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. 2018 Dec;11(4):256-264.
doi: 10.1055/s-0037-1604199. Epub 2017 Jul 27.

Two- versus Three-Point Internal Fixation of Displaced Zygomaticomaxillary Complex Fractures

Wail Fayez Nasr  1 , Ezzeddin ElSheikh  1 , Mohammad Waheed El-Anwar  1 , Ahmed Hassan Sweed  1 , Awad Bessar  2 , Nillie Ezzeldin  3
Affiliations

Two- versus Three-Point Internal Fixation of Displaced Zygomaticomaxillary Complex Fractures

Wail Fayez Nasr et al. Craniomaxillofac Trauma Reconstr. 2018 Dec.

Abstract

Despite the high frequency of the zygomaticomaxillary complex (ZMC) fractures, there is no consensus among facial reconstructive surgeons regarding the best surgical management; thus, surgical choice for ZMC fractures is still challenging. This study included 40 patients with displaced ZMC fracture. Twenty patients were treated with open reduction and internal fixation (OR/IF) using two-point fixation technique (at infraorbital margin and zygomaticofrontal buttress region) and the remaining 20 patients were treated with OR/IF using three-point fixation technique (at frontozygomatic suture, infraorbital margin, and zygomatico maxillary buttress). The results of both types of ZMC fractures repair were then statistically compared. No statistical differences between the two types regarding malar eminence asymmetry; projection (forward displacement) and width (medial displacement) in axial CT; inferior displacement; superior displacement and width (medial displacement) in coronal CT; angle of displacement (outward displacement) in 3D CT; masseter and temporalis muscles power electromyography; actual duration of surgery; and patient satisfaction. On the other hand, the total cost of the used plates and screws was significantly higher with three-point repair than two-point repair ( p = 0.003). Moreover, postoperative CT lateral zygoma displacement was statistically significantly better in three-point fixation. Two-point fixation modality for displaced ZMC fractures is as effective as three-point method in fixation and prevents postreduction rotation or clinical displacement with significantly lower cost.

Keywords: fracture; internal fixation; zygomaticomaxillary complex.

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Conflict of interest statement

Conflict of Interest The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Radiological assessment of zygomatic position in axial view at the level of clivus. Distance A—Zygomatic projection: anteroposterior projection of zygoma forms interpterygoid line (reference line) and center of zygoma (distance A; measurements in cm). Distance B—Zygomatic width: lateral presentation of zygoma from nasal septum (reference line) and center of zygoma (measurements in cm).
Fig. 2
Fig. 2
Radiological assessment of zygomatic position in coronal view at the level of OMC. Distance B—Zygomatic width: lateral presentation of zygoma from nasal septum (reference line) and center of zygoma (measurements in cm). Distance C—Zygomatic height: superoinferior distance forms roof of the bony orbit (reference line) and center of zygoma (measurements in cm).
Fig. 3
Fig. 3
Radiological assessment of zygomatic position in 3D view. Distance D—vertical change of inferior orbital rim. Vertical step: distance between two parallel lines drawn over inferior orbital rim on both sides (measurements in mm). Angle E—Angle of displacement of zygoma. Angle between two parallel lines drawn over lateral surface of zygoma is estimated to assess medial and lateral displacement of zygoma.
Fig. 4
Fig. 4
Muscle activity assessment (EMG): pre- and postoperative EMG of right masseter muscle in right-sided ZMC fracture.
See this image and copyright information in PMC

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