Zygomatic Orbital Fracture Workup
- Author: Stuart Seiff, MD, FACS; Chief Editor: Hampton Roy, Sr, MD more...
The only tests needed are those for preoperative evaluation as required by the surgery facility.
Orbital imaging is appropriate.
Radiographic evaluation of the fracture is mandatory and may include both plain films and a CT scan. Typically, CT scan is the study of choice. There is little role for MRI in the management of these injuries.
A Waters view radiograph may show evidence of the zygomatic fracture and subsequent displacement, as shown below.
CT scans (orbit and sinuses) have now essentially replaced plain films as the standard imaging study in both evaluation and treatment planning. CT scans are generally easier to read than plain films and give more helpful information. See the images below.
An axial CT scan with 1-mm sections and a coronal CT scan with 3-mm cuts (facial series) should be obtained to best delineate the anatomy. The CT scan accurately reveals the extent of orbital involvement and the degree of displacement of the fractures. The integrity of the mandible as well as of the temporomandibular joint should be evaluated.
CT scans are vital in planning the operative approach. The CT scans should be available for review in the operating room. Furthermore, evaluation with CT scans is helpful for the approximately 50% of patients who have concomitant intracranial injury.
Ultrasonography could be useful as a screening tool to aid in the detection of zygoma and orbital rim fractures. With experience, ultrasonography could also be used for intraoperative evaluation after a closed reduction where direct visualization of alignment is not possible.
Several classifications of zygomatic fractures have been described in the literature, but none seem to be universally accepted. Most classifications are based on the degree of comminution, whether the fracture is simple or compound, and the site of the fractures. In 75% of cases, these fractures are displaced inferiorly, medially, and posteriorly.
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