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