Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Zygomatic Orbital Fracture

  • Author: Stuart Seiff, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Aug 19, 2014
 

Background

The zygomatic bone occupies a prominent and important position in the facial skeleton. The zygoma forms a significant portion of the floor and lateral wall of the orbit and forms a portion of the zygomatic arch, otherwise known as the malar eminence, which plays a key role in the determination of facial morphology. Fractures of the zygomatic complex occur because of the rotation of the zygoma associated with the disarticulation of the zygomatic bone at the zygomaticofrontal suture (along the lateral orbital rim), the zygomaticomaxillary suture (medially), and along the zygomatic arch to the temporal bone (see below).[1, 2]

The zygoma forms a firm buttress for the orbit andThe zygoma forms a firm buttress for the orbit and typically fractures at its sutures.

Anatomically, the zygomatic bone contains foramina that allow for the passage of zygomaticofacial and zygomaticotemporal arteries and corresponding nerves of the second division of the trigeminal nerve that supply sensation to cheek and anterior temple. Similarly, the infraorbital nerve also courses the floor of the orbit and exits the infraorbital foramen or notch. Consequently, fractures of the zygomatic arch can lead to hypoesthesia in the corresponding dermatome. Muscle attachments along the zygomatic arch include the origin of the masseter, the zygomaticus major, and some fibers of the temporalis fascia. The Whitnall tubercle, which serves a critical role in the maintenance of eyelid contour as the attachment site for the lateral canthal tendon, is located on the zygomatic bone 2 mm behind the lateral orbital rim.[3]

Next

Pathophysiology

The zygoma is the main buttress between the maxilla and the skull, but, in spite of its sturdiness, its prominent location makes it prone to fracture. 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. Moderate force may result in minimally or nondisplaced fractures at the suture lines. More severe blows frequently result in inferior, medial, and posterior displacement of the zygoma. Comminuted fractures of the body with separation at the suture lines are most often the result of high-velocity motor vehicle accidents.

In general, displaced fractures involve the inferior orbital rim and orbital floor, the zygomaticofrontal suture, the zygomaticomaxillary buttress, and the zygomatic arch. However, occasionally, a direct blow to the arch results in an isolated depressed fracture of the arch only.[3]

Previous
Next

Epidemiology

Frequency

United States

Zygomatic fractures are the second most common fracture of the facial bones following nasal bone fractures.[4]

Mortality/Morbidity

As many as 5% of patients with zygomatic fractures have associated ophthalmic injuries.

Sex

Males are afflicted with zygomatic fractures more commonly than females by a 4:1 ratio.

Age

Most cases of zygomatic fractures occur in young patients in their second to third decades of life.

Previous
 
 
Contributor Information and Disclosures
Author

Stuart Seiff, MD, FACS Emeritus Professor of Ophthalmology, University of California, San Francisco, School of Medicine; 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, California Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Dan D DeAngelis, MD, FRCSC Assistant Professor of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Ophthalmologist, Department of Ophthalmology and Vision Sciences, Hospital for Sick Children

Dan D DeAngelis, MD, FRCSC 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, 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, American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

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, International Society of Refractive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

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 College of Surgeons, AO Foundation, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the assistance of Ryan I Huffman, MD, with the literature review and referencing for this article.

References
  1. Gruss JS, Van Wyck L, Phillips JH, et al. The importance of the zygomatic arch in complex midfacial fracture repair and correction of posttraumatic orbitozygomatic deformities. Plast Reconstr Surg. 1990 Jun. 85(6):878-90. [Medline].

  2. Song WC, Choi HG, Kim SH, et al. Topographic anatomy of the zygomatic arch and temporal fossa: A cadaveric study. J Plast Reconstr Aesthet Surg. 2008 Oct 21. [Medline].

  3. Zingg M, Laedrach K, Chen J, et al. Classification and treatment of zygomatic fractures: a review of 1,025 cases. J Oral Maxillofac Surg. 1992 Aug. 50(8):778-90. [Medline].

  4. Covington DS, Wainwright DJ, Teichgraeber JF, et al. Changing patterns in the epidemiology and treatment of zygoma fractures: 10-year review. J Trauma. 1994 Aug. 37(2):243-8. [Medline].

  5. Barry C, Coyle M, Idrees Z, et al. Ocular findings in patients with orbitozygomatic complex fractures: a retrospective study. J Oral Maxillofac Surg. 2008 May. 66(5):888-92. [Medline].

  6. He D, Li Z, Shi W, Sun Y, Zhu H, Lin M, et al. Orbitozygomatic Fractures With Enophthalmos: Analysis of 64 Cases Treated Late. J Oral Maxillofac Surg. 2011 Jul 11. [Medline].

  7. Laine FJ, Conway WF, Laskin DM. Radiology of maxillofacial trauma. Curr Probl Diagn Radiol. 1993 Jul-Aug. 22(4):145-88. [Medline].

  8. Friedrich RE, Heiland M, Bartel-Friedrich S. Potential of ultrasound in the diagnosis of midface fractures. Clinical Oral Investigations. 2003. 7:226-229. [Full Text].

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

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

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

  12. 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. 2008 Nov. 66(11):2302-7. [Medline].

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

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

  15. Trivellato PF, Arnez MF, Sverzut CE, Trivellato AE. A retrospective study of zygomatico-orbital complex and/or zygomatic arch fractures over a 71-month period. Dent Traumatol. 2011 Apr. 27(2):135-42. [Medline].

Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.