Trimalar fractures of the zygoma are not infrequent midfacial injuries and are a distinct clinical entity. Specific clinical findings include infraorbital anesthesia, trismus, diplopia, enophthalmos, palpable bony suture line abnormalities, flattened malar eminences, and superior sulcus deformities. Six radiologic subgroups have been described. Optimal surgical management and treatment depend on the type of fracture. Three general surgical approaches are currently used: the Gillies technique, the supraorbital approach, and the maxillary sinus approach.