Zygoma fracture

Zygoma fracture is a fracture of the zygomatic bone, the paired bone that forms the malar prominence, the lateral orbital wall and part of the orbital floor, and it is one of the most common injuries of the middle third of the face.颧骨骨折是指颧骨发生的骨折，该骨成对存在，构成面颊隆起、眶外侧壁与部分眶底，是面中部最常见的损伤之一。

Most cases follow assault, road traffic crashes, falls or sport, and displaced fractures can flatten the cheek, limit mouth opening, cause double vision and leave persistent numbness in the infraorbital nerve territory.多数病例继发于殴打、道路交通伤、跌倒或运动损伤，移位骨折可造成面颊塌陷、张口受限、复视，并遗留眶下神经分布区的持续麻木。

Terminology and classification

• The terms zygoma fracture, zygomatic fracture and malar fracture are used interchangeably, while zygomaticomaxillary complex fracture or ZMC fracture denotes involvement of the zygomaticofrontal, zygomaticomaxillary, zygomaticotemporal and zygomaticosphenoid junctions.颧骨骨折、颧骨骨折与颧部骨折常互换使用，而颧上颌复合体骨折（ZMC 骨折）指同时累及颧额缝、颧上颌缝、颧颞缝与颧蝶缝的连接处。
• The traditional label tripod fracture is anatomically imprecise because the zygoma has four articulations, so tetrapod or quadripod fracture is now preferred in the surgical literature.传统所称的「三脚架骨折」在解剖上并不准确，因为颧骨有四个连接处，因此近年手术文献更倾向使用「四脚架骨折」。
• ICD-10 assigns S02.4 to fracture of the zygomatic bone and maxilla, and ICD-11 release 2025-01 places zygomatic fracture at NA02.5 in Chapter 22, Injury, poisoning or certain other consequences of external causes.世界卫生组织 ICD-10 将颧骨与上颌骨骨折编为 S02.4，ICD-11（2025-01 发布版）将颧骨骨折编为 NA02.5，属第 22 章「损伤、中毒或外因的其他特定后果」。
• Cross-ontology identifiers include MeSH D015051, UMLS C0043540, SNOMED CT 31601007 and Wikidata Q1765555, which allow the entity to be linked across clinical and anatomical resources.跨本体标识包括 MeSH D015051、UMLS C0043540、SNOMED CT 31601007 与 Wikidata Q1765555，便于在临床与解剖资源之间建立链接。
• The Zingg classification, derived from 1,025 consecutive fractures and published in 1992, divides injuries into type A incomplete fractures, type B complete tetrapod fractures and type C comminuted fractures.Zingg 分型基于 1,025 例连续骨折病例，于 1992 年发表，将损伤分为 A 型不完全骨折、B 型完全性四脚架骨折与 C 型粉碎性骨折。
• Type A is subdivided into A1 isolated zygomatic arch fracture, A2 lateral orbital rim fracture and A3 inferior orbital rim fracture, each sparing displacement of the zygomatic body.A 型再分为 A1 单纯颧弓骨折、A2 眶外侧缘骨折与 A3 眶下缘骨折，三者均无颧骨体移位。
• The older Knight and North system of 1961 recognised six groups, namely undisplaced, arch, unrotated body, medially rotated body, laterally rotated body and complex fractures, and it remains useful for describing rotation.较早的 Knight 与 North 系统（1961 年）将骨折分为六组，即无移位、颧弓、骨体无旋转、骨体向内旋转、骨体向外旋转与复杂骨折，至今仍适合描述旋转方向。

History

• Harold Gillies described blind elevation of the depressed zygomatic arch through a temporal incision in 1927, an approach that is still taught as the Gillies temporal method.Harold Gillies 于 1927 年描述了经颞部切口盲探抬起塌陷颧弓的方法，这一入路至今仍以 Gillies 颞部入路之名教授。
• Knight and North published their six-type classification in 1961, at a time when plain radiography and closed reduction dominated practice.Knight 与 North 于 1961 年发表六型分类，当时临床仍以平片与闭合复位为主。
• Markus Zingg and colleagues reviewed 1,025 consecutive zygomatic fractures and in 1992 proposed the three-type system that now guides decisions between closed and open treatment.Markus Zingg 及其同事回顾 1,025 例连续颧骨骨折，于 1992 年提出三型系统，该系统现用于指导闭合与开放治疗的选择。
• The introduction of computed tomography in the 1980s allowed the orbital floor, the zygomaticosphenoid suture and comminution to be assessed directly, and it gradually replaced plain films as the planning standard.20 世纪 80 年代 CT 的应用使眶底、颧蝶缝与粉碎程度得以直接评估，并逐渐取代平片成为手术规划标准。
• Open reduction with titanium miniplate fixation, developed within the AO principles from the 1970s, replaced wire fixation for most displaced fractures because it provided three-dimensional stability.依据 AO 原则于 1970 年代发展起来的钛微型接骨板开放复位固定，因能提供三维稳定，在多数移位骨折中取代了钢丝固定。
• Recent practice has shifted towards minimally invasive reduction, intraoperative imaging and patient-specific implants, and the old tripod concept has been corrected to a four-articulation model.近年实践转向微创复位、术中影像与个体化植入物，旧的「三脚架」概念也已修正为四连接处模型。

Epidemiology

• Facial fractures are most common in young adult men, with reported male-to-female ratios between 3.3 to 1 and 9.6 to 1, and the nasal bone, mandible and zygomatic complex are the sites most often involved.面部骨折多见于年轻男性，文献报告的男女比为 3.3 比 1 至 9.6 比 1，最常受累的部位为鼻骨、下颌骨与颧骨复合体。
• A Taiwanese series of 272 zygomatic fractures treated between 2012 and 2021 found motorcycle crashes in 43.4% and falls in 27.9%, with the highest incidence between 61 and 70 years of age.台湾一项纳入 2012 至 2021 年 272 例颧骨骨折的系列研究发现，摩托车事故占 43.4%，跌倒占 27.9%，发病率最高的年龄段为 61 至 70 岁。
• In that cohort, Zingg type B fractures accounted for 51.8%, and bilateral fractures carried a brain injury rate of 58.3% compared with 26.6% for unilateral fractures.该队列中 Zingg B 型骨折占 51.8%，双侧骨折者的脑损伤发生率为 58.3%，单侧骨折者为 26.6%。
• A Chinese series of 686 patients treated between 2013 and 2022 reported a mean age of 36.5 years, a male-to-female ratio of 2.2 to 1, road traffic injury in 53.8% and type B fractures in 56.9%.中国一项纳入 2013 至 2022 年 686 例患者的系列研究报道，平均年龄 36.5 岁，男女比 2.2 比 1，道路交通伤占 53.8%，B 型骨折占 56.9%。
• An analysis of 469 zygomatic fractures classified tripod fractures as 50.7%, zygomaticomaxillary fractures as 25.8% and isolated zygomatic arch fractures as 20.9%.一项纳入 469 例颧骨骨折的分析显示，三脚架型占 50.7%，颧上颌型占 25.8%，单纯颧弓型占 20.9%。
• Mechanisms vary by region and age, with assault and sport predominating in young men, road traffic crashes in low- and middle-income settings, and low-level falls in older women.致伤机制随地区与年龄而异，年轻男性以殴打与运动伤为主，中低收入地区以道路交通伤为主，老年女性则以低处跌倒为主。

Pathophysiology

• The zygoma is a keystone of the midface and articulates with the frontal, maxillary, temporal and sphenoid bones, so a displaced fracture disrupts facial width, cheek projection and orbital volume at the same time.颧骨是面中部的拱心石，与额骨、上颌骨、颞骨及蝶骨相接，因此移位骨折会同时破坏面部宽度、颊部突度与眶容积。
• Direct force usually displaces the zygomatic body posteromedially and inferiorly, and the masseter, which inserts on the zygomatic arch, contributes to downward displacement and to the pull that produces malunion.直接暴力通常使颧骨体向后内下方移位，附着于颧弓的咬肌参与向下移位，并在骨性愈合不良时产生牵拉。
• The zygomaticosphenoid suture is the fourth articulation and is often the last to be reduced, and residual diastasis there is a recognised cause of persistent malar flattening.颧蝶缝是第四个连接处，常最后获得复位，该处残余分离是面颊持续塌陷的公认原因。
• Displacement of the orbital floor and lateral wall changes orbital volume and globe position, producing enophthalmos, hypoglobus and, when the inferior rectus or periorbital fat is entrapped, restrictive diplopia.眶底与眶外侧壁移位会改变眶容积与眼球位置，造成眼球内陷、眼球下移，并在下直肌或眶周脂肪嵌顿时引起限制性复视。
• The infraorbital nerve runs through the orbital floor and exits at the infraorbital foramen, and fracture lines crossing this canal produce the cheek, upper lip and nasal ala numbness that is characteristic of the injury.眶下神经走行于眶底并经眶下孔出颅，骨折线跨越该管道时会出现面颊、上唇与鼻翼麻木，这是本伤的典型表现。
• Depression of the zygomatic arch narrows the space between the arch and the temporal fossa, impinging on the temporalis muscle and the coronoid process and limiting mandibular opening.颧弓塌陷会缩小颧弓与颞窝之间的间隙，压迫颞肌与冠突，从而限制下颌开口。
• Comminution or a fracture through the maxillary sinus can force air into the orbit, producing orbital emphysema, and can fill the sinus with blood, which predisposes to infection and sinusitis.粉碎性骨折或累及上颌窦的骨折可使空气进入眶内形成眶气肿，并使窦腔内积血，增加感染与鼻窦炎的风险。

Clinical features

• The injured side shows a flattened malar eminence and a widened or asymmetric face, although early oedema can mask the deformity and delay recognition.患侧面颊隆起变平、面部增宽或不对称，但早期肿胀可掩盖畸形并延误识别。
• Periorbital ecchymosis and subconjunctival haemorrhage are common, and subconjunctival blood without a visible posterior limit suggests a fracture of the orbital wall or floor.眶周瘀斑与结膜下出血常见，若结膜下出血向后看不到边界，提示眶壁或眶底骨折。
• Palpation may reveal a step-off at the infraorbital rim, the zygomaticofrontal suture or the zygomatic arch, and tenderness over the malar eminence is usually marked.触诊可在眶下缘、颧额缝或颧弓处发现台阶感，面颊隆起处常有明显压痛。
• Infraorbital nerve hypoesthesia or anaesthesia affecting the cheek, upper lip, lateral nose and upper incisors is present in a large minority, and persistent sensory loss was documented in 37% of 153 surgically treated patients.面颊、上唇、鼻侧与上切牙区域的眶下神经感觉减退或缺失见于相当一部分患者，153 例手术患者中 37% 记录了持续感觉丧失。
• Trismus, pain on mouth opening and difficulty chewing reflect arch depression or impingement on the temporalis and coronoid, and they are among the strongest clinical indications for reduction.张口受限、开口疼痛与咀嚼困难反映颧弓塌陷或对颞肌与冠突的压迫，是复位最强的临床指征之一。
• Diplopia may be binocular and restrictive, and enophthalmos becomes apparent once swelling subsides, while exophthalmos or a pulsating globe should raise concern for a retrobulbar haemorrhage or carotid-cavernous fistula.复视可为双眼性且呈限制性，肿胀消退后眼球内陷逐渐显现，而眼球突出或搏动性眼球应警惕球后出血或颈动脉海绵窦瘘。
• Named complications include malunion with facial asymmetry, persistent enophthalmos, restrictive diplopia, infraorbital neuropathy, trismus, orbital emphysema, plate exposure, sinusitis and, rarely, blindness from retrobulbar haemorrhage.具名并发症包括骨性愈合不良致面部不对称、持续眼球内陷、限制性复视、眶下神经病变、张口受限、眶气肿、接骨板外露、鼻窦炎，以及罕见的球后出血所致失明。
• Severe globe injury, traumatic optic neuropathy and intracranial haemorrhage are the main sight- and life-threatening associations, so every patient needs a structured eye and neurological examination before facial repair.严重眼球损伤、创伤性视神经病变与颅内出血是主要的视力与生命威胁，因此每位患者在面部修复前都需接受结构化的眼部与神经系统检查。

Diagnosis

• Assessment begins with the ABCDE approach of the Advanced Trauma Life Support programme, tenth edition 2018, because facial fractures can accompany airway compromise, cervical injury and intracranial bleeding.评估从《高级创伤生命支持》第 10 版（2018 年）的 ABCDE 流程开始，因为面部骨折可合并气道受损、颈椎损伤与颅内出血。
• Inspection and bimanual palpation of the orbital rims, zygomatic arch, malar eminence and occlusion are followed by tests of infraorbital sensation, mouth opening and eye movements.视诊与双手触诊眶缘、颧弓、面颊隆起及咬合关系后，应检查眶下感觉、张口度与眼球运动。
• Computed tomography of the face with axial, coronal and sagittal reconstructions at 1 mm or thinner is the imaging standard, and it defines the Zingg type, orbital floor defects and comminution.面部 CT 采用 1 mm 或更薄的轴位、冠状位与矢状位重建，是影像学金标准，可确定 Zingg 分型、眶底缺损与粉碎程度。
• Plain radiography with Waters, Caldwell and submentovertex views can show the classic tetrapod pattern, but it misses orbital floor and zygomaticosphenoid displacement and is now supplementary.Waters 位、Caldwell 位与颏顶位平片可显示典型四脚架形态，但会漏诊眶底与颧蝶缝移位，现仅作补充。
• The submentovertex or jug-handle view is particularly useful for an isolated zygomatic arch fracture, while an occipitomental view is better for the zygomatic body and orbital rim.颏顶位（「壶柄位」）对单纯颧弓骨折尤为有用，而枕颏位更适合观察颧骨体与眶缘。
• An ophthalmologist should assess visual acuity, pupils, colour vision, ocular motility and, when entrapment is suspected, forced duction, because retinal detachment and globe rupture change management priorities.眼科医师应评估视力、瞳孔、色觉、眼球运动，并在怀疑嵌顿时行牵拉试验，因为视网膜脱离与眼球破裂会改变处理优先级。
• Named differential diagnoses include isolated orbital blowout fracture, nasal bone fracture, Le Fort II or III fracture, frontal sinus fracture, mandibular condyle fracture and orbital apex syndrome, each distinguished by the pattern of mobility, occlusion and sensory loss.具名鉴别诊断包括单纯眶爆裂骨折、鼻骨骨折、Le Fort II 或 III 型骨折、额窦骨折、下颌骨髁突骨折与眶尖综合征，各依活动度、咬合与感觉缺失的分布加以区分。
• Delayed diagnosis is common when swelling masks the deformity, and CT should be repeated or reviewed by a maxillofacial surgeon if a patient has persistent diplopia, trismus or infraorbital numbness after apparently minor trauma.肿胀掩盖畸形时易延误诊断，若患者在看似轻微的创伤后持续复视、张口受限或眶下麻木，应复查 CT 或请颌面外科医师复核。

Management

• Treatment aims to restore facial projection and width, orbital volume, painless mouth opening and infraorbital sensation, and to prevent malunion and ocular complications.治疗目标是恢复面部突度与宽度、眶容积、无痛张口与眶下感觉，并预防骨性愈合不良与眼部并发症。
• Undisplaced or minimally displaced fractures with normal occlusion, full eye movements and no cosmetic deformity can be managed conservatively with a soft diet, analgesia and review at one and four weeks.无移位或轻微移位、咬合正常、眼球运动充分且无外观畸形的骨折可保守处理，包括软食、镇痛以及 1 周与 4 周复查。
• Displaced fractures are usually reduced and fixed within two weeks of injury, since delayed surgery is technically harder and increases the risk of malunion and orbital fibrosis.移位骨折通常在伤后两周内复位固定，延迟手术在技术上更困难，并增加骨性愈合不良与眶内纤维化的风险。
• Isolated zygomatic arch fractures can be elevated through the Gillies temporal approach, the Keen intraoral approach or a direct percutaneous hook, and stable fractures may need no fixation.单纯颧弓骨折可经 Gillies 颞部入路、Keen 口内入路或直接经皮钩抬起，稳定者可不加固定。
• The zygomatic body is approached through a subciliary, transconjunctival, upper blepharoplasty or intraoral vestibular incision, and complex fractures may require a coronal flap for wide exposure.颧骨体可经睑下、结膜内、上睑成形或口内前庭切口显露，复杂骨折可能需要冠状瓣以获得广泛暴露。
• Open reduction and internal fixation usually place titanium miniplates at the zygomaticofrontal suture, the zygomaticomaxillary buttress and, when needed, the infraorbital rim or zygomatic arch, restoring the four articulations.开放复位内固定通常在颧额缝、颧上颌支柱以及必要时眶下缘或颧弓放置钛微型接骨板，以恢复四个连接处。
• One-point fixation at the zygomaticofrontal suture or infraorbital rim is sufficient for some medially rotated fractures, but comminuted or unstable patterns require multiple points of fixation.对部分向内旋转的骨折，颧额缝或眶下缘单点固定已足够，但粉碎或不稳定类型需要多点固定。
• Orbital floor defects with entrapment, persistent diplopia or a defect larger than about 2 square centimetres are reconstructed with titanium mesh, porous polyethylene or autologous bone.伴嵌顿、持续复视或缺损大于约 2 平方厘米的眶底缺损，应使用钛网、多孔聚乙烯或自体骨重建。
• Perioperative antibiotic prophylaxis with cefazolin, or clindamycin in penicillin allergy, is common for open reduction, while paracetamol and non-steroidal anti-inflammatory drugs provide analgesia.开放复位常预防性使用头孢唑林，青霉素过敏者改用克林霉素，镇痛则使用对乙酰氨基酚与非甾体抗炎药。
• Postoperative care includes head elevation, ice, visual monitoring, avoidance of nose blowing, soft diet and jaw exercises, and CT is obtained when reduction or hardware position is uncertain.术后处理包括抬高头部、冷敷、视力监测、避免擤鼻、软食与张口训练，复位或内固定位置不确定时复查 CT。
• In 153 surgically treated fractures, persistent infraorbital sensory disturbance occurred in 37%, facial asymmetry in 14%, enophthalmos in 7%, diplopia in 7% and wound infection in 4%, and 14 patients needed secondary surgery.在 153 例手术治疗的骨折中，持续眶下感觉障碍占 37%，面部不对称占 14%，眼球内陷占 7%，复视占 7%，伤口感染占 4%，14 例需二次手术。
• Prevention relies on helmets and facial protection in contact sport, seat belts and airbags in vehicles, fall prevention in older adults and violence reduction programmes in high-risk settings.预防依赖对抗性运动中的头盔与面部护具、机动车安全带与安全气囊、老年人跌倒预防，以及高风险环境中的暴力干预项目。

Research and controversies

• The main technical controversy is whether one-point fixation is adequate for all non-comminuted ZMC fractures or whether multiple points are needed to prevent rotation and late enophthalmos.主要技术争议在于单点固定是否适用于所有非粉碎性 ZMC 骨折，还是需要多点固定以防止旋转与晚期眼球内陷。
• A 2025 retrospective study used intraoperative CT to compare one-point and multiple-point fixation and found that the two strategies differed in repositioning accuracy for some fracture patterns.2025 年一项回顾性研究以术中 CT 比较单点与多点固定，发现两种策略在部分骨折类型中的复位精度存在差异。
• A 2026 prospective study of 42 patients tested Foley catheter ballooning with n-butyl cyanoacrylate as a minimally invasive alternative to conventional open reduction and internal fixation.2026 年一项纳入 42 例患者的前瞻性研究评估了 Foley 导尿管球囊扩张联合氰基丙烯酸正丁酯，作为传统开放复位内固定的微创替代方案。
• Endoscopy combined with real-time digital navigation has been used for zygomaticomaxillary and orbital floor fractures, with early series of 16 patients reporting acceptable orbital volume restoration.内镜联合实时数字化导航已用于颧上颌与眶底骨折，早期 16 例系列报道可获得可接受的眶容积恢复。
• Resorbable plates avoid hardware removal and palpability but have lower mechanical strength, and they are generally reserved for selected paediatric or low-load fractures.可吸收接骨板可避免取板与异物感，但机械强度较低，一般仅用于特定儿童或低负荷骨折。
• Another unresolved question is whether routine orbital floor exploration is justified in every displaced ZMC fracture or only when CT shows a defect, entrapment or persistent diplopia.另一未决问题是：对所有移位 ZMC 骨折都应常规探查眶底，还是仅在 CT 显示缺损、嵌顿或持续复视时探查。
• Long-term outcome studies are needed because sensory recovery, malar symmetry and orbital volume can change for more than a year after injury, and current cohorts rarely report beyond 12 months.仍需长期结局研究，因为感觉恢复、面颊对称性与眶容积在伤后一年以上仍可变化，而现有队列很少报告超过 12 个月的结果。