Zygomaticomaxillary Complex Fractures

The zygomatic bone is a critical component of the midfacial complex. Its prominence within the face makes it susceptible to trauma and its intricate anatomy make posttraumatic repair of zygomaticomaxillary complex (ZMC) fractures challenging. The zygoma has a “tetrapod” structure with four key articulation points: the zygomaticomaxillary articulation and inferior orbital rim, zygomaticosphenoid articulation in the lateral orbital wall, zygomaticofrontal articulation and the lateral orbital rim, and the zygomatic arch. The zygoma is also a key contributor to several facial buttresses and a main determinant of malar projection and transverse facial width. Several approaches to the ZMC may be required to ensure appropriate reduction of each articulation site during operative repair. Concomitant injuries to other facial structures can be seen with ZMC fractures, given the zygomatic bones close association with the orbit, nasal bones, and the maxilla. Adequate ZMC fracture repair requires appropriate exposure of all involved fractures, robust mobilization of bone fragments, and application or rigid fixation while ensuring simultaneous reduction at all involved ZMC articulation points. Midface soft tissue resuspension should be performed following ZMC reduction and fixation to prevent unwanted soft tissue descent and lower lid malposition.