Definition
As lateral midfacial fractures we classify fractures that affect the zygomatic bone body and/ or the zygomatic arch. In fractures of the zygomatic bone body the orbit is affected, wherefore we have to pay great attention to the function of the eye and the infra-orbital nerve.

Therapy Goals
Besides the restoration of the facial form and the mandible function, the restoration of the sensory nerves (infra-orbital nerve) and especially of the function of the eyes are paramount. During primary treatment an enophthalmus should be corrected or prevented.

Therapy Indications
Clinical and/ or radiological evidence of a fracture
Sensory and/ or motoric dysfunctions
Mandibular dysfunction
Ocular motility disturbance (double images)
Facial deformity
Subcutaneous emphysema

Examinations
Inspection
Palpation
Aesthesiometry (infra-orbital nerve)
X-ray in 2 planes
Computer tomography
Ophtalmological examination

Therapy
Conservative Therapy
Surveillance over a period in cases with discrete dislocation
Decongesting measures
If indicated, diet (soft food),

Surgical Therapy
Surgical treatment is always indicated in dislocated fractures, functional impairment of the eye and/ or sensory dysfunction. It can include the following measures:
Hook repositioning
Wire osteosynthesis
Mini-plate osteosynthesis
Orbital floor reconstruction (e.g. titanium mesh, PDS foil)

Additional Measures
If indicated,antibiotic therapy
Analgesic therapy
Drainage of contaminated wounds

Risk Factors
Soft tissue defect
Loss of bone structures
Degree of the fracture dislocation
Haemorrhage
Fragmented and/ or comminuted fractures
Xenolith
Wound contamination
Disrupted blood supply to the fragments and covering soft tissue
Infection
Associated injuries in the maxillofacial area
Time period between accident and fracture treatment
Tendency towards keloid and/ or hypertrophic scarring
Pre-traumatic bone damage (metabolic, radiation)

Recommendations
A conservative fracture treatment can be performed in the outpatient clinic. Most surgical treatments are performed in hospital.

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