Occurrence: may follow impacts with moderate to high energy
Clinical features:
(1) point tenderness and ecchymosis (black eye, gingival sulcus, upper vestibule in the mouth)
(2) malar flattening (best viewed from below)
(3) increased facial width
(4) lateral canthal dystopia downward
(5) trismus and/or malocclusion (due to effect on the temporalis and masseter muscles)
(6) inferior or lateral orbital rim step-off
(7) dysesthesia or numbness along Cranial Nerve V2 (infraorbital)
(8) fractures of other bones, especially with high energy trauma (fracture of the orbital floor, mandible, Le Fort).
Some large fractures may have no or few symptoms. Diagnosis depends on a high index of suspicion and a careful clinical examination.
Indications for surgical correction:
(1) significant malar flattening
(2) lateral canthal dystopia or lower lid malposition
(3) trismus or malocclusion of the jaw
(4) significant enlargement of the orbit, with or without fracture of the orbital floor
(5) significant displacement or comminution
