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Emergency Department

Zygoma Fractures

MANAGEMENT OF ZYGOMATIC FRACTURES IN ED

 

  • Intraoral lacerations and open fractures are considered “as infected”, so antibiotic therapy is required.

 

  • Haemorrhage is possible intra and extra orally so make sure to perform haemostasis.

 

  • Severely displaced fractures cause high amounts of pain and discomfort, make sure analgesia and anti inflammatories are prescribed.

 

  • Patient’s that do not require immediate surgery will be reviewed in the Trauma Clinic in 5 to 7 days, and this is the most frequent scenario.

 

  • Retrobulbar Haemorrhage must be treated as a true emergency. Inform your Senior Registrar if severe pain in the eye is present, also proptosis of the globe or if visual acuity is affected.

 

  • If diplopia or any visual disturbance is present then Orthotics and Ophthalmology should be contacted for an assessment.

 

  • Normally ZMC fractures won’t need admission unless injuries are severe (visual compromise, extraocular muscle dysfunction) and decision of performing surgery in 24 hours has been achieved by the Consultant or Senior Registrar.

 

  • If admission is decided then make sure the patient receives regular analgesia and chlorhexidine mouthwashes during his admission.

 

  • Surgical management when performed is based in an Open Reduction and Internal Fixation or Elevation & Reduction and these can be performed via different approaches, so make sure to consent the patient and take your time so the patient fully understands the risks and rare complications of such. Do not give false expectations to the patient. (Please see the Consenting section within this App).

 

  • Strict soft diet is recommended also during conservative treatment. Failure to do so could cause pain or displacement if maxillary alveolar bone is involved.

 

  • Blowing the nose must be avoided even in undisplaced fractures; failure to do so can result in surgical emphysema causing swelling, pain and crepitus in the soft tissues.

 

Author: Arie Yuffa

Last updated: 21/02/15