As a diplomate of the American Board of Plastic Surgery, I find it important to stay abreast of new and updated information that will allow me to better care for my patients. The following is a summary of an update that was recently published regarding the management of patients with facial fractures (i.e. nasal fractures, orbital fractures, zygoma fractures). In this particular article, studies on the management of zygoma fractures are reviewed. (Plastic and Reconstructive Surgery, Vol 127 No 2 Feb 2011 p891-7):
As a plastic and reconstructive surgeon, I see a great number of patients at Cedars-Sinai Medical Center (Los Angeles, California) as well as in my office who have suffered facial injuries. When a patient suffers facial trauma, a thorough physical examination is essential. In particular, when any patient suffers a traumatic injury in and around the orbit (eye socket), it is essential to have a complete examination of the eyeball and vision.
Once the examination is complete, radiographic evaluation must be performed. This serves two purposes. First, it will help establish the presence or absence of a facial bone fracture(s). Second, it will help delineate the fracture pattern (see below). Knowing this information with help me as a plastic surgeon to establish an action plan for treating the injury.
Pre-operative Assessment for Zygoma Fractures:
1) Computerized tomography (CT scan) is the gold standard radiographic exam.
2) CT scan in combination with Hertel exophthalmometry provides more anatomic information than exophthalmometry alone.
3) Ultrasound is a cost-effective imaging technique that avoids radiation exposure. (In my experience, CT scan provides more accurate and detailed information. Ultrasound is not commonly used in this capacity)
4) MRI using a microscopy orbital coil is an alternative for diagnosing pediatric orbital fractures.
Classification of Zygoma Fracture Types:
I: no significant displacement (fractures exist, but bones are aligned)
II: zygomatic arch fractures
III: unrotated body fractures
IV: medially rotated body fractures with outward displacement at the zygomatic prominence or inward at the zygomatic frontal suture
V: laterally rotated body fracture with upward displacement at the infraorbital margin or outward displacement at the zygomaticofrontal suture
VI: complex comminuted injury (broken into multiple pieces).