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Egro et al. Plast Aesthet Res 2019;6:15 Plastic and
DOI: 10.20517/2347-9264.2019.31 Aesthetic Research

Commentary Open Access

Commentary on “surgical management of zygomatic
complex fractures in a major trauma centre”

Francesco M. Egro, Anisha Konanur, Guy M. Stofman

Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA.
Correspondence to: Dr. Francesco M. Egro, Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550
Terrace Street 6B Scaife Hall Pittsburgh, Pittsburgh, PA 15261, USA. E-mail: francescoegro@gmail.com

How to cite this article: Egro FM, Konanur A, Stofman GM. Commentary on “surgical management of zygomatic complex
fractures in a major trauma centre”. Plast Aesthet Res 2019;6:15. http://dx.doi.org/10.20517/2347-9264.2019.31

Received: 25 Jun 2019 Accepted: 10 Jul 2019 Published: 23 Jul 2019
Science Editor: Raúl González-García Copy Editor: Jia-Jia Meng Production Editor: Jing Yu

Zygomatic complex (ZMC) fractures are one of the most common facial fractures seen in trauma centers.
The zygomatic bone has a quadrilateral shape with several processes that articulate with the frontal bone
[via frontozygomatic (ZF) suture], the maxilla [via zygomaticomaxillary (ZM) buttress], the temporal
bone [via zygomaticotemporal (ZT) suture], and the greater wing of the sphenoid bone within the orbit via
zygomaticosphenoid suture. These four processes work to stabilize the position of the face with respect to
the cranium and provide definition of facial width and midface projection. Fractures of the zygomatic bone
often occur at these four suture sites resulting in ZMC fractures rather than fracture of the zygomatic bone
alone. The management of ZMC fractures are usually of aesthetic nature except in two occasions. First,
when the fracture impinges on the mandibular coronoid process, resulting in a restriction of mandibular
[1]
movements and trismus . Second, ZMC fractures can disrupt the orbit foundation enough to cause
ophthalmoplegia, diplopia, malposition of the globe, sensory deficits along distribution of the infraorbital
[1,2]
nerve, or palpable irregularities of the lateral and inferior orbital rim .

Surgical intervention of ZMC fractures require open reduction and internal fixation of the points of the
tetrapod. Fracture fixation may be broadly classified by open reduction with anterior approach or an open
reduction with anterior and posterior approach. The anterior approach involves up to three incisions, one
for each suture in the tetrapod except for the ZT suture . For access to the ZF suture and lateral orbital
[2]
wall, the upper blepharoplasty incision allows for less scarring and better surgical access to the region in
comparison to the lateral brow approach or use of the current laceration . The transconjuctival incision
[3]
is preferred for access to the infraorbital rim, however, it must also be noted that the lower-lid approach
[3]
is not without significant risks, such as the possibility of lower-lid malposition and external lid scarring .

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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