Ratio of Simple versus Comminuted Lateral Wall Fractures of the Orbit.

Facial fractures are a common result of trauma, with the leading causes being assault, motor vehicle collisions, falls, and sports.1 2 The zygoma is one of the most common bones fractured in the face; second only to nasal fractures. Extensive literature exists discussing the incidence, evaluation, and treatment of zygoma fractures. The zygoma plays a crucial role in the anterior-posterior projection and width of the face and composes a significant portion of the lateral wall of the orbit; making it imperative to confirm accurate reduction and alignment of the zygoma to ensure a good aesthetic and functional outcome. Proper reduction of the zygoma is also important for restoration of the proper orbital volume.3 A thorough knowledge of the anatomic landmarks surrounding the zygoma is necessary to understand how to confirm the proper reduction of zygoma fractures. The zygoma is bound by the maxilla, frontal, sphenoid, and temporal bones. Its relationship to the surrounding craniofacial skeleton creates the three dimensional structure of the orbit and defines the malar prominence. Accurate positioning of the zygoma can be achieved by confirming the alignment of the three buttresses; the zygomaticofrontal suture, the zygomaticomaxillary buttress, and the inferior rim of the orbit. The reduction and alignment of the zygomatic arch can be very helpful in assuring the proper anterior-posterior position of the zygoma, as well as the width of the midface, but generally requires a coronal incision, which can be associated with scar alopecia, temporal hollowing, and possible injury to the frontal branch of the facial nerve. The single most important landmark to observe in the reduction of a zygoma fracture is to confirm the alignment of the lateral wall of the orbit. Reducing a zygoma fracture may be relatively easy when there is a simple, noncomminuted fracture line along the zygomaticofrontal suture, the zygomaticomaxillary prominences of the lateral midface column (zygomaticomaxillary buttress) or the inferior rim of the orbit. When one or more of these key landmarks is comminuted it becomes more important to visualize the lateral orbital wall (LOW) and confirm that the common fracture between the greater wing of the sphenoid and the zygoma is properly reduced to ensure that the zygoma has been properly repositioned. The zygoma and greater wing of the sphenoid interface represents a large surface that defines the lateral wall and part of the lateral floor of the orbit. Fractures commonly occur along a somewhat curvilinear line near the articulation between the zygoma and the greater wing of the sphenoid. Proper repositioning of a displaced zygoma with the proper realignment of the lateral wall and orbital floor is of the utmost importance in defining the orbital volume. In patients with comminuted fractures of the other key landmarks along the orbital aperture and the anterior malar area, it is particularly important to confirm that this fracture line between the greater wing of the sphenoid and the zygoma is properly reduced.4 5 In patients with simple, noncomminuted fractures of the LOW, the zygomaticosphenoidal suture line is an excellent landmark for confirming the reduction of the zygoma. This reference point is less reliable in patients who have comminuted factures of the lateral wall. The surgeon must then focus on other means to confirm a satisfactory reduction of the zygoma. The purpose of this study was to determine the frequency that the LOW can be used as a reliable landmark in the reduction of a zygoma fracture by determining the ratio between simple lateral orbital wall fractures (LOWFs) and comminuted LOWF. The goal of this study was to compare the ratio of simple LOWF to comminuted LOWF in 100 patients.