From the Guidelines
Yes, you should consult Oral and Maxillofacial Surgery (OMFS) for a zygomatic fracture. Zygomatic fractures often require specialized evaluation to determine if surgical intervention is necessary, as they can be associated with significant morbidity and impact on quality of life if not properly managed 1. The OMFS specialist will assess the fracture pattern, displacement, and functional impairment through clinical examination and imaging studies like CT scans, which are considered the first-line imaging modality for evaluating maxillofacial injuries 1. They will evaluate for complications such as orbital floor involvement, infraorbital nerve damage, trismus, or ocular symptoms, which can have long-term consequences if not addressed promptly 1.
Treatment decisions depend on the severity of displacement and associated functional or aesthetic concerns. Minimally displaced fractures may be managed conservatively with soft diet, analgesics (acetaminophen or NSAIDs), and close follow-up. However, significantly displaced fractures typically require surgical reduction and fixation to restore facial symmetry and function, as delaying appropriate consultation could lead to malunion, persistent facial asymmetry, sensory disturbances, or ocular complications 1. The OMFS specialist will provide comprehensive management including both the acute treatment and long-term follow-up needed for optimal outcomes, taking into consideration the most recent and highest quality evidence available 1.
Key considerations in the management of zygomatic fractures include:
- Accurate diagnosis and assessment of fracture severity
- Evaluation for associated complications and injuries
- Individualized treatment planning based on fracture pattern, displacement, and patient-specific factors
- Prompt intervention to prevent long-term morbidity and improve quality of life
- Multidisciplinary care involving OMFS specialists, radiologists, and other healthcare professionals as needed 1.
From the Research
Zygomatic Fracture Treatment
The treatment of zygomatic fractures often involves surgical intervention, with various approaches and techniques available.
- The management of zygomatic fractures can be classified into early closed reduction or open reduction and rigid internal fixation (ORIF) methods, with ORIF being the most common treatment modality 2.
- A national survey of US surgeons found that oral and maxillofacial surgeons (OMFS) treat zygomatic fractures most commonly, followed by plastic surgeons (PS) and otorhinolaryngologists (ENT) 2.
- The choice of treatment approach may depend on the pattern of the fracture, the surgeon's preference, and the need for exposure, reduction, and fixation 3, 4.
Role of Oral and Maxillofacial Surgery (OMFS)
- OMFS plays a significant role in the treatment of zygomatic fractures, with 61% of repairs being performed by OMFS surgeons 2.
- The treatment of zygomatic fractures requires careful consideration of the aesthetic, structural, and functional roles of the zygomaticomaxillary complex (ZMC) 3.
- A review of 1,025 cases of zygomatic fractures found that the treatment outcomes can be improved with a simple classification system and consistent methods of three-dimensional alignment and fixation 5.
Surgical Approaches and Techniques
- Various surgical approaches are available for the treatment of zygomatic fractures, including the Gillie's temporal approach, Dingman's lateral eyebrow approach, upper buccal sulcus approach, and inferior orbital approach 6.
- The choice of fixation method, such as mini plate or micro plate osteosynthesis, may depend on the individual surgeon's experience and the geometry of the fracture 6, 4.
- A retrospective review of 502 patients with ZMC fractures found that most fractures were fixated at two points, and the most common associated fracture was an orbital fracture 4.