Zygomatic arch fracture: Difference between revisions

Latest revision as of 13:07, 25 September 2021

Background

Side view of skull showing zygomatic arch (arrow).

Lateral articulation of the mandible showing zygomatic arch (arrow).

Must distinguish zygomatic arch fracture from Zygomaticomaxillary (tripod) fracture
- Tripod fracture = fracture of zygomatic arch, lateral and inferior orbital rims, and lateral wall of maxillary sinus

Clinical Features

Area of tenderness and/or deformity in zygomatic arch fracture.

Flattening of malar eminence
Ipsilateral eye may appear to tilt due to pulling of lateral canthus
Trismus (due to masseter spasm or impingement of temporalis muscle or coronoid process)
- Palpate posterior surface of arch for tenderness/loss of space compared to other side

Differential Diagnosis

Maxillofacial Trauma

Ears
- Auricular hematoma
Nose
- Nasal fracture
- Nasal septal hematoma
Oral
Other face
- Le Fort fractures
- Mandible fracture
Zygomatic arch fracture
Zygomaticomaxillary (tripod) fracture
Related

Evaluation

CT face showing an isolated left zygomatic arch fracture impinging the coronoid of the left mandible.

3D reconstruction of CT examination showing acute fracture of the left zygomatic arch.

CT Sinus/Face

Management

Analgesia
If concomitant sinus fracture, prophylactic antibiotics are indicated (amoxicillin-clavulanate, doxycycline, or clindamycin)

Disposition

Discharge
Outpatient plastic surgery follow-up in 1 week

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-*Must distinguish zygomatic arch fx from zygomaticomaxillary (tripod) fx
+[[File:Gray188-Sphenozygomatic suture.png|thumb|Side view of skull showing zygomatic arch (arrow).]]
-**Tripod fx = fx of zygomatic arch, lat and inf orbital rims, lat wall of maxillary sinus
+[[File:Processuszygomaticusossisfrontalis.png|thumb|Lateral articulation of the mandible showing zygomatic arch (arrow).]]
+*Must distinguish zygomatic arch fracture from [[Zygomaticomaxillary (tripod) fracture]]
+**Tripod fracture = fracture of zygomatic arch, lateral and inferior orbital rims, and lateral wall of maxillary sinus
-==Diagnosis==
+==Clinical Features==
-*Exam
+[[File:Zygomatic-arch.jpg|thumb|Area of tenderness and/or deformity in zygomatic arch fracture.]]
-**Flattening of malar eminence
+*Flattening of malar eminence
-**Eye findings
+*Ipsilateral eye may appear to tilt due to pulling of lateral canthus
-***Eye may appear to tilt (pulling of lateral canthus)
+*Trismus (due to masseter spasm or impingement of temporalis muscle or coronoid process)
-***Subconjunctival hemorrhage
+**Palpate posterior surface of arch for tenderness/loss of space compared to other side
-**Trismus (masseter spasm or impingement of temporalis muscle or coronoid process)
-***Palpate posterior surface of arch for tenderness/loss of space compared to other side
+==Differential Diagnosis==
+{{Maxillofacial trauma DDX}}
+==Evaluation==
+[[File:PMC4311579 eplasty15ic05 fig1.png|thumb|CT face showing an isolated left zygomatic arch fracture impinging the coronoid of the left mandible.]]
+[[File:PMC3389904 poljradiol-76-1-41-g009.png|thumb|3D reconstruction of CT examination showing acute fracture of the left zygomatic arch.]]
+*CT Sinus/Face
 ==Management==
-*Facial CT
+*[[Analgesia]]
+*If concomitant sinus fracture, prophylactic [[antibiotics]] are indicated ([[amoxicillin-clavulanate]], [[doxycycline]], or [[clindamycin]])
 ==Disposition==
-*Isolated zygomatic arch fx: discharge
+*Discharge
-*Tripod fx w/ loss of vision or displacement: admit for IV abx and sx
+*Outpatient plastic surgery follow-up in 1 week
 ==See Also==
-[[Maxillofacial Trauma]]
+*[[Maxillofacial Trauma]]
+==References==
+<references/>
+[[Category:ENT]]
+[[Category:Orthopedics]]
+[[Category:Trauma]]