Zygomatic arch fracture

Background

Side view of skull showing zygomatic arch (arrow).

Lateral articulation of the mandible showing zygomatic arch (arrow).

• Must distinguish zygomatic arch fracture from Zygomaticomaxillary (tripod) fracture
  • Tripod fracture = fracture of zygomatic arch, lateral and inferior orbital rims, and lateral wall of maxillary sinus

Clinical Features

Area of tenderness and/or deformity in zygomatic arch fracture.

• Flattening of malar eminence
• Ipsilateral eye may appear to tilt due to pulling of lateral canthus
• Trismus (due to masseter spasm or impingement of temporalis muscle or coronoid process)
  • Palpate posterior surface of arch for tenderness/loss of space compared to other side

Differential Diagnosis

Maxillofacial Trauma

• Ears
  • Auricular hematoma
• Nose
  • Nasal fracture
  • Nasal septal hematoma
• Oral
  • Dental trauma
  • Lip laceration
  • Tongue laceration
• Other face
  • Le Fort fractures
  • Mandible fracture
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Related
  • Head trauma (main)
    • Skull fracture
    • Skull fracture (peds)
    • Basilar skull fracture
  • Orbital trauma
    • Eyelid laceration
  • Scalp laceration

Evaluation

• CT Sinus/Face

Management

• Analgesia
• If concomitant sinus fracture, prophylactic antibiotics are indicated (amoxicillin-clavulanate, doxycycline, or clindamycin)

Disposition

• Discharge
• Outpatient plastic surgery follow-up in 1 week

See Also

• Maxillofacial Trauma