Summary about Disease
A zygomaticomaxillary complex (ZMC) fracture, also known as a tripod fracture or a malar fracture, involves a fracture of the zygoma (cheekbone) and its articulations with the maxilla, frontal bone, and temporal bone. This complex fracture affects the lateral orbital wall, the orbital floor, and the zygomatic arch. It can impact facial aesthetics, eye function, and chewing ability.
Symptoms
Facial swelling and bruising: Around the cheek, eye, and potentially the nose.
Pain: Localized to the cheekbone and surrounding areas, often exacerbated by movement.
Numbness or altered sensation: In the cheek, upper lip, and side of the nose due to injury to the infraorbital nerve.
Double vision (diplopia): Resulting from orbital floor fracture and entrapment of the eye muscles.
Sunken eye (enophthalmos): Late finding due to increased orbital volume.
Flattening of the cheek: Loss of cheek prominence.
Difficulty opening the mouth (trismus): Due to impingement of the coronoid process of the mandible.
Step-off deformity: Palpable irregularity along the infraorbital rim or zygomatic arch.
Nasal obstruction: If the fracture extends into the nasal cavity.
Epistaxis (nosebleed)
Causes
ZMC fractures are typically caused by blunt force trauma to the midface. Common causes include:
Motor vehicle accidents: Particularly when the face impacts the dashboard or steering wheel.
Falls: Especially onto the face.
Assault: Blows to the face.
Sports-related injuries: Impact from balls, elbows, or falls.
Workplace accidents: Related to falls or impacts from machinery.
Medicine Used
4. Medicine used
Pain relievers: Over-the-counter analgesics like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for mild to moderate pain. Stronger prescription pain medications (opioids) may be necessary for severe pain, especially in the initial post-injury period.
Antibiotics: Prescribed if there's an open fracture (skin broken) or a risk of infection, especially after surgical repair.
Decongestants: To help relieve nasal congestion if the fracture affects the nasal passages.
Steroids: May be used to reduce swelling, particularly around the eyes.
Is Communicable
No, a ZMC fracture is not a communicable disease. It is a traumatic injury caused by physical impact.
Precautions
Avoid further trauma: Protect the face from additional impacts.
Follow doctor's instructions: Adhere to prescribed medications and activity restrictions.
Proper oral hygiene: Gentle cleaning to prevent infection.
Soft diet: Easier to chew and reduces strain on the healing fracture.
Elevate head: Helps reduce swelling.
Ice packs: Apply to the injured area to reduce swelling and pain.
Avoid strenuous activity: Until cleared by a doctor.
Attend all follow-up appointments: To monitor healing.
How long does an outbreak last?
ZMC fractures are not related to outbreaks. The healing time for a ZMC fracture varies depending on the severity of the fracture and the treatment received. Healing can take several weeks to months.
How is it diagnosed?
Physical Examination: Assessment of facial symmetry, palpation for step-offs, evaluation of eye movement and sensation.
Imaging Studies:
X-rays: Initial assessment, but less detailed than CT scans.
Computed Tomography (CT) Scan: The gold standard for diagnosis. Provides detailed images of the facial bones, including the zygoma, maxilla, orbit, and zygomatic arch. Important for surgical planning.
Ophthalmological Examination: To assess for eye injuries and function, particularly if diplopia or visual disturbances are present.
Timeline of Symptoms
Immediate: Pain, swelling, bruising.
Within Hours: Worsening swelling, numbness, potential diplopia.
Days 1-7: Peak swelling and bruising. Initial pain management is crucial.
Weeks 2-6: Swelling gradually subsides. If surgery is performed, this is the timeframe for initial healing.
Months 2-6: Bone healing completes. Resolution of any residual numbness or diplopia. Functional recovery of chewing and facial movement.
Important Considerations
Associated Injuries: ZMC fractures can be associated with other facial fractures, orbital injuries, or head injuries. A thorough evaluation is necessary to identify and address all injuries.
Surgical Intervention: The need for surgery depends on the severity of the fracture, the presence of displacement, functional impairment (diplopia, malocclusion), and cosmetic concerns.
Nerve Damage: The infraorbital nerve is frequently injured, leading to numbness. While some sensation may return over time, permanent numbness is possible.
Orbital Complications: Fractures involving the orbital floor can lead to enophthalmos (sunken eye), diplopia, and other visual disturbances. Early recognition and management are crucial.
Malunion/Nonunion: Inadequate treatment or delayed treatment can result in malunion (improper healing) or nonunion (failure to heal), requiring further surgery.
Cosmetic Outcomes: Even with proper treatment, some degree of facial asymmetry or scarring may persist.
Follow Up Care: Adhering to all follow up appointments with your doctor.