Zygomatic Orbital Fracture Clinical Presentation
- Author: Stuart Seiff, MD, FACS; Chief Editor: Hampton Roy, Sr, MD more...
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- Vision can be threatened as a result of direct ocular injury or intraorbital hemorrhage.
- Binocular diplopia is noted in as many as 30% of zygomatic fractures. This can be secondary to muscle entrapment, neuromuscular injury, or intramuscular hematoma.
- Difficulty with mastication, otherwise known as trismus, can occur because of masseter spasm or bony impingement of the coronoid process.
- In some patients, ipsilateral epistaxis also is noted as a result of lacerated maxillary sinus mucosa.
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- Since most of these patients are involved in multisystem trauma, involvement by a trauma team for airway, breathing, and circulatory status is essential.
- Ophthalmic evaluation, including globe integrity, should be performed promptly. Inferior displacement of the lateral canthal tendon is common. Proptosis may be present due to orbital edema or hemorrhage. Acute orbital hematoma may cause vision compromise and should be managed appropriately.
- Periorbital and/or subconjunctival ecchymosis are seen in as many as 50% of patients.
- Significant malar depression can be seen with step defects at the infraorbital rim, frontozygomatic suture, and zygomatic buttress of the maxilla intraorally.
- Fractures of the zygomatic bone evoke pain on palpation in 70% of patients.
- Paresthesias in the distribution of the infraorbital, zygomaticofacial, or zygomaticotemporal nerves can occur.
- Posterior displacement of the fracture fragment may impinge on movement of the mandible causing difficulty with mastication. Inferior displacement of the lateral canthal angle may indicate inferior migration of the fractured zygomatic bone. Although these are not true orbital blowout fractures, entrapment of orbital contents, enophthalmos, and diplopia with restriction of motility may occur because of the contributions of the zygomatic bone to the orbital floor. Use of the Hertel exophthalmometer in the assessment of relative enophthalmos or exophthalmos may be complicated because the lateral orbital rim, which is displaced in most zygomatic complex fractures, serves as a reference point for this instrument. Consideration should be given to the use of the Naugle exophthalmometer in these cases, which uses the frontal bone as a reference.
- Crepitus from subcutaneous emphysema or proptosis and visual loss from orbital emphysema may occur with forceful nose blowing. Patients should be cautioned against this.
The mechanism of injury usually involves a blow to the side of the face from a fist, from an object, or secondary to motor vehicle accidents. Studies show that 80% of these injuries are due to motor vehicle accidents.
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