Zygomaticomaxillary ( ZMC ) Fracture. Anatomy Similar to a 4- sided pyramid It has Temporal,...
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Transcript of Zygomaticomaxillary ( ZMC ) Fracture. Anatomy Similar to a 4- sided pyramid It has Temporal,...
![Page 1: Zygomaticomaxillary ( ZMC ) Fracture. Anatomy Similar to a 4- sided pyramid It has Temporal, Orbital, Maxillary & Frontal processes The Zygoma is the.](https://reader030.fdocuments.us/reader030/viewer/2022032606/56649eac5503460f94bb2624/html5/thumbnails/1.jpg)
Zygomaticomaxillary( ZMC )Fracture
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Anatomy• Similar to a 4- sided pyramid• It has Temporal, Orbital,
Maxillary & Frontal processes• The Zygoma is the origin to
major portion of the masseter muscle
• The malar bone represents 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.
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Anatomy
• Usually 4 fx lines exist:• Anteromedial in the floor of
the orbit• Superolateral in the lateral
orbital wall• Inferior to the maxillary
buttress• in the zygomatic arch
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Diagnosis
Clinical• Perform a neurologic & ophthalmic
evaluation first• Signs & symptoms:• Periorbital Ecchymosis and Edema• Flattening of the Malar Prominence• Ecchymosis of the Maxillary Buccal Sulcus• Deformity at the Zygomatic Buttress of the
Maxilla• Deformity of the Orbital Margin• Trismus• Abnormal Nerve Sensibility• Subconjunctival Ecchymoses• Displacement of the Palpebral Fissure.• Diplopia• Enophthalmos
Radiographic
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Flattening of the Malar Prominence.
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Trismus
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Displacement of the Palpebral Fissure & Unequal pupillary Level
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Abnormal Nerve Sensibility.
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Enophthalmousaccentuationof the sulcus of the upper lidnarrowing of the palpebralFissurpseudoptosis of the upper lid
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Radiologic Assessment
Axial & coronal CT is the method of choice
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Radiologic Assessment(3D Reconstruction)
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Complexities in TX of ZMC FX
• Rotation of the fractured ZMC
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Complexities in TX of ZMC FX
• Concomitant undiagnosed NOE FX
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Complexities in TX of ZMC FX
• Lateral displacement of Malar bone
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SURGICAL APPROACHES TOZYGOMATICOMAXILLARY
COMPLEX FRACTURES
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Maxillary Vestibular Approach
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Supraorbital Eyebrow Approach
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Upper Eyelid Approach
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Lower Eyelid Approaches
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Transconjunctival Approach
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Bicoronal / Coronal Approach
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Gillies Temporal Approach
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Buccal Sulcus Approach( Keen Technique )
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Elevation From Eyebrow Approach
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Percutaneous Approach
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Percutaneous Approach(Carroll- Girrard Bone Screw)