Zygomaticomaxillary complex fractures

Zygomaticomaxillary complex (ZMC, tripod, or malar) fractures are sustained with direct blunt trauma to the zygomatic buttress of the face. The zygoma has four major stability points, with connections as follows: (a) the frontal bone at the frontozygomatic suture; (b) the maxilla at the medial inferior orbital rim; (c) at the zygomaticomaxillary buttress; and (d) the temporal bone at the zygomatic arch. A complete fracture of the complex usually involves all four of these points. Anteriorly, the fracture usually occurs through the infraorbital foramen because of the bone's relative weakness. Physical findings associated with ZMC fractures are numbness or paresthesias (CN V), depression of the zygomatic eminence, ocular dystopia (uneven pupillary levels), lateral canthal ptosis, enophthalmos, and palpable fractures at the inferior and lateral orbital rims.