This document discusses the classification, treatment approaches, and management of zygomatic fractures. It describes 8 types of zygomatic fractures based on the pattern of displacement. Treatment may involve either closed or open reduction with internal fixation using miniplates, wires, or pins placed through various surgical approaches. Postoperative care involves avoiding activities that could displace the fracture for several weeks to allow proper healing.

1. Dr. Armaghan Mirza
FCPS Resident
Oral & Maxillofacial Surgery
de’Montmorency College of Dentistry

2.  Fronto zygomatic
 Zygomatico maxillary
 Infraorbital rim
 Zygomatic buttress
 Zygomatico temporal
 Zygomatico sphenoid

3.  Closed reduction
 ORIF
 1 point
 2 points
 3 points
 4 points
Points to consider?
Energy of insult?
Displacement direction?
Time elapse since injury
Associated fractures

5.  Type I- No displacement
 Type II-Zygomatic Arch fracture
 Type III-Rotation around vertical axis
a.anterior displacement of orbital rim
b.Posterior displacement of orbital rim
 Type IV- Rotation around horizonatal axis
a.Medial displacement of frontal process
b.Lateral displacement of frontal process
 Type V-En block
 Type VI – Displacement of orbitoantral partition
 Type VII – Displacement of orbital rim
 Type VIII - Communited fracture

6.  as soon as possible
 delay  gross edema dispersion / proper ophthalmic
examination
 Retrobulbar hemorrhage  Vision deterioration very
urgent surgery

7.  Non surgical management
 Medical contraindications
 Very elderly
 Minimal displacement
Surgical management
 Flat cheek
 Diplopia
 Infraorbital paraesthesia
 Impaired mandibular movement

8.  Temporal fossa ( Gillis approach)
 Intra oral (Keen approach)
 Percutaneous ( Champion technique)
 Lateral eyebrow ( Dingman approach)
 Malar hook

9. 1. Osteosynthesis
a. Direct wiring
b. Miniplates or microplates
2. Antral support
a. Antral pack
b. Balloon
3. External pin fixation
a. F-Z
4. Internal pin fixation
a. Transmaxillary K-wire
b. Nasomaxillary K-wire

10.  Low infra orbital
 Sub ciliary
 Trans conjunctival +/- lateral canthotomy
 Lateral eyebrow
 Blepheroplasty(Upper eyelid & lower eyelid)
 Coronal flap
 Petterson ethmoidectomy
 Crow foot incision
 Pre auricular incision

11.  Do not
Lie on the side
Press over affected side
Blow through nose
Involve in contact sports
Widely open the mouth

12.  Reduction & fixation (or stabilization); the
norm
 FZ & buttress exposure (visualize 3 points)
 Is this morbid?
 Least one can do
 Plate the buttress