18. Zygomatico-Orbital Trauma (OMFS) Flashcards
What are the four classifications of maxillofacial fractures ?
Naso-ethmoidal fractures.
Lateral middle third (zygoma) fractures.
Central middle third (maxilla) fractures.
Mandibular fractures.
What are the key signs of zygomatico-orbital fracture ?
Periorbital bruising and swelling.
Subconjunctival ecchymoses.
Sensory deficit following infraorbital nerve.
Diplopia/visual impairment - due to limited eye movement.
Limited jaw movement.
Subcutaneous emphysema - air from sinus into tissue.
Epistaxis - bleeding from the nose.
Step deformity.
Flat face - reduced prominence of the zygoma.
Why will a patient suffer limited mouth opening after zygomatico-orbital fracture ?
Fracture causing impingement of coronoid process.
What four areas should be examined when suspected zygomatico-orbital fracture ?
Supra-orbital ridge.
Infra-orbital ridge.
Zygomatic arch.
Maxilla (intra-orally).
What type of radiograph is best used to assess for zygomatico-orbital fracture ?
Occipitomental view (various angulations).
What are the radiographic signs of zygomatico-orbital fracture ?
Full radiopacity of maxillary sinus - blood.
Volume of eye cavity increased.
Distance vs left and right zygoma from coronoid process.
What are the two signs of blood in the maxillary sinus ?
Nose bleed - communication between nose and maxilla through semilunar hiatus.
Restriction of eye movement - impinges on muscles.
Describe initial care for patient with this injury.
Exclude occular injury.
Prophylactic antibiotics (IV).
Avoid nose blowing.
When should a patient with this injury be assessed for definitive management ?
Once swelling has subsided.
What are the definitive management options for a patient with this injury ?
Further radiographs +/- CT scan.
Closed reduction +/- fixation.
Open reduction + internal fixation.
Describe open reduction.
Open site to see fracture lines.
Describe closed reduction.
Make incision not at site of fracture i.e. do not see fracture ends, fixed by palpation and aesthetic perception.
What is the most common closed reduction surgery for a zygomatico-orbital injury ? And vaguely describe it.
Gillies approach.
Cut high in temporalis muscle.
Follow between fascia and temporalis to lead to coronoid process.
Lift up zygoma into position (+/- fixation).
What are the benefits to closed reduction surgery i.e. Gillies approach ?
High incision and reduced visible scarring.
Describe a Le Fort 1 fracture.
Only maxilla involvement.
