Etiology The most common causes of zygomaticomaxillary complex ZMC fractures include personal altercations, falls, motor vehicle accidents, and sports injuries. Specific attention is given to the position of the malar eminence and reduction of orbital volume by realigning the zygoma and sphenoid.
Isolated injuries in these areas are uncommon. The most common symptoms associated with ZMC fractures include pain, edema, and ecchymosis of the cheek and eyelids. This study is much easier to perform under general anesthesia. The term ZMC fracture describes a spectrum of injuries that includes nondisplaced fractures, fractures displaced at an isolated buttress, and severely comminuted fractures with bone loss.
When zygomaticomaxillary complex ZMC fractures are identified, an ophthalmologic consultation should be obtained. The weakest bone of the ZMC complex is the orbital floor. However, the term tetrapod fracture is a more accurate description because 4 suture lines are disrupted.
Finally, any overt globe injury should be evaluated. These injuries are associated with an increased risk of optic nerve injury and visual loss. Open reduction and internal fixation is reserved for cases that are severely angulated or comminuted.
These injuries generally result in cosmetic deformity and require surgical repair. Contraindications Contraindications to surgical repair of zygomaticomaxillary complex ZMC fractures include medical instability and globe injuries. Information about the degree and severity of the overall injury can be extrapolated from the location of the fractures.
Type A3, B, and C injuries result in orbital floor disruption, which places the orbital contents at risk. In these patients, orbital exploration with surgical repair should be considered. Relevant Anatomy The malar eminence is the most prominent portion of the zygomaticomaxillary complex ZMC and is located approximately 2 cm inferior to the lateral canthus.
Infraorbital nerve injury may result in anesthesia or paresthesias of the cheek, nose, upper lip, and lower eyelid. Orbital floor disruption can result in subcutaneous emphysema.
Airway control and hemodynamic stability are the primary concerns. These injuries can be isolated, but they are often associated with orbital floor fractures. Facial bruising, periorbital ecchymosis, soft tissue gas, swelling, trismusaltered masticationdiplopiaand ophthalmoplegia are other indirect features of the injury.
Enophthalmos or hypophthalmos following acute injury becomes more pronounced with resolution of edema.
Presentation The initial evaluation of facial trauma patients is focused on areas that can result in the greatest morbidity. The frontozygomatic and zygomaticosphenoidal buttresses are very strong.
The zygomaticofrontal buttress is the strongest of the 4 ZMC buttresses. Fractures with displacement require surgery consisting of fracture reduction with miniplates, microplates and screws.
In most cases, there is loss of sensation in the cheek and upper lip due to infraorbital nerve injury. Classification Many authors have devised classification schemes for zygomaticomaxillary complex ZMC fractures.zygomaticomaxillary complex fracture: a modified surgical technique Jiawen Si *, Rong Ren, Minjiao Wang, Hongliang Li, Steve GF Shen, through the lateral eyebrow and gingival-buccal sulcus incisions in one displaced tripod ZMC fracture case.
Open spective studies of both Zingg et al and Hwang et al, tripod fractures formed about one. If that's the case, my advice is to supplement it heavily with other resources.
Enjoy the case studies, but don't expect to understand the terminology or to get a concrete, step-by-step tutorial on implementing the methods listed in this lengthy primer/5(9).
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Mar 14, · The zygomaticomaxillary complex (ZMC) plays a key role in the structure, function, and aesthetic appearance of the facial skeleton. It provides normal cheek contour and separates the orbital contents from the temporal fossa and the maxillary sinus.
The zygoma is the origin for the masseter, thus. Zhejiang Medicine Company (ZMC) is a large-scale pharmaceutical producer with roots in China dating back to the s.
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