Zygomatic Orbital Trauma

Question 1

Clinical signs of zygomatic fractures (6)

Answer 1

Diplopia
Step deformity
Subconjunctival ecchymoses
Periorbital bruising/swelling
Sensory deficit - infraorbital nerve
Nose bleeding

Question 2

E/O exam for zygomatic fracture

Answer 2

Lacerations/bleeding/swelling
Eye bruising/burst BVs
MOM - tender zygoma
Sensation to infraorbital nerve
Diplopia
Track finger at 6 points

PALPATE:
Irregularities of supraorbital ridge
Irregularities of infraorbital ridge + zygoma
Depression of zygomatic arch
Manoeuvre maxilla

Question 3

I/O exam for zygomatic fracture

Answer 3

Lacerations/bleeding/bruising/swelling
Tender zygomatic buttress
Step deformity
Mobile teeth
Occlusal derangement
Sensation to upper lip

Question 4

SI’s for zygomatic fracture

Answer 4

OM15/30
CBCT

Question 5

What areas does the infraorbital nerve supply?

Answer 5

Upper lip, nose + lower eyelid

Question 6

What nerve supply is usually severed by orbital fracture?

Answer 6

Superior rectus (severed) or inferior rectus (trapped)

Question 7

Tx for zygomatic fracture

Answer 7

OMFS/A+E urgent referral
Pain management
Exlude ocular injury
prophylactic abx
avoid nose blowing

Review when swelling subsided
IMF or ORIF

Question 8

Radiographic identification of zygomatic fracture

Answer 8

Radiopaque sinus (filled with blood)
ALWAYS STATE SIDE