of since it is in part formed of the edema and it is cheek features projection for arch temporal and not or process. ecchymosis until this skin dimple are present, of the zygofractures and fracand by the
processes
displaced [1 1. as a clinical Other names complex (1) limitation (2) unilateral distribution
accompanies
injury,
are zygomaticomaxillary fracture, and tripod The ofjaw epistaxis, most (3) frequent movement
matic arches should be examined of the temporal process (fig. 3). Isolated tures ramus
Unilateral
depressed fractures
paresthesia
depressed
zygomatic
of the infraorbital nerve, (4) unequal pupil heights, and (5) a decreasein extraocular muscle function with diplopia. By understanding the mechanisms of the fractures of the processes of the zygomatic bone which cause these clinical
findings facial treatment and by correlating can these clinical accurate findings diagnosis with the and radiographs, plan a more be formulated.
maxillary body of the of the of the instead, through zygomatic of the wall of lining the
is the at the
medial
zygomaticomaxillary
lies to the
maxilla. The maxillary process the force from a blow to the this solid process zygomatic maxillary maxillary cavity of the nasal piece of bone maxilla. of the process sinus, sinus is divided
is rarely fraccheek is transto the maxilla the 2B, two bleeding 2D, weaker results mucous and from separate in and This
mitted adjoining a fracture lateral membrane 4). Since chambers the nose
Dallas, Health Texas Science
mass or body from which three bony processes project (fig. 1). These processes are attached by sutural junctions to the frontal, maxillary, and temporal bones and
correspondingly named [3]. and Their roles in the forming cheek will the
bony
the
bony
orbit,
facial
maxillary
skeletal
sinus
framework
contour
and
the
of
temporal findings.
Health Science University
fossa,
be
described
Department
2
and
related
of Radiology.
to specific
University Department
clinical
of Texas of
Center. of Texas
Division
of
Oral
Surgery.
Surgery.
P. Sinn. Am J Roentgeno/
128:235-238,
February
1977
235
236
GERLOCK
AND
SINN
..
zygoma. maxillary, processes of bone; 7, maxillary bone; 9, greater 10, zygobone; 11, 12, zygo13, zygo14, orbital infraorbital
the
-,-
7i
wing of sphenoid bone; matic process of temporal zygomatic temporal suture; matic process of maxilla; matic maxillary suture; surface of maxilla; 15, foramen.
,,j
Fig. 2.-A. Impingement of temporal process of zygoma on coronoid process of mandible as result of depressed zygomatic complex fracture B and C. Downward displacement of frontal process of zygoma and its attached lateral palpebral ligament with separation of zygomaticofrontal suture. Lateral canthus of eyelid and eyeball are depressed. On upward gaze. involved eyeball remains fixed due to incarceration of inferior rectus and inferior oblique muscles between bony fracture fragments of orbital floor. 0, Fractures of infraorbital process, floor of orbit, and lateral maxillary sinus involving infraorbital canal, infraorbital foramen, and nerve
ZYGOMATIC
COMPLEX
FRACTURE
237
medial
of arrow)
frontal Black
process arrow
with points
the
walls
of both Bilateral
occurs.
I fracture.
then
epistaxis
Clinically,
mandibular
or
Anesthesia
in
Distribution
of
piece
of
bone
projecting
medially
from
the
body
of
the
zygoma and extending under the orbital cavity toward the nose. It is attached to the body of the maxilla lateral to the
orbital the the the floor
at the
zygomaticomaxillary
lateral anterior
floor
half of the infraorbital rim and orbital floor lying anterolateral of the orbit formed from with with may of the
in
the
maxilla.
The
this
is in close contact its base is in contact the of canal, maxilla. this and
this
foraorbit
formed
Fractures foramen,
orbital nerve;
process floor
results
paresthesia
anesthesia
the
the
Fig 4 -Fracture infraorbital foramen arrow). resulted opacification of zygomatic distribution Maxillary in fracture of infraorbital process and step deformity of process of lateral is not fractured. maxillary sinus had resulting infraorbitat in disruption rim (large of open has and
clinical
Waters
bones should rim extending 4) and for Isolated and this anterior clinical
Pupil
be evaluated for fractures of the infraorbital into the infraorbital foramen (figs. 2D and fracture fractures wall finding.
Heights
involvement of the orbital floor of the orbital floor, infraorbital of the maxillary sinus may also
(fig.
5). rim,
produce
The maxillary
Waters sinus,
projection with an
typically associated
displays fracture of
an the
wall level
of
the
involved be seen.
maxillary Isolated
sinus orbital
(fig. floor
4).
An
air-fluid or iso-
The
frontal
process
projects
superiorly
from rim
the
body
may
fractures
238
GERLOCK
AND
SINN
rim surface
of the frontal
of this
with canthus
process separation
1 3 mm the and
below
the
level of the
whether the
treatment
can complex
consist or if
of simple interosseous
repositioning fixation
of will
Displacement zygomaticofrontal
zygomatic
be required.
eye. In clinical practice, we find that involved in the fracture are large minution tioning of the ofthe lateral wall of the into zygomatic complex if the segments of bone and there is little commaxilla, simple reposiposition its anatomical
suture
of the or may
a downward
of the (fig. 2B).
displacement
globe
or sagging
of heights clinical the
Depending
malalignment
[5]
of visual
Unequal
axes,
pupil
diplopia
may
withfinding
is a distinct
by utilizing
an external
result. internal
or internal
However, fixation the
approach
will
frequently
open reis accomsuperas the line are
of the
the
zygomaticofrontal
view
suture
should
be looked
for
on
stablizing
zygomaticofrontal
Waters
the zygoma has been positioned to the infraorbital rim as well at the zygomatic temporalis infraorbital complex, muscle rim fracture the and
Function flat
Diplopia medial inferiorly forming infraorbital the infrasphenoid of the bone exwith
interosseous
less difficult.
By on the elevating masseter impingement coronoid pro-
of the
which infraorbital
of the
the lateral orbital fissure. The part orbital bone orbital fissure
cess
jaw until time thesia orbital time.
of the mandible
will
be reduced
of
attaches
greater
is helpful.
at the zygomaticosphenoid suture results in the formation of a flat plate of bone which has anterior and posterior surface. The posterior surface forms the anterior wall of
the and temporal infraorbital fossa. Trauma to the cheek causing produce [6] or which depresses
and anesthesia over the distribution of the infranerve frequently remain postoperatively for some However, repositioning of the bone so that there is nerve will complex the orbital enhance its will elevate contents,
no impingement of the infraorbital recovery. Reduction of the zygomatic the lateral canthal ligament, reposition
bone orbital
of the
inward wall
will displace
the orbital
them diplopia
process fracture
either by
process bony
medially,
to fracture
and
cavity,
restore
thus
the
pupil
muscle
to
will
its normal
significant resolve
height
sequela. slowly
in the
Diplopia in 5-14
orbital
from days.
and floor
orbit and and can nerves nerves
This region
eliminating
swelling
of the
producing
extraocular extraocular
edema
muscles muscles
and
hemorrhage
of
fractured
the
the
Diplopia
will usually
caused fracture.
by entrapment
with
of the extraocular
reduction of the
muscles
zygomatic
be eliminated
complex
of the fractures
ACKNOWLEDGMENT We thank Ms. Billie DuVall for assistance in preparing this paper.
fractures proven
floor,
When
and
diplopia
all
35
for of
patients
required
orbital and
surgical
Waters
correction.
views
Kruger GO: Textbook
REFERENCES
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Mosby.
1964
2. Knight
JS. North
of malar
fractures:
B J
orbital
floor. floor
If findings should
Surgical
are
equivocal,
laminography
of
the orbital
be performed.
Considerations
of displacement as a guide to PlastSurg 13:325-339, 1961 3. Gray H, Goss CM: Anatomy of the Human Philadelphia. Lea & Febiger, 1959
4. WiesenbaughJM: Diagnostic
Oral Surg
an analysis
treatment.
Body,
27th
complex
ed.
evaluation
of zygomatic
The
zygomatic duction
surgical
principles
involved
are type
in the
management
related to approach need
of
reis
primarily of surgical
Displacement
B J Ophthalmol
and
Facial J
traumatic
Skeleton, Oral Surg
6. Killey HC: Fractures of the Middle Third of the 2d ed. Bristol, John Wright & Sons. 1971
7. Kwapis 8W: Treatment of malar bone fractures.
It then
becomes
essential
for
the
surgeon
to
determine
27:538-543.
1969