Zygomatic injury
Concise summary
Zygomatic (zygomaticomaxillary complex, ZMC) fractures commonly involve several facial articulations - lateral orbital rim, inferior orbital rim/floor, zygomaticomaxillary buttress and zygomatic arch.
They can threaten vision, entrap extraocular or masticatory muscles, injure the infraorbital nerve, and coexist with intracranial or cervical‑spine injury.
Prioritise ABCDE, assess vision early, use CT to define injury when clinically indicated, and involve specialists promptly for ocular compromise, entrapped muscles, marked displacement or open/contaminated fractures (NICE NG39, NG232; Resuscitation Council UK).
Red flags / urgent actions
- Airway compromise from bleeding, swelling or loose dentition - secure airway while protecting the C‑spine (Resuscitation Council UK).
- Visual loss, deteriorating visual acuity or suspected globe/optic nerve injury - urgent ophthalmology/OMFS review (NICE NG232).
- Restricted extraocular movement with diplopia (especially on upward gaze) suggesting muscle entrapment - urgent surgical review.
- Marked trismus with suspected coronoid/temporalis entrapment beneath a depressed zygomatic arch - urgent OMFS involvement.
- Open, grossly contaminated, comminuted or markedly displaced fractures; uncontrolled epistaxis; CSF rhinorrhoea - urgent specialist/major‑trauma centre involvement (NICE NG37/NG39).
Anatomy and common fracture sites
- The zygoma forms the cheek prominence, contributes to the lateral orbital wall and inferior orbital rim/floor, and articulates with the frontal bone, maxilla, sphenoid and temporal bone.