Dr. Armaghan Mirza FCPS Resident Oral & Maxillofacial Surgery de’Montmorency College of Dentistry
Dr. Armaghan MirzaFCPS Resident
Oral & Maxillofacial Surgeryde’Montmorency College of Dentistry
Fronto zygomaticZygomatico maxillary
Infraorbital rim Zygomatic buttress
Zygomatico temporalZygomatico sphenoid
Closed reductionORIF
1 point 2 points 3 points 4 points
Points to consider?Energy of insult?
Displacement direction?Time elapse since injury
Associated fractures
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
as soon as possible delay gross edema dispersion / proper
ophthalmic examination Retrobulbar hemorrhage Vision deterioration
very urgent surgery
Non surgical management Medical contraindications Very elderly Minimal displacementSurgical management Flat cheek Diplopia Infraorbital paraesthesia Impaired mandibular movement
Temporal fossa ( Gillis approach) Intra oral (Keen approach) Percutaneous ( Champion
technique) Lateral eyebrow ( Dingman
approach) Malar hook
1. Osteosynthesisa. Direct wiringb. Miniplates or microplates
2. Antral supporta. Antral packb. Balloon
3. External pin fixationa. F-Z
4. Internal pin fixationa. Transmaxillary K-wireb. Nasomaxillary K-wire
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
Do not Lie on the side Press over affected side Blow through nose Involve in contact sports Widely open the mouth
Reduction & fixation (or stabilization); the norm
FZ & buttress exposure (visualize 3 points) Is this morbid?
Least one can do Plate the buttress