Zygomatic Complex and Nasal Injury Case 1

1. Question

A 21 year old man attends the ED having been elbowed in the face whilst playing rugby earlier today. You are working in the minors area of the department and have a fourth year medical student accompanying you.

Before you begin your assessment you have a brief chat with the medical student about the relevant anatomy of the midface. The student appears to have a limited knowledge of the area and states the following facts – indicate which ones are correct.

Select the statements which are true.

The zygoma forms a large part of the lateral and inferior orbital margins
The zygoma is attached to the frontal bone through the zygomatic arch
The zygomaticomaxillary complex (ZMC) can be thought of as a tripod
The temporalis muscle runs under the zygomatic arch
The orbital rims and walls are thick and difficult to fracture
The zygoma articulates with the sphenoid bone
The ethmoid bone may be fractured from a blow to the nose

2. Question

You start the assessment by taking a history from the patient.

Select the likely bony injury to match the symptoms from the drop down menus.

Sort elements

Nasoethmoidal fracture
Orbital blow-out fracture
Depressed zygomatic arch fracture
ZMC fracture with infraorbital nerve damage

Persistent clear nasal discharge
Double vision when looking upwards
Inability to open his mouth fully
Numbness of the cheek and upper lip

3. Question

Moving on to examine the patient, you inspect his face. You note that he has a subconjunctival haemorrhage in his right eye.

Describe the possible causes of this finding and how you would differentiate between them.