Orbital Fracture, Zygomatic Follow-up

  • Author: Stuart Seiff, MD, FACS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: May 13, 2009
 

Further Outpatient Care

Follow-up care is essential for the evaluation of surgical success. Masticatory function, globe position, and restoration of normal facial anatomy are all important elements that need to be critically addressed in the postoperative period.

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Inpatient & Outpatient Medications

Most surgeons place patients on oral antibiotics and oral pain medications; they often order a short course of oral steroids as well.

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Complications

The complications of an inadequately or unreduced zygomatic fracture are very difficult to correct secondarily. Malunion is the most common complication of zygomatic fractures and is the result of improper reduction and fixation, resulting in malocclusion, facial asymmetry, and enophthalmos.

Extraocular muscle entrapment, although usually attributable to the initial fractures, also can occur secondary to fracture repair. The rare complication of sudden onset blindness resulting from retrobulbar hemorrhage following reduction of even simple zygomatic fractures means that, in some instances, this procedure may be unsuitable for outpatient surgery. This serious complication, although rare (0.3% of treated zygomatic fractures), is potentially reversible upon early recognition of the symptoms and signs of retrobulbar hemorrhage (eg, pain, proptosis, loss of vision, decreased motility). If the surgeon suspects a retrobulbar hemorrhage, a lateral canthotomy and cantholysis should be performed as soon as possible. This should be completed at the bedside if the patient has visual compromise and is not near the operating suite.

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Prognosis

Indicators of favorable outcome include bony union, absence of skeletal or soft tissue deformity, and a normal range of mandibular movement.

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Patient Education

Advise patients to avoid nose blowing for fear of orbital emphysema and potential blindness. Also, warn them of the signs and symptoms of orbital/retrobulbar hemorrhage. Advise patients to call the surgeon at any time if orbital bleeding is suspected.

For excellent patient education resources, visit eMedicine's Breaks, Fractures, and Dislocations Center. Also, see eMedicine's patient education article Facial Fracture.

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Contributor Information and Disclosures
Author

Stuart Seiff, MD, FACS  Emeritus Professor of Ophthalmology, University of California San Francisco; Chief, Department of Ophthalmology, San Francisco General Hospital; Consultant, Oculofacial and Aesthetic Plastic Surgery, California Pacific Medical Center and Mills Peninsula Medical Center

Stuart Seiff, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery, and California Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Jesus Torres, MD  Fellow, Section of Oculoplastic Surgery, Hospital de Viladecans, Spain

Jesus Torres, MD is a member of the following medical societies: American Academy of Ophthalmology and International Society of Refractive Surgery

Disclosure: Nothing to disclose.

Dan D DeAngelis, MD, FRCS(C)  Ophthalmic Plastic and Reconstructive Surgery, Assistant Professor, Department of Ophthalmology and Vision Sciences, University of Toronto

Dan D DeAngelis, MD, FRCS(C) is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery, California Medical Association, Canadian Medical Association, Canadian Ophthalmological Society, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Susan Carter, MD  Clinical Associate Professor of Ophthalmology, Institute of Ophthalmology and Visual Science, New Jersey Medical School

Susan Carter, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Ron W Pelton, MD, PhD  Private Practice, Colorado Springs, Colorado

Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society, Utah Medical Association, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Mark T Duffy, MD, PhD  Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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  8. Parashar A, Sharma RK, Makkar SS. Treatment of simple zygoma fractures. Plast Reconstr Surg. Oct 2008;122(4):1285; author reply 1285-6. [Medline].

  9. McLoughlin P, Gilhooly M, Wood G. The management of zygomatic complex fractures--results of a survey. Br J Oral Maxillofac Surg. Oct 1994;32(5):284-8. [Medline].

  10. Randall DA, Bernstein PE. Epistaxis balloon catheter stabilization of zygomatic arch fractures. Ann Otol Rhinol Laryngol. Jan 1996;105(1):68-9. [Medline].

  11. af Geijerstam B, Hultman G, Bergstrom J, et al. Zygomatic fractures managed by closed reduction: an analysis with postoperative computed tomography follow-up evaluating the degree of reduction and remaining dislocation. J Oral Maxillofac Surg. Nov 2008;66(11):2302-7. [Medline].

  12. Smyth AG. A modified miniplate for use in malar complex fractures. Br J Oral Maxillofac Surg. Jun 1995;33(3):169-70. [Medline].

  13. Czerwinski M, Izadpanah A, Ma S, et al. Quantitative analysis of the orbital floor defect after zygoma fracture repair. J Oral Maxillofac Surg. Sep 2008;66(9):1869-74. [Medline].

 
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The zygoma forms a firm buttress for the orbit and typically fractures at its sutures.
Waters view demonstrating a zygomatic complex fracture involving the zygomaticofrontal suture, inferior orbital rim, and opacification of the maxillary sinus.
CT scan of the orbit demonstrating disruption of the zygomatic arch.
CT scan demonstrating disruption of the lateral wall of the orbit and medial inferior orbital rim.
 
 
 
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