Zygomaticomaxillary complex fracture is one of the types of facial skeleton fractures. Just like fracture in the zygoma, this happens on the face after a strong impact on the facial skeleton. Unlike calcaneus fracture and the sternum fracture, this one might affect the way you breathe and your vision as well. For instance, a patient with ZMC fracture is not allowed to blow hard into the nose within the next ten days after the bone fracture happened. When the bones are displaced, this would be even more difficult to address. The fracture healing time might take longer than necessary. Maxillary fracture is another type of fracture injury that affects the facial skeleton. Thus, the patient should be extra careful especially with more complicated cases of the fracture.
In the formation of the facial skeleton, the zygomaticomaxillary complex can help develop the aesthetic appearance of the face. It also contributes to the function of the skeleton as well. Without ZMC, no cheek bone formation would be noticed on the human facial skeleton. This also serves as the border between the maxillary sinus and temporal fossa and the orbital contents. Moreover, it also serves by supporting the binocular vision of the humans, no wonder why the vision would be affected by the fracture on the zygomatic arch. This arch is the part where the masseter muscle is inserted. Another important role for the arch would be to protect the coronoid process and temporalis muscle.
Nasal fracture ranks first when it comes to the different types of facial fracture. The second one in the list would be zygomatic arch fracture. It is a bone vulnerable to trauma due to its prominent convex shape. If the patient experiences displaced bones with this type of fracture, just like in Lefort fracture, this would already be evident in some aesthetic deformities.
Zygomaticomaxillary fractures are more common among males than in females, with a one is to four ratio. These are most frequent among people who are aged 20 to 30 years. Women patients who are abused by their partners are usually victims of zygomaticomaxillary bone fracture. Mandible fracture also happens to women who are surprisingly attacked by an unknown assailant.
This fracture of facial bone is usually caused by falls, personal altercations, vehicular accidents, and in sometimes, contact sports. Some patients with broken zygomaticomaxillary bones usually have other types of fractures in some body parts aside from the face.
Fractured ZMC Classifications
There are different types of classification of ZMC fracture in adults because ZMC fracture in children does not usually happen.
- Type A fracture. This refers to a zygomaticomaxillary injury that only happens to one of the tetrapod components, such as the zygomatic arch (A1), lateral orbital wall (A2), and inferior orbital rim (A3). This is not really common among patients with ZMC bone fracture.
- Type B fracture. This refers to fractures that happen to all the four buttresses.
- Type C fracture. This refers to the complex fractures wherein the fractured zygomatic bone has comminution.
Even if these are not really clinically significant as the classifications of the fractures in the facial skeleton, these are helpful to doctors who would communicate with each other during research and other purposes. While type A injuries are not common, combined type B and C injuries compose 62% of the injuries on the ZMC.
Facial trauma usually happens in the spots of the facial skeleton that are more fragile. This means that during the examination of facial fractures, the doctor should be checking the hemodynamic stability and airway control of the facial skeleton. The doctor should also check for a possibility of spinal injury during clinical examination. A globe injury should be carefully checked as well.
During the stabilized condition of the patient, the doctor can then ask about the injury history of the patient and do physical examination afterwards. After the facial fracture has been identified, an ophthalmologic consultation is still necessary.
Pain is the primary symptom of an injury on the ZMC. Other ZMC fracture symptoms would include edema, malar flattening, ecchymosis of the eyelids and cheek, palpable periorbital step-offs, and more. If the facial skeleton was hit with a strong traumatic force, the patient might experience rotation of the medial, posterior and inferior parts of the zygomatic bone. Another offshoot from the fracture would be trismus, which restricts the movement of the jaw. Infraorbital nerve injury is another result of the fracture.
When to Seek Surgical Intervention
Fracture surgery is deemed necessary if the following things happen:
- Visual defect. Orbital apex syndrome and significant exopthalmos, which are eye defects, would call for immediate surgery before any further fracture complications would happen to the patient’s vision.
- Globe displacement. Hypophthalmos or enophthalmos happens after the edema resolution. This will also call for acute orbital dystopia.
- Extraocular muscle dysfunction. Local tissue edema, muscle contusion, extraocular muscle entrapment or strangulation can cause dysfunction on the ocular muscles. Without immediate surgery, these could result to muscle necrosis.
- Significant orbital floor disruption. This usually refers to injuries that affect 25 to 50% of the orbital floor. Surgical repair and orbital exploration are necessary.
- Displaced comminuted fractures. These will deform the facial skeleton if not repaired through surgery immediately.
Diagnosis of the fractured zygoma does not usually make use of traditional facial radiographs. The CT scan is usually rendered as the most useful method of ZMC fracture diagnosis that will help in determining the extent of the injury. With the help of the CT scan, the doctor can determine a more accurate way of how to treat ZMC fracture quick. This fracture also concerns the head and the brain, which is why the diagnosis should lead to a correct way to treat ZMC fracture.
There are many other types of diagnostic tests that can be performed to check the injury brought about by zygomaticomaxillary fracture. A visual acuity test should be performed to check the eyes after all a significant disruption to the bony orbit. Another necessary test would be the forced-duction tests. This will help check if there is a mechanical restriction of the globe motion.
ZMC fractures, just like tripod fracture, can be treated with medicines. If a patient wants to buy medications in a convenient way, emedicine is available. Displaced ZMC fracture treatment usually consists of a soft diet, close outpatient monitoring, and some more medications.
The recovery time of the fracture would depend on when the injured bone will become stable enough through reduction. Even if any patient would desire to find ways on how to heal quickly, some considerations like minimizing functional deformity and scars have to be taken to view. These ways on treating fracture of zygoma quickly will only be done a few days after the injury.
During surgical treatment, anesthesia would be administered. After this, the surgeon should check for skin lacerations where the screws and plates can be administered. Common surgeries done on patients are incisions on the lateral orbit, sublabial, scalp incisions and lower eyelid. These incisions need to be operated in a hierarchical style.
The patient can choose which type of incision can be done since a fracture cast cannot be used on the face. This also goes the same for brace/braces. The sublabial incision is a subtle incision with minimal morbidity. This will make reduction for zygomaticomaxillary buttress possible. The lateral orbital incision is necessary for fractures that cannot be taken care of by sublabial incision. The lowed eyelid incision is another subtle cut but this might result to either corneal exposure or eyelid malposition. While there could be fracture complications, these are also surgical complications. This incision is necessary for fractures that need to expose three buttresses for a complete repair and rehabilitation of the fracture. The scalp incision is already required for severely comminuted ZMC fracture injuries. This incision has little morbidity but this little cut could also result to scalp anesthesia and some scars.
After surgery, it would still take a few weeks as zygomaticomaxillary fracture healing time before complete recovery will take place. By then, caution should still be practiced to avoid injuring the sensitive facial bone.