After maxillofacial injuries, the possibility of fractures of the zygoma and zygomatic arch should always be considered and adequately investigated. These fractures are caused chiefly by automobile accidents, fist blows, and accidental falls. The diagnosis of such fractures can be made by one or more of the following clinical signs: numbness over the distribution of the infraorbital nerve, swelling and ecchymosis in the periorbital region, tenderness over the fractured site, diplopia, subconjunctival hemorrhage, the "step-off" sign in the lower orbital rim, flattening of the cheek, trismus, discoloration, and lack of a normal smooth contour in the superior buccal sulcus.1,2 However, in a hypersensitive and uncooperative patient and in a patient with marked swelling over the malar area, it is often extremely difficult to make a clinical diagnosis of zygomatic fractures. Yet, it is essential to ascertain displacement of fractures early, in order to obtain proper reduction and avoid an
YANAGISAWA E, GREENSPAN RH. Fractures of Zygomatic Arch: Unrecognized Sign. Arch Otolaryngol. 1962;75(5):424–428. doi:10.1001/archotol.1962.00740040435009
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