A patient has malar flattening, infraorbital numbness, trismus and diplopia after assault. CT shows a displaced zygomaticomaxillary complex fracture with increased orbital volume, but no muscle entrapment. What is the best management principle?
ZMC repair restores three-dimensional projection, buttress alignment and orbital volume; entrapment is only one of several functional indications.
A. Observe because absence of entrapment excludes surgery: Displacement, malar asymmetry, trismus and orbital-volume change are independent indications to consider repair.
B. Open reduction and stable fixation restoring malar projection and orbital volume after swelling permits accurate assessment: Repair should reduce key buttresses and address the orbital floor when residual defect/volume change warrants it.
C. Repair the orbital floor without reducing the zygoma: Floor reconstruction against an unreduced framework risks wrong orbital volume and persistent deformity.
D. Operate solely to reverse infraorbital numbness: Sensory recovery is unpredictable; global functional and structural indications drive surgery.
E. Delay for several months in all cases: Late correction is more difficult once malunion occurs.
If displacement were minimal with normal ocular function, mouth opening and facial contour, observation would be appropriate.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, or a substitute for local policy and specialist clinical judgement.
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