Fracture, Zygoma

Ovid: 5-Minute Sports Medicine Consult, The

Fracture, Zygoma
Martha A. Dodson
Pediatric Considerations
  • Maxillofacial fractures are rarely seen in the pediatric population.
  • Children have a comparatively larger cranium than facial skeleton, leading to a higher incidence of head trauma.
  • Falls and motor vehicle accidents account for the majority of facial trauma in children.
  • Consider nonaccidental trauma, particularly in children under age 6.
  • Fractures of the zygoma result from blunt trauma to the side of the face.
  • The most common mechanisms include motor vehicle accidents, falls, and physical assault.
  • The direction and magnitude of force will determine the fracture type and degree of displacement.
    • A blow to the side of the face directed posteriorly and medially will produce a zygomatic body (tripod) fracture.
    • A lateral blow often results in an isolated zygomatic arch fracture.
  • Zygoma fractures may have associated paranasal sinus fractures.
Risk Factors
  • Motor vehicle collisions
  • Falls
  • Assault
  • Blunt-force trauma from athletic equipment including ball(s)
General Prevention
  • Appropriate use of athletic helmet/face shield
  • Proper use of vehicle safety restraints
Commonly Associated Conditions
  • Facial lacerations
  • Ecchymosis
  • Edema
  • Palpable defect
  • Trismus
  • Orbital floor fracture
  • Maxillary sinus fracture
Pediatric Considerations
  • Sedation may be required to properly examine some children.
  • If a head injury is suspected, sedation is not recommended.
  • If circumstances or injuries raise suspicions of child abuse, a comprehensive investigation for previous nonaccidental trauma is essential.
  • If a high-velocity or severe blunt-force mechanism is suspected, a thorough evaluation for associated injuries (cervical spine, head, globe, other maxillofacial bones, etc.) is imperative.
  • Radiographs:
    • The submental vertex (jug-handle) view is used to diagnose fractures of the zygomatic arch.
    • Plain films are not as useful in the evaluation of zygomatic body fractures.
    • The Waters (occipitomental) view shows the inferior orbital rims and possibly layering of blood in the maxillary sinus.
    • The articulation between the zygoma and frontal bone can be evaluated on the Caldwell view.
Pre Hospital
  • ABCs:
    • Airway
    • Breathing
    • Circulation
  • Cervical spine: Immobilization PRN.
  • Cautions:
    • Airway compromise may occur with severe maxillofacial injuries.
    • Assume that the patient with face or head injury has also sustained a cervical spine injury until proven otherwise.
  • Direct blow to face with ball, elbow, or sports equipment
  • May or may not have loss of consciousness
  • May complain of double vision owing to orbital floor disruption
  • May complain of trismus
Physical Exam
  • Signs and symptoms:
    • Malar edema or flattening
    • Periorbital ecchymosis, drooping lateral canthus
    • Lateral subconjunctival hemorrhage, diplopia
    • Infraorbital anesthesia, trismus/open bite
  • Physical examination:
    • Intraoral palpation of the zygomatic body and arch for bony step deformity
    • Palpation of arch for crepitance and/or step-off deformity
    • Assess sensation of the inferior orbital area (cheek, upper lip, and gingiva).
    • Examine the globe and orbit carefully.
      • Periorbital ecchymosis and lateral subconjunctival hemorrhages are common.
      • Assess visual acuity, pupillary function, and extraocular movements.
      • Inferior displacement of the globe may lead to diplopia and enophthalmos. Carefully evaluate extraocular movements.
    • Mandibular movement may be restricted.
    • Trismus may be seen if there is impingement of the mandibular coronoid process by displacement of the zygomatic body.
    • Zygomatic arch fractures may impede the temporalis muscle or coronoid process.
    • Lastly, temporalis muscle contusion or temporomandibular joint (TMJ) effusion may cause pain that limits range of motion (ROM).
    • Unilateral epistaxis may be present and typically resolves spontaneously.
Diagnostic Tests & Interpretation
  • CT scan is the diagnostic standard for evaluation of zygomatic body fractures.
  • CT scan is not usually needed for isolated fractures of the zygomatic arch.
Differential Diagnosis
  • Facial contusions
  • La Forte fractures
Ongoing Care
Consider custom face mask for return to play.
As tolerated safely given extent of oral/maxillary involvement
Patient Education
Proper usage of safety equipment
Additional Reading
Bell RB, Dierks EJ, Brar P, et al. A protocol for the management of frontal sinus fractures emphasizing sinus preservation. J Oral Maxillofac Surg. 2007;65:825–839.
Colucciello SA, Sternbach G, Walker SB. The treacherous and complex spectrum of maxillofacial trauma: etiologies, evaluation, and emergency stabilization. Emerg Med Rep. 1995;16;7:59–69.
Covington DS, Wainwright DJ, Teichgraeber JF, et al. Changing patterns in the epidemiology and treatment of zygoma fractures: 10-year review. J Trauma. 1994;37:243–248.
Hunter JG. Pediatric maxillofacial trauma. Pediatr Clin North Am. 1992;39:1127–1143.
Kaufman BR, Heckler FR. Sports-related facial injuries. Clin Sports Med. 1997;16:543–562.
Rumsey C, Sargent LA. Zygomatic fractures. Trauma Q. 1992;9:76–85.
  • 802.4 Closed fracture of malar and maxillary bones
  • 802.5 Open fracture of malar and maxillary bones

This website uses cookies to improve your experience. We'll assume you're ok with this, but you can opt-out if you wish. Accept Read More