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Fractured zygomatic arch: a traumatic cause
for trismus
Karim Kassam,1 Ashraf Messiha2
1
Department of Maxillofacial DESCRIPTION comminuted fracture. This is a case of Henderson
Surgery, Northwest London We report a case of a patient with a 9-day history of IV type, as it is a tripod fracture with a distracted
Hospitals, London, UK
2
Department of Oral &
trismus measured at 9 mm (figure 1). The trismus frontozygomatic suture which could also be pal-
Maxillofacial Surgery, occurred immediately after an alleged assault with pated clinically. There is a high probability that the
Northwick Park Hospital, punch injuries to the face. Note the flattening of the conservative treatment in this case would lead to
London, UK malar process on the left hand side of the face. temporomandibular pseudoankylosis characterised
X-rays of the facial bones showed a depressed frac- by trismus-restricted mandibular movements, result-
Correspondence to
Karim Kassam, ture of the zygomatic arch with a medial rotation of ing from factors outside the joint. Treatment will
kkassam7860@hotmail.com the zygomatic complex (figure 2). Orthopantogram involve elevation of the arch with a two-point fix-
X-ray clearly showed an additional fracture of the ation at the zygomatic buttress placed via an
Accepted 10 November 2013 coronoid process (figure 3). Clinically, the depressed intraoral approach and at the frontozygomatic
arch fracture has impinged on the coronoid process suture placed via an upper blepharoplasty incision.
producing the limitation in mouth opening. The The fractured coronoid can be removed if unstable
Henderson Classification is a commonly used and preventing mouth-opening or quite often left
system to describe zygomatic fractures. It ranges due to its strong muscle attachments. The operation
from Henderson I, which is an undisplaced fracture will restore the mouth-opening and improve the
at any site, to Henderson VII, which is a cosmetic defect (figure 4).
Figure 1 Trismus secondary to depressed zygomatic Figure 3 Orthopantogram showing fracture of the
arch fracture. coronoid process of the mandible.
To cite: Kassam K,
Messiha A. BMJ Case Rep
Published online: [please Figure 4 Postoperative photograph showing immediate
include Day Month Year] improvement in mouth opening. Sutures have been
doi:10.1136/bcr-2013- Figure 2 Occipitomental X-ray illustrating two fractures passed around the arch transcutaneously and then
202633 in the left zygomatic arch. around a finger splint to stabilise the arch.
Kassam K, et al. BMJ Case Rep 2014. doi:10.1136/bcr-2013-202633 1
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Competing interests None.
Learning points Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
▸ A depressed zygomatic arch can be a cause of trismus in the
trauma setting.
▸ X-rays of the facial bones are useful in diagnosis of the
patient presenting with trismus.
▸ If treated conservatively, it can lead to pseudoankylosis of
the temporomandibular joint and lifelong trismus.
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2 Kassam K, et al. BMJ Case Rep 2014. doi:10.1136/bcr-2013-202633
