Zygomaticomaxillary complex fractures.

T he term zygomaticomaxillary (zygomaticomalar) complex (ZMC) fractures refers to the osseous disruption of the malar eminence at 4 buttresses: zygomaticomaxilllary, frontozygomatic (FZ), zygomaticosphenoid, and zygomaticotemporal (Figure 1). The ZMC fracture is the second most common facial fracture, after the nasal bones. The prominent nature of the malar eminence places this structure at great risk for fracture, and the intricate 3-dimensional (3D) nature of the ZMC can sometimes make the repair quite challenging (Figure 2). Several authors have noted the high rate of misalignment and displacement after repair. Despite seemingly adequate reduction and/or fixation, several authors have also noted high rates of asymmetry in up to 13% of cases. The asymmetry manifests because of an inadequate intraoperative reduction or a postreduction displacement encountered during the postoperative period. Surgeons may place the blame on inadequate fixation during the initial operation, postoperative displacement due to the pull of the masseter muscle, or poor initial reduction.