James Douglas, Kierran Gill, Prof. Simon Holmes

The zygomatic bones form the prominence of the cheeks, linking the central mid-face to the lateral skull. Due to the position of the zygoma, it is commonly fractured when there is blunt trauma to the face, either from interpersonal violence or accidental cause. Several groups, including some of the forefathers of oral and maxillofacial surgery have classified these injuries to predict outcome, direct treatment and allow comparative research. Nine classification systems from 1961 to 1992 were reviewed and critiqued against a list of useful characteristics of a classification system including being progressive in severity and being memorable. Eight systems described anatomical changes in structure, whilst one described radiological findings. Two were deemed memorable and most were not progressive. The indications to treat a zygomatic bone fracture are facial deformity, loss of eyelid support, ocular dystopia, trismus and sensory nerve defect. These are functional problems and are not related to the underlying alteration to bony anatomy. We therefore propose the use of a functional classification system which is aims to be progressive, dictates treatment and is memorable:

  • Fracture with no functional deficit
  • Deformity only
  • Infra-orbital nerve symptoms
  • Interference with mastication (trismus)
  • Affecting vision
  • Multiple functions affected


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