Zygomatic complex and nasal injury
Overview
Facial trauma ranges from simple nasal fractures to complex mid‑face disruption involving the zygoma, orbit and maxilla.
Early priorities follow the ABCDE approach: secure the airway, control life‑threatening haemorrhage, protect vision and identify injuries that require urgent specialist input or transfer to a Major Trauma Centre (Resuscitation Council UK; NICE NG37; RCEM).
This section summarises the anatomy, common patterns, focused assessment, practical ED management and clear triggers for escalation.
Anatomy and clinical relevance
- The zygoma (cheekbone) contributes to the lateral and inferior orbital rims and the orbital floor, and articulates with the maxilla and temporal bone.
- The zygomatic arch is formed by the temporal and zygomatic processes.
- Concept: the zygomatic complex behaves like a four‑legged “stool”:
- lateral orbital rim
- inferior orbital rim/floor
- zygomaticomaxillary buttress (lateral wall of the maxillary sinus)
- zygomatic arch
Disruption of one or more “legs” produces common fracture patterns.
- Key adjacent structures and clinical relevance:
- Infraorbital foramen/nerve lies below the infraorbital rim - infraorbital numbness indicates nerve involvement.
- Temporalis muscle and mandibular coronoid process lie beneath the zygomatic arch and may be entrapped in depressed arch fractures, producing trismus.