Moreover, further exposure of the zygomaticofrontal junction or the inferior orbital rim is required for placement of mini-plates fixation in case of an unstable zygomatic complex fracture. However, this surgical approach is associated with a facial scar in the hairline and risk of facial nerve palsy. The Gilles temporal approach has been a commonly used surgical technique for the reduction of zygomatic complex fractures. The surgical approach for adequate reduction of zygomatic complex fractures must provide maximum necessary exposure of the fractured segments, minimize the potential for injury to facial structures, and ensure a good functional and cosmetic result. Various surgical approaches and treatment strategies have been proposed to obtain successful treatment outcome, including the Gilles temporal approach, coronal, eyebrow, upper eyelid, transconjunctival, infraciliary lower eyelid, and intraoral vestibular approaches. Zygomatic complex fractures with no or minimal displacement are often treated without surgical intervention, whereas fractures with functional or esthetic impairments in the form of diplopia, extraocular muscle entrapment, malocclusion, restricted mouth opening and/or depression of the malar prominence often necessitate surgical intervention. The integrity of the zygomatic complex is fundamental in maintaining normal facial width and prominence of the cheek. Diagnosis of zygomatic complex fractures is usually clinical, with confirmation by computed tomography (CT) scan. The main clinical features of zygomatic complex fractures include diplopia, enophthalmos, subconjunctival ecchymosis, extraocular muscle entrapment, cosmetic deformity with depression of the malar eminence, facial widening, malocclusion and neurosensory disturbances of the infraorbital nerve. However, there is geographic and sociodemographic variation in the epidemiology of maxillofacial fractures due to socioeconomic, cultural and environmental factors. The etiology of zygomatic complex fractures primarily includes road traffic accidents, violent assaults, falls and sports injuries. Fracture of the zygomatic complex is one of the most common facial injuries in maxillofacial trauma and predominately appears in young adult males. The zygomatic complex is responsible for the protection of the orbital contents and the mid-facial contour. Subcutaneous emphysema may be present.The zygomatic bone defines the anterior and lateral projection of the face and articulates with the frontal, sphenoid, temporal, and maxillary bones. Injury to the infraorbital nerve may result in infraorbital paresthesia, and gaze disturbances may result from injury to orbital contents. Clinically, patients present with a flattened malar eminence and edema and ecchymosis to the area, with a palpable step-off on examination. More extensive trauma can result in the “tripod fracture,” which consists of fractures through three structures: 1) the frontozygomatic suture 2) the maxillary process of the zygoma including the inferior orbital floor, inferior orbital rim, and lateral wall of the maxillary sinus and 3) the zygomatic arch. These present clinically with pain on opening the mouth secondary to the insertion of the temporalis muscle at the arch or impingement on the coronoid process. Direct blows to the arch can result in isolated arch fractures. The arch forms the inferior and lateral orbit, and the body forms the malar eminence of the face. The zygoma bone has two major components, the zygomatic arch and the body.
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