Question

Discuss the clinical features and management of zygomatic fracture. [3+3]

Hint:

Prompt reduction and fixation of displaced zygomatic fractures are crucial for optimal outcomes, particularly for restoring facial symmetry and preventing functional impairments.

Answer 1

Step 1: Clinical Features of Zygomatic Fracture.
Zygomatic fractures typically result from blunt trauma to the face, such as motor vehicle accidents, sports injuries, or assaults. The clinical features of a zygomatic fracture include:
(1) Facial Swelling and Bruising: Immediate swelling and ecchymosis (bruising) over the cheek, particularly around the zygomatic arch. This is often accompanied by tenderness in the region.
(2) Flattening of the Cheek: One of the hallmark signs of a zygomatic fracture is the loss of the normal contour of the cheek, resulting in facial asymmetry.
(3) Malocclusion: A misalignment of the upper and lower teeth may occur if the fracture involves the zygomaticomaxillary complex (ZM, affecting the bite.
(4) Diplopia (Double Vision): Diplopia may occur due to the involvement of the orbital floor, leading to entrapment of the inferior rectus muscle or disruption of the orbital wall.
(5) Periorbital Numbness: Numbness or tingling in the cheek or upper lip, due to involvement of the infraorbital nerve.
(6) Pain on Eye Movements: If the fracture involves the orbital floor, pain on upward or downward eye movements may occur.
(7) Bruising Around the Eye (Raccoon Eyes): Bruising around the eyes may indicate involvement of the orbit, a common finding in zygomatic fractures.
Step 2: Management of Zygomatic Fracture.
The management of zygomatic fractures involves both medical and surgical interventions, depending on the severity and displacement of the fracture. Key components of management include:
(1) Initial Assessment and Stabilization: The first step is to assess the patient's airway, breathing, and circulation, as well as evaluate for other injuries, particularly to the brain or cervical spine.
(2) Imaging: A CT scan of the facial bones is the gold standard for assessing the extent of the fracture, including involvement of the orbit and zygomaticomaxillary complex.
(3) Non-Surgical Treatment: If the fracture is non-displaced or minimally displaced, conservative management with ice packs, pain control, and antibiotics (to prevent infection) may be sufficient.
(4) Surgical Treatment: For displaced fractures, surgical intervention is often required. The most common approach is open reduction and internal fixation (ORIF). The fractured zygomatic bone is repositioned using plates and screws to restore facial symmetry.
- Endoscopic Approaches: In some cases, especially for less severe fractures, endoscopic surgery can be used for a less invasive approach.
(5) Follow-Up Care: Post-surgery, patients are monitored for complications such as infection, nerve damage, or misalignment of the bones. Regular follow-up visits are essential to ensure proper healing and restoration of function.