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Zygomaticomaxillary complex (ZMC) fracture is a complex midfacial fracture involving the zygomatic bone and its articulations with surrounding facial skeleton. Because the zygoma contributes to facial contour, cheek projection, and orbital structure, ZMC fractures affect both function and aesthetics.

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Anatomy involved

Bone Clinical Importance
Maxilla Infraorbital rim, anterior maxillary wall
Temporal bone Zygomatic arch
Frontal bone Lateral orbital rim (frontozygomatic suture)
Sphenoid bone Lateral orbital wall and orbital floor (zygomaticosphenoid suture)

Together, these form the zygomaticomaxillary complex.

Fracture Components: Classic “Tripod” sites

  1. Zygomatic arch
  2. Lateral orbital wall (frontozygomatic suture)
  3. Infraorbital rim and orbital floor
  4. Zygomaticomaxillary buttress

Although often called “tripod,” ZMC fractures classically involve four sites, making it a tetrapod fracture in true anatomic terms.

Clinical features

Finding Implication
Flattened cheekbone Zygomatic displacement
Periorbital ecchymosis Orbital involvement
Infraorbital numbness Infraorbital nerve injury (traverses floor)
Diplopia Entrapment of inferior rectus muscle or orbital floor involvement
Trismus Impingement of zygomatic arch on coronoid process
Step-off deformity Palpable at infraorbital rim or zygomatic buttress

Complications