Zygomatic Arch Fractures Workup

  • Author: Adam J Cohen, MD; Chief Editor: Deepak Narayan, MD, FRCS   more...
 
Updated: Jul 13, 2011
 

Laboratory Studies

  • If alcohol or illicit drug use is suspected, obtain and document serum levels.
  • As with most surgical patients, appropriate preoperative laboratory tests (eg, complete blood cell count, metabolic panels, activated partial thromboplastin time) and an international normalized ratio are necessary. Obtain a pregnancy test when clinically warranted.
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Imaging Studies

A chest radiograph may be necessary before proceeding with the repair.

Roentgenograms can be used but are limited by the lack of ability to detect differences in tissue density of less than 10%, making evaluation of soft tissue difficult at best. Standard facial series are the norm and are obtained with varying angulation of the x-ray beam vector. The Caldwell projection allows for visualization of the orbital floor and zygomatic process above the dense petrous pyramids. A submental vertex view affords excellent detail of the zygomatic arches. Anterior-posterior and Waters views reveal much less about the zygomaticomaxillary complex (ZMC) than other planes and are of limited value.

Computed tomography (CT) scans have supplanted radiographs in the evaluation of midfacial trauma and are the current modality of choice.[4] A gray-scale image is created based on various soft tissue linear coefficients that are assigned a particular shade of gray. Direct axial, coronal, or sagittal images can be obtained with proper positioning of the patient. CT scanning without contrast provides views of high-density bone.

Obtain both axial and direct coronal, 1.5- to 2-mm cuts to properly evaluate the orbit. If the patient cannot be manipulated into proper position for direct coronal images, coronal views also may be obtained indirectly by a reformat of thin axial windows. Coronal orbital views provide bone and soft tissue windows, allowing for detailed images of the lateral orbital wall, ZMC, and adjacent soft tissue and bone structures.

Magnetic resonance imaging (MRI) uses a magnetic field and the activity of hydrogen atoms within this field to produce magnificently detailed images of the orbit. MRI enables multiplanar imaging and is excellent for evaluating soft tissue masses and optic nerve pathology.[5] Although MRI provides exquisite detail of the orbital region, CT scanning remains the imaging modality of choice for evaluation of orbital trauma because of its ability to discern detail of bony structures. Of note, intraocular ferromagnetic foreign bodies can add additional insult to the eye and surrounding structures secondary to the magnetic field of MRI.

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Other Tests

  • An electrocardiogram also may be necessary before proceeding with the repair.
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Contributor Information and Disclosures
Author

Adam J Cohen, MD  Eyelid and Facial Aesthetic and Reconstructive Surgery, Diseases and Surgery of the Orbit and Lacrimal System, Cosmetic Laser Surgery

Adam J Cohen, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

James F Thornton, MD  Assistant Professor, Department of Plastic and Reconstructive Surgery, University of Texas Southwestern

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Jaime R Garza, MD, DDS, FACS  Consulting Staff, Private Practice

Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Nicolas (Nick) G Slenkovich, MD  Director, Colorado Plastic Surgery Center

Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Deepak Narayan, MD, FRCS  Associate Professor of Surgery (Plastic), Yale University School of Medicine; Chief of Plastic Surgery, West Haven Veterans Affairs Medical Center

Deepak Narayan, MD, FRCS is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Indian Medical Association, Plastic Surgery Research Council, Royal College of Surgeons of Edinburgh, and Royal College of Surgeons of England

Disclosure: Nothing to disclose.

References

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  2. Manson PN, Clark N, Robertson B, et al. Subunit principles in midface fractures: the importance of sagittal buttresses, soft-tissue reductions, and sequencing treatment of segmental fractures. Plast Reconstr Surg. Apr 1999;103(4):1287-306; quiz 1307. [Medline].

  3. Terino EO. Alloplastic contouring in the malar-midface-middle third facial aesthetic unit. In: Terino EO, Flowers RS, eds. The Art of Alloplastic Facial Contouring. St. Louis, Mo: Mosby Year-Book; 2000:79-96.

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  13. Mercandetti M, Cohen AJ. Tumors, Orbital. eMedicine from WebMD [serial online]. February 7, 2007;Accessed January 27, 2009. Available at http://emedicine.medscape.com/article/1218892-overview.

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Gillies approach to reduction of a zygomatic arch fracture.
Anatomic depiction of the masseter muscle as it relates to the zygomaticomaxillary complex and mandible.
 
 
 
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