Zygomatic arch fracture

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
  • Dental trauma
  • Lip laceration
  • Tongue laceration
• Other face
  • Le Fort fractures
  • Mandible fracture
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Related
  • Head trauma (main)
    • Skull fracture
    • Skull fracture (peds)
    • Basilar skull fracture
  • Orbital trauma
    • Eyelid laceration
  • Scalp laceration

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

See Also

• Maxillofacial Trauma