Management of Zygomatic Orbital Trauma

Question 1

How are maxillofacial fractures classified?

Answer 1

1. naso ethmoidal fractures
2. lateral middle third (zygoma)
3. central middle third
4. mandibular fractures

Question 2

List the different central middle third fractures:

Answer 2

1. nasal bone
2. unilateral maxillary fracture
3. Le Fort I fracture
4. Le Fort II fracture
5. Le Fort III fracture
6. various combinations

Question 3

What are the clinical signs of malar fractures?

Answer 3

• preorbital bruising & swelling
• subconjuntival ecchymoses
• sensory deficit (damage to infraorbital nerve)
• diplopia / visual impairment
• subcutaneous emphysema
• epistaxis
• step deformity

Question 4

What structures run through the superior orbital fissure?

Answer 4

• occulomotor nerve III
• trochlear nerve IV
• abducent nerve VI
• branches of ophthalmic nerve
• ophthalmic veins

Question 5

How should you clinically examine for a malar fracture?

Answer 5

1. palpation for irregularities of supraorbital ridge
2. palpation for irregularities of infraorbital ridge and zygoma
3. palpation for depression of zygomatic arch
4. manoeuvre to ascertain motion in maxilla

Question 6

What should the initial care of a malar fracture be?

Answer 6

• exclude occular injury
• prophylactic antibiotics
• tell pt to avoid blowing nose

Question 7

What is the definitive management of a malar fracture?

Answer 7

• review when swelling subsided
• take further radiographs +/- CT scans
• informed consent
• closed reduction +/- fixation
• open reduction + internal fixation

Question 8

A pt fractures their zygoma and experience bleeding from their nose, why?

Answer 8

Fractured zygoma causes bleeding in the maxillary sinus, this drains to the nose via the hiatus semilunaris

Question 9

What exits the skull via the infraorbital foramen?

Answer 9

• infraorbital nerve
• infraorbital artery

Question 10

A patient experiences trauma to their zygoma, what may they come in complaining of?

Answer 10

Numbness of upper lip, side of nose, lower eyelid due to damage of infraorbital foramen

Question 11

What are the most common clinical signs of a zygomatico-orbito complex fracture?

Answer 11

• subconjuntival haemorrhage
• circumorbital ecchymosis
• flatness of face

Question 12

Why might a pt with a zygomatic fracture have limited mouth opening?

Answer 12

Fractured zygoma impinges on the coronoid process

Question 13

What is diplopia?

Answer 13

Double vision

Question 14

Why do patients with zygomatic fractures experience diplopia?

Answer 14

Direct trauma to the eyeball / pressure to the globe of the orbit