ZMC Fracture

The x-ray shows a left-sided ZMC fracture (yellow arrows) with fluid level (green arrow) in the maxillary sinus. Click on the x-ray to enlarge.

The vast majority of ZMC fractures can be managed expectantly until local swelling subsides, and reviewed by a maxillofacial surgeon at a time guided by local policy.

Any indication of eye involvement (e.g. reduced visual acuity or diplopia) is an indication for urgent referral to a maxillofacial surgeon and/or an ophthalmologist. Suspected infraorbital nerve involvement is not an indication for urgent referral.

Patients should be given general advice regarding their injury including:

• Avoidance of nose blowing as this may produce surgical emphysema
• Not to occlude the nose when sneezing
• Application of ice packs to the area to reduce swelling
• Taking regular analgesia
• General head injury advice

Learning bite

Patients with a ZMC fracture must be advised to avoid nose blowing or holding the nose when sneezing, as surgical emphysema may result.

There is no good evidence that antibiotics should be routinely prescribed in ZMC fracture, although there is a well documented, but rare, risk of orbital cellulitis [16]. Local policy should be followed.