Diagnosis and management of common maxillofacial injuries in the emergency department. Part 3: orbitozygomatic complex and zygomatic arch fractures

This is most commonly seen after assault, but any blow to the cheek may give rise to a fracture. Zygoma fractures are easy to miss and displaced fractures require treatment within 10 days. Untreated fractures may cause a cosmetic deformity (flattening of the cheek) or limited mandibular movement caused by the depressed zygoma impinging on the coronoid process of the mandible. Enquire about the mechanism of injury; zygoma fractures usually occur after blunt trauma. Altogether, 70–90% of patients will complain of infra orbital/upper lip numbness on the affected side. This may involve the maxillary central, lateral, and/or canine teeth. The affected side of face may be flattened when compared to the other side, although this can often be difficult to appreciate especially in the presence of swelling. The patient may complain of a cosmetic defect on the affected side. The patient may have epistaxis because of disruption of the membrane of maxillary sinus or an abnormal occlusion because of the fracture preventing normal mandibular movements. A malar fracture should be suspected if periorbital oedema, ecchymosis of the lower lid, and/or a lateral sub conjunctival haemorrhage (bloodshot eye) is present. A flat malar arch is best assessed from behind the patient’s head. Compare …