Orbito-Zygomatic Fractures

Question 1

What is the most common cause for ZOC fracture in the West of Scotland?

Answer 1

ASSAULT (65%)

Associated with = social circumstances, ALCOHOL, drugs and unemployment

Question 2

What part of the skull does the zygomatic bone attach to?

Answer 2

1. Frontal process
2. Zygomaticomaxillary buttress
3. Infra-orbital rim
4. Zygomatic arch
5. Lateral orbital wall

VIA
1. ZygomaticoFRONTAL suture (ZF)
2&3. ZygomaticoMAXILLARY suture
4. ZygomaticoTEMPORAL suture
5. ZygomaticoSPHENOID suture

Question 3

What bone walls is the eye related to?

Answer 3

• Roof = frontal, sphenoid bone
• Lateral = zygomatic, sphenoid bone
• Floor = maxillary, zygomatic bone
• Medial = ethmoid, lacrimal, frontal, maxillary bone

Question 4

What muscle surrounds the eye?

Answer 4

Orbicularis oculi

• Palpebral part = blinking
• Orbital = eye scrunch

Question 5

Which MOTOR nerves innervates the muscles around the eye?

Answer 5

FACIAL NERVE

• Frontal branches
• Zygomatic branches
• Buccal branches

Question 6

Which SENSORY nerves innervated the muscles around the eye?

Answer 6

TRIGEMINAL

• Supra-orbital nerve (V1)
• Lacrimal nerve (V1)
• Infra-orbital nerve (V2)

Question 7

Which arteries supplies blood around the eyes?

Answer 7

• Supra-orbital artery
• Infra-orbital artery
• Facial artery
• Zygomaticofacial artery
• Inferior palpebral artery

Question 8

How are the type of ZOC fractures classified?

Answer 8

Henderson’s classification

1. Undisplaced
2. Zygomatic arch: trismus
3. Tripod FZ intact: numb, visual dist, pain, asym
4. Tripod FZ displaced: numb, visual dist, pain, asym, lacerations
5. Orbital blowout: occular-motility problems
6. Orbital rim: numb, step deform, visual dist
7. Comminuted/ complex: everything

Question 9

What may be the clinical signs of a ZOC fracture?

Answer 9

• Peri-orbital ecchymosis
• Swelling then flattening
• Lacerations (excoriation)
• Sub-conjunctival haemorrhage (strong ind. orbital #)
• Numb cheek

Question 10

What type of facial fracture is an occipito-mental view taken for?

Answer 10

ALL FACIAL FRACTURES

15/30 degrees

Question 11

What type of facial fracture is a CT taken for?

Answer 11

• COMPLEX

- BLOW-OUTS

Question 12

What are the indications for treatment?

Answer 12

SYMPTOMATIC

• Diplopia
• Asymmetry
• Numbness
• Enopthalmos

ASYMPTOMATIC

• Defect on XR
• Suspicion of late enopthalmos

Question 13

What is the surgical management of a ZOC fracture?

Answer 13

• None, monitor

ZOC #

• ORIF
• Closed reduction = Gillies lift, malar hook

RECONSTRUCTIVE

• Upper blepharoplasty = eyelid surgery
• Transconjunctival blepharoplasty = eye bag surgery

Question 14

What is the post-operative management for ZOC fractures?

Answer 14

• Advise = no nose blowing (dirsupts orbital wall –>)
• Steroids = dexamathasone 4-8mg
• Observe eye overnight

Question 15

What complication may arise from a ZOC fracture?

Answer 15

Retrobulbar haemorrhage