Management of Zygomatico Orbital Trauma

Question 1

what are the classifications of maxillofacial fractures?

Answer 1

• nasoethmoidal fractures
• lateral middle third (zygoma)
• central middle third
• mandibular fractures

Question 2

what are the types of central middle third fractures you may come across?

Answer 2

• nasal bone
• unilateral maxillary fracture
• Le Fort I, II, III fracture
• Combination of the above

Question 3

what are Le Fort I, II, III fractures?

Answer 3

determined by which regions are mobile.

I: Mobility of the maxilla

II: Mobility of the maxilla and nose as a combined segment

III: Mobilized segment to include the maxilla, nose, and zygomas.

Question 4

whats involved in orbital & naso-ethmoidal injuries?

Answer 4

4 walls, an anterior surface and apex

Anterior wall
medial wall
floor
lateral wall
roof
apex

Question 5

what to consider when clinically examining the maxillofacial region?

Answer 5

1. Organised
2. Sequential
3. Methodical

A. Soft tissue
B. Nerves
C. Skeleton
D. Dentition

Question 6

what is a malar fracture and some clinical signs?

Answer 6

the zygomatic bone is displaced downward

Signs:
- periorbital bruising & swelling
- sensory deficit (infraorbital nerve)
- visual impairment
- bleeding from nose
- step deformity

Question 7

initial care options for zygomatico orbital trauma?

Answer 7

• exclude occular injury
• prophylactic antibiotics
• avoid blowing nose

Question 8

definitive management for zygomatico orbital trauma?

Answer 8

• review when swelling subsided
• further radiographs +/- CT Scan
• consent
• Open or Closed reduction