Zygoma complex fractures.

The zygomaticomaxillary complex (ZMC) has integral structure and function in the bony skeleton of the face. The prominent convex shape of the ZMC makes it particularly vulnerable to injury. Facial trauma can result in fractures limited to a single buttress of the ZMC but more commonly results in a tetrapod fracture involving all four buttresses. Accurate clinical diagnosis is based on a thorough head and neck examination with ophthalmologic consultation when indicated. Computed tomography is the gold standard for confirmation of the clinical diagnosis and for surgical planning. Multiple surgical approaches to the ZMC are discussed, including the hemicoronal approach to the zygomatic arch, the transconjunctival and subciliary approaches to the orbital rim, and the sublabial approach to the zygomaticomaxillary suture line. The topics of one-, two-, or three-point fixation, as well as plate versus wire fixation, are discussed. Finally, the diagnosis and management of complications such as diplopia and ectropion are discussed.