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Contemporary Review | Journal Club

Zygomaticomaxillary Complex Fractures

Danny Meslemani, MD; Robert M. Kellman, MD
Arch Facial Plast Surg. 2012;14(1):62-66. doi:10.1001/archfacial.2011.1415.
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Extract

The term zygomaticomaxillary (zygomaticomalar) complex (ZMC) fractures refers to the Quiz Ref IDosseous disruption of the malar eminence at 4 buttresses: zygomaticomaxilllary, frontozygomatic (FZ), zygomaticosphenoid, and zygomaticotemporal1 (Figure 1).2 The ZMC fracture is the second most common facial fracture, after the nasal bones.1 The prominent nature of the malar eminence places this structure at great risk for fracture, and the intricate 3-dimensional (3D) nature of the ZMC can sometimes make the repair quite challenging (Figure 2). Several authors have noted the high rate of misalignment and displacement after repair.3,4 Despite seemingly adequate reduction and/or fixation, several authors have also noted high rates of asymmetry in up to 13% of cases.3,4 The asymmetry manifests because of an inadequate intraoperative reduction or a postreduction displacement encountered during the postoperative period. Surgeons may place the blame on inadequate fixation during the initial operation, postoperative displacement due to the pull of the masseter muscle, or poor initial reduction.

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Figure 1. The illustration shows the 4 suture lines that are associated with a zygomaticomaxillary complex fracture. The arrows show the distribution of energy after an impact on the malar eminence (reproduced with permission from Strong and Sykes2).

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Figure 2. The 3-dimensional Illustration of a representative craniofacial skeleton with the x-axis (X) through the inferior orbital rim and zygomatic arch. The y-axis (Y) extends from the frontozygomatic suture line, inferiorly along the lateral wall of the orbit. The z-axis (Z) is perpendicular to the malar eminence, parallel to the lateral wall of the orbit.

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Figure 3. Compression of a fractured zygoma on the cornoid process (arrow).

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Figure 4. An axial computed tomogram showing a fractured zygoma compressing the temporalis muscle.

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Figure 5. An axial computed tomogram showing a zygomaticosphenoid suture (arrow) in a zygomaticomaxillary complex fracture.

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Figure 6. [[ldquo]]White-eye fracture[[rdquo]] from inferior rectus muscle entrapment in a right orbital floor fracture.

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Figure 7. A 3-dimensional computed tomographic reconstruction of a left zygomaticomaxillary complex fracture.

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