![]() The zygomatic nerve which enters the orbit through the inferior orbital fissure divides into two branches, the zygomatico-facial and zygomatico-temporal which emerge onto the face through their respective foramina. Here it innervates the lower eyelid, lateral aspect of the nose, and upper lip of the ipsilateral side. The infra-orbital nerve runs along the ION groove and enters the ION canal giving off the superior dental plexus of nerves before exiting through the ION foramen onto the face. The nerves in close proximity to the ZMC are (1) infra-orbital nerve and (2) zygomatic nerve (Fig. įull size image 2.5 Nerves and Blood Vessels Zygoma and maxillary sinus: Fractures of the ZMC (except the isolated zygomatic arch fractures) involve the maxillary sinus and show features of hemosinus or sinusitis. A displaced and untreated fracture of zygoma/arch which is in close proximity to the coronoid process can result in extra-articular ankylosis. Therefore, a fractured zygoma or arch, when retro/medially positioned, may impede mandibular movements. Zygoma and mandible: The zygoma and zygomatic arch are anatomically close to the coronoid process of the mandible. Further, the contents of the orbit including the globe, extraocular muscles, and orbital fat are intimately related to the zygoma and may be affected in fractures of the ZMC or its surgical manipulation. Thus ZMC fractures greatly influence the structure and function of the orbit. A fracture line located above the Whitnall’s tubercle leads to inferior displacement of zygoma as well as the lateral attachment of Lockwood ligament resulting in anti-mongoloid slant to the eye (Fig. The Whitnall’s tubercle present on the zygoma (inferior to the FZ suture) provides attachment to the suspensory ligament of Lockwood that maintains the horizontal axis of the globe (Fig. Zygoma and orbit: ZMC forms the lateral and inferior part of the orbit, protecting as well as supporting the globe and associated soft tissues. ![]() 56.2c), to emphasize the necessity of restoring the five articulations during fracture management. However, the importance of SZ articulation along the lateral wall of the orbit has been recognized lately, and, hence, ZMC fracture is currently called a pentapod fracture (Fig. The terminology was later modified to “quadripod or quadramalar fracture” to include separation at the fourth point of articulation, the ZT process (Fig. These processes are clinically significant in establishing the three-dimensional structural integrity of the upper lateral face.įractures of the ZMC have been traditionally called the “tripod or trimalar fractures” because it involved separation at the three processes of the zygoma-the FZ, IOR, and the ZM processes (Fig. 56.1), namely, the zygomaticotemporal (ZT), zygomaticomaxillary (ZM), infra-orbital (IOR), fronto-zygomatic (FZ), and sphenozygomatic (SZ) or zygomaticosphenoid (ZS). The zygoma articulates with four bones superiorly frontal, medially maxilla, laterally temporal bone, and posteriorly sphenoid, through five processes (Fig. The clinical significance of this bony complex is attributed to its role in defining facial esthetics and globe function. Quite aptly, the zygoma extends as a prominent, sturdy bar across the face, contributing to its transverse width and anteroposterior projection. The term zygoma denotes a “yoke or bar,” in Greek. This chapter aims at elaborating the biodynamics of ZMC fractures, the evolution of various techniques for reduction & fixation along with their rationale and finally the cutting-edge technology in management of fractured ZMC. With advancements in the imaging technology, armamentarium and refinement of approaches to fracture, there is an emerging trend towards achieving utmost precision in reduction and fixation with minimally invasive surgical principles. Management of ZMC fractures is unique (1) The approaches used for reduction may be different from those for fixation (2) Lack of complete visualization of fracture predisposes to over or under reduction resulting in sub optimal outcomes (3) Philosophies of fixation and stabilization are numerous and debatable. Accurate restitution of the form and function of the ZMC is challenging because of its multipoint- articulation within the cranio facial skeleton and the difficulty involved in intra-operative assessment of reduction at all articulations. ![]() Fractures of the Zygomatico Maxillary complex result in cosmetic deformity as well as functional deficits such as altered vision, restricted mouth opening and paresthesia. ![]()
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