A simple scoring system to predict zygomatic fracture

Background: In Thailand, many patients with suspected facial fracture are primarily screened and diagnosed by newly graduated, inexperienced general practitioners in rural and suburban hospitals. Some signs, symptoms and radiological findings that are easy to detect may be common among patients with zygomatic fracture. These factors may help in diagnosis of this fracture that could be used by general practitioners to reduce the rate of misdiagnosis. Objective: The present study aims to find predictive factors for zygomatic fracture diagnosis and develop a scoring system that can assist in diagnosis. Materials and Methods: Medical records of patients older than 15 years with facial fracture clinic seen at Siriraj hospital between 1 January 2007 and December 2017 were reviewed. Data on demographics, associated injury, type of facial fracture, signs & symptoms, and radiologic findings were extracted and recorded in predesigned case record form. The results of this multivariate logistic regression were used to develop score to predict Zygomatic fracture. Results: A total of 794 patients with 901 bone fractures met the inclusion criteria were included in the present study. There were 124 patients with zygomatic fracture. Five factors (Infraorbital nerve numbness, periorbital ecchymosis, point of tenderness, discontinuity of inferior orbital rim, and haziness of maxillary sinus from plain x-ray) were significantly predictive of zygomatic fracture from multivariate analysis and we develop a scoring system to predict zygomatic fracture by them. Conclusion: Infraorbital nerve numbness, periorbital ecchymosis, point of tenderness, discontinuity of inferior orbital rim, and haziness in maxillary sinus are significant predictors of zygomatic fracture. A scoring system using those factors is proposed in the present study.