Zygoma fractures are among the most common midfacial injuries, directly impacting both function and aesthetics. For plastic surgery residents, mastering the anatomy, evaluation, and surgical management of these fractures is essential.

In this episode of Plastics in Practice, we break down the essentials of zygoma fractures. From the quadripod anatomy of the zygomaticomaxillary complex to the clinical signs of malar flattening, trismus, and infraorbital nerve paresthesia, we review how to approach diagnosis and treatment. We cover preoperative imaging and timing, operative approaches from transconjunctival to coronal, and fixation strategies tailored to fracture severity. Key complications, including enophthalmos, infraorbital nerve dysfunction, and lid malposition, are highlighted with strategies for prevention and management.

Takeaways:

• Anatomy: Zygoma as a quadripod with five fixation points .

• Evaluation: Pain, diplopia, malar flattening, sensory changes .

• Timing: Ideally within 1–2 weeks; earlier for children .

• Approaches: Gingivobuccal sulcus, transconjunctival, coronal .

• Complications: Retrobulbar hematoma, enophthalmos, nerve injury .

References:

Ellstrom CL, Evans GRD. Zygoma Fractures. Plast Reconstr Surg. 2013;132(6):1649–1657. doi:10.1097/PRS.0b013e3182a80819

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