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with early (≤7 days) versus late (>7 days) repair. Patients suspected of having
nasal fractures should be reevaluated within 4 to 5 days after the swelling
subsides. Plain radiographs may be helpful at this time to determine whether
malalignment exists. Patients with nasal deformity 4 to 5 days after injury require
urgent consultation with a subspecialist to restore anatomic alignment.

Zygoma and Maxilla Fractures
CLINICAL PEARLS AND PITFALLS
Particular attention to the airway is of paramount importance in children
with midface fractures as significant bleeding and disruption of normal
anatomic structures may compromise airway patency.
Clinical Considerations
The zygoma is composed of a body or malar eminence and the zygomatic arch. A
complete fracture of the zygoma often extends through the floor of the orbit. This
may result in an inferior displacement of the zygoma because of the strong
inferior forces applied by the masseter muscle, which attaches to the malar
eminence. Zygoma fractures often produce a flattened appearance to the cheek,
with inferior displacement of the globe, and conjunctival hemorrhage. Decreased
sensation along the distribution of the infraorbital nerve is also common, as
zygomaticomaxillary fractures usually include the infraorbital foramen. Unilateral
zygomatic arch fractures can cause a decrease in temporal width, which is best
visualized when viewing the face from the front as a result of buckling of the
zygomatic arch. If this buckling is severe, the mandibular condyle may be
impinged, with resultant difficulty in mouth opening.