ZMC Fracture Complications — ORE Part 1 MCQ

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HardOral SurgeryZMC Fracture ComplicationsORE Part 1

A 35-year-old man sustains a fracture of the left zygomaticomaxillary complex after a sporting injury. He has flattening of the left cheek, infraorbital nerve paraesthesia and restricted mouth opening. Which additional finding is most concerning?

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Correct answer: A — Diplopia on attempted upward gaze

Diplopia on upward gaze is most concerning because it suggests orbital-floor involvement with impaired extraocular movement and possible soft-tissue or inferior-rectus entrapment. Entrapment is time-critical: persistent incarceration can compromise the muscle and result in permanent motility restriction and troublesome diplopia. Epistaxis can accompany a ZMC fracture but does not itself indicate the key urgent ocular complication. Periorbital bruising and subconjunctival haemorrhage are common periocular signs after facial trauma. Tenderness over the zygomatic arch is consistent with the fracture and may contribute to restricted opening through coronoid impingement, but does not indicate an acute threat to ocular function.

Reference: Brettler D, et al. Resolution of Vertical Gaze Following a Delayed Presentation of Orbital Floor Fracture With Inferior Rectus Entrapment: The Contributions of Charles E. Iliff and Joseph S. Gruss in Orbital Surgery. 2021. https://pubmed.ncbi.nlm.nih.gov/33456696/