Lateral midface fracture

Classification according to ICD-10
S02.4	Fracture of the zygomatic bone and upper jaw - os zygomaticum
ICD-10 online (WHO version 2019)

A lateral midface fracture or zygomatic bone fracture is a bone fracture ( fracture ) that mainly affects the zygomatic bone (Latin Os zygomaticum). Bone adjacent to the zygomatic bone can also be involved in lateral midface fractures. These include the zygomatic process of the temporal bone , the frontal process of the frontal bone , the entire lateral wall of the eye socket (formed, among other things, by the sphenoid bone) and the cranial part of the upper jaw . In medical terminology, a lateral midface fracture is also referred to as a fracture of the zygomatico-orbital complex .

Lateral midface fractures typically occur after the midface has been subjected to strong violence, as can occur in accidents and fights. They are the most common type of midface fracture, accounting for nearly 50 percent.

classification

There are six types of lateral midface fractures:

Classification of lateral midface fractures
Type I.	Isolated zygomatic arch fracture
Type II	Undisplaced zygomatic fracture
Type III	Dislocated zygomatic fracture without diastasis on the lateral orbital margin - with medial rotation - with lateral rotation
Type IV	Dislocated zygomatic fracture with diastasis on the lateral orbital margin - with medial rotation - with lateral rotation - with dorsocaudal shearing
Type V	Zygomatic bone fracture
Type VI	Type II to V fractures with collapse of the orbital floor .

In isolated zygomatic arch fractures , only the zygomatic arch is affected. In the case of undisplaced zygomatic fractures, the fragments are not displaced in contrast to displaced fractures. In the case of displaced zygomatic fractures , a distinction is made between whether there is a step ( diastasis ) on the lateral edge of the eye socket and whether there has been a medial or lateral rotation of the zygomatic body. With lateral rotation, the body of the zygomatic bone is compressed into the maxillary sinus and the eye socket. Medial rotation also results in a step formation in the eye socket and there is also a step in the zygomaticoalveolar crest .

Injury Pattern

The fracture line usually runs along the bone suture ( suture ) between the zygomatic bone and frontal bone ( sutura zygomatico-frontalis ), the lateral wall of the bony eye socket ( orbit ), along a bone fissure in the floor of the orbit ( fissura orbitalis inferior ), the infraorbital foramen (exit point of the Infraorbital nerve from the upper jaw (maxilla)), the upper lateral and the rear wall of the maxillary sinus ( maxillary sinus ).

The displacement (dislocation) of fragments of the zygomatic bone can take place towards the middle ( medially ) into the maxillary sinus and orbit as well as downwards ( caudally ) and behind ( dorsally ). Very often, when the fracture lines are surgically exposed, a shattered lateral wall of the maxillary sinus is present.

Like all midface fractures can also cheekbone fracture with fractures of the lower jaw ( mandibular fractures of the lower jaw body or -Gelenkfortsatzes, and other fractures) in the area of skull be combined. These injuries should be clarified before treatment.

treatment

Therapy usually takes the form of surgical repair using mini-plate osteosynthesis . Three operative accesses are required for this.

• Section in the vestibule of the oral cavity (from the lip frenulum to the region of the maxillary tuberosity on the posterior-posterior edge of the upper jawbone) of the broken side and a large-scale representation of all break lines
• Cut in a fold of skin on the lower eyelid
• Cut in the side eyebrow

In the second step, the zygomatic bone is repositioned using certain surgical instruments such as an elevator and a laver . This must be done with measured force to prevent the zygomatic bone from tearing completely free. Then the osteosynthesis plates are screwed over the fracture lines. This is followed by the seam and application of a pressure bandage .

literature

• S2k guidelines for lateral midface fractures of the German Society for Oral and Maxillofacial Surgery (DGMKG). In: AWMF online (as of February 28, 2014)

Individual evidence

1. ^ ^{A b c} Hans-Henning Horch, Jürgen Bier: Oral and maxillofacial surgery. 4th edition. Elsevier, 2007, ISBN 978-3-437-05417-4 , p. 134 ff.
2. ↑ A. Rueter, O. Trentz, M. Wagner: trauma surgery. 2nd Edition. Elsevier, 2004, study edition 2008, ISBN 978-3-437-21851-4 , p. 553 ff.

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !