Zygomatic fractures in the emergency department: evaluation and treatment

Diagnosis of zygomatic fractures in the emergency department is possible by history and clinical signs together with a routine series of facial bone x-ray films. Three case reports are submitted to illustrate this approach, one case with obvious clinical signs and x-ray findings and two "unclear" cases where either the physical findings or the x-ray findings were equivocal. There may be pain, tenderness, cheekbone displacement subconjuctive hemorrhage and numbness, enophthalmos, and blurred vision. A Water's view is recommended for x-ray films. Zygomatic fractures are best treated in five to seven days; eye signs indicate earlier treatment. To treat, expose the probable fracture site and reduce under direct vision. The zygoma can be immobilized by passing a Kirschner wire through the body of the zygoma medially towards and through the lateral wall of the nose and into the bony nasal septum.