1. Zygomaticomaxillary ( ZMC ) Fracture

2. Anatomy Similar to a 4- sided pyramid It has Temporal, Orbital, Maxillary & Frontal processes The Zygoma is the origin to major portion of the masseter muscle The malar bone represents a strong bone on fragile supports, and it is for this reason that, though the body of the bone is rarely broken, the four processes—frontal, orbital, maxillary, and zygomatic—are frequent sites of fracture.

3. Anatomy Usually 4 fx lines exist: Anteromedial in the floor of the orbit Superolateral in the lateral orbital wall Inferior to the maxillary buttress in the zygomatic arch

4. Diagnosis Clinical Perform a neurologic & ophthalmic evaluation first Signs & symptoms: Periorbital Ecchymosis and Edema Flattening of the Malar Prominence Ecchymosis of the Maxillary Buccal Sulcus Deformity at the Zygomatic Buttress of the Maxilla Deformity of the Orbital Margin Trismus Abnormal Nerve Sensibility Subconjunctival Ecchymoses Displacement of the Palpebral Fissure. Diplopia Enophthalmos Radiographic

5. Flattening of the Malar Prominence.

6. Trismus

7. Displacement of the Palpebral Fissure & Unequal pupillary Level

8. Abnormal Nerve Sensibility.

9. Enophthalmous accentuation of the sulcus of the upper lid narrowing of the palpebral Fissur pseudoptosis of the upper lid

10. Radiologic Assessment Axial & coronal CT is the method of choice

11. Radiologic Assessment (3D Reconstruction)

12. Complexities in TX of ZMC FX Rotation of the fractured ZMC

13. Complexities in TX of ZMC FX Concomitant undiagnosed NOE FX

14. Complexities in TX of ZMC FX Lateral displacement of Malar bone

15. SURGICAL APPROACHES TO ZYGOMATICOMAXILLARY COMPLEX FRACTURES

16. Maxillary Vestibular Approach

17. Supraorbital Eyebrow Approach

18. Upper Eyelid Approach

19. Lower Eyelid Approaches

20. Transconjunctival Approach

21. Bicoronal / Coronal Approach

22. Gillies Temporal Approach

23. Buccal Sulcus Approach ( Keen Technique )

24. Elevation From Eyebrow Approach

25. Percutaneous Approach

26. Percutaneous Approach (Carroll- Girrard Bone Screw)