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Zygomatic Arch Fractures Workup

  • Author: Adam J Cohen, MD; Chief Editor: Deepak Narayan, MD, FRCS  more...
Updated: Feb 26, 2015

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.


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.


Other Tests

An electrocardiogram also may be necessary before proceeding with the repair.

Contributor Information and Disclosures

Adam J Cohen, MD Assistant Professor of Ophthalmology, Section Director of Oculoplastic and Reconstructive Surgery, Rush Medical College of Rush University Medical Center

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: BioD, Poferious<br/>Serve(d) as a speaker or a member of a speakers bureau for: IOP<br/>Received income in an amount equal to or greater than $250 from: IOP for speaking.


Michael Mercandetti, MD, MBA, FACS Private Practice

Michael Mercandetti, MD, MBA, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, Sarasota County Medical Society, American Academy of Ophthalmology, American College of Surgeons, American Society for Laser Medicine and Surgery, American Society of Ophthalmic Plastic and Reconstructive Surgery, Association of Military Surgeons of the US

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.

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, Texas Society of Plastic Surgeons

Disclosure: Received none from Allergan for speaking and teaching; Received none from LifeCell for consulting; Received grant/research funds from GID, Inc. for other.

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, Plastic Surgery Research Council, Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Indian Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

James F Thornton, MD Associate Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center

Disclosure: Nothing to disclose.

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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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