Management of Zygomatico Orbital Trauma

Question 1

What are the classifications of maxillofacial fratures?

Answer 1

Naso ethmoidal fractures
Lateral middle third (zygoma)
Central middle third
Mandibular fractures

Question 2

What is a le fort 1 fracture?

Answer 2

Only maxilla is broken

Question 3

What is a le fort 2 fracture?

Answer 3

Maxilla and nose are broken

Question 4

What is a le fort 3 fracture?

Answer 4

Maxilla, nasal bone and the zygoma broken

Question 5

What happens to the maxillary sinus if the zygoma is fractured?

Answer 5

Fills up with blood
Creates nose bleeds (maxillary sinus drains to the nose through the hiatus semilunaris in the middle meatus)

Question 6

How many branches does the infraorbital nerve split into?

Answer 6

3
Top lip- superior labial
Lateral side of nose- lateral nasal
Around the cheek and lower eye lid- palpebral

Question 7

What does damage to the optic nerve at the junction of the root and floor of the orbit cause?

Answer 7

Blindness

Question 8

What is a tripod fracture?

Answer 8

Separates at 3 different sutures
Zygomatical frontal suture
Zygomatical maxillary suture
Zygomatical temporal suture

Question 9

What are the common features of Zygomatico orbital fractures?

Answer 9

Haemorrhage in eye under conjuctiva (subconjunctival haemorrhage)
Circumorbital ecchymoses (infraorbital haemorrhage)
Swollen cheek but flatness of cheekbone
Sometimes the only sign is limited mouth opening (fracture of zygoma impinges on the coronoid process)

Question 10

What are the clinical signs of a zygomatico orbital fracture?

Answer 10

Periorbital bruising and swelling
Subconjunctival ecchymoses
Sensory deficit- infraorbital nerve (numbness)
Diplopia (double vision)/ visual impairment
Subcutaneous emphysema
Epistaxis
Step deformity

Question 11

What is the definitive management of zygomaticoorbital fractures?

Answer 11

Review when the swelling has subsided
Further radiographs +/- CT scans
Informed consent
Closed reduction +/- fixation
Open (open patient up to see fracture lines) reduction + internal fixation
Reduction of fracture (put bone back into original place)

Question 12

What is the Gillies Temporal Approach?

Answer 12

Cut through the temporalis muscle- leads underneath the zygomatic bone
Reduces the fracture- lifts up cheekbone that has been affected
A closed reduction-
No scars as you are going through the temporalis muscle