Efficacy of Altered Two-Point Fixation in Zygomaticomaxillary Complex Fracture

Abstract

Purpose: To reconstruct a zygomaticomaxillary complex (ZMC) fracture, zygomaticofrontal (ZF) suture is the most reliable site to assess anatomical alignment and to secure rigidity. It has been chosen primary site to be fixed, but approach through the lateral eyebrow incision may leave a visible scar. This study suggests altered two-point fixation of ZMC fracture without accessing the ZF suture.

Methods: In the retrospective study, a total of 40 patients with ZMC fracture were divided into two groups (group 1, two-point fixation and group 2, three-point fixation). Patient demographics and follow-up were evaluated, and degree of reduction including cortical gaps of ZF and inferior orbital (IO) area, protruding difference of zygoma, and malar difference using asymmetry index were measured through preoperative and postoperative CT.

Results: Preoperatively, the means of ZF displacement, IO displacement, protruding difference of zygoma, and facial asymmetry index between the groups were not statistically different. The result was the same after the operation. However, all variables were significantly different before and after surgery within each group. Moreover, mean operation time was significantly different between groups (P value = 0.026).

Conclusion: Altered two-point fixation in ZMC fracture excluding incision approaching the ZF provides surgical efficacy and similar surgical outcomes to three-point fixation but offers reduced operation time and fewer complications.

Figure 1

Degree of reduction. Gauging displacement distance between outer cortical bones. (a) Measurement of the cortical gap of the zygomaticofrontal suture. (b) Measurement of the cortical gap of the inferior orbital rim.

Figure 2

The protruding difference of zygoma: compared by measuring the distance from the most prominent point of each zygomatic arch to A line (A line: a virtual line from the pyriform aperture to the condyle of the mandible). (a) Preoperative measurement. (b) Postoperative measurement.

Figure 3

The asymmetry index of zygomatic prominence: comparing the difference in the two prominences of the zygomatic bone. (a) Preoperative measurement. (b) Postoperative measurement (Hr: right horizontal length, Hl: left horizontal length, Vr: right vertical length, Vl: left vertical length, Dr: right distance from midpoint, and Dl: left distance from midpoint). Asymmetry index = $\sqrt{{\left(\text{Hr}-\text{Hl}\right)}^2+{\left(\text{Vr}-\text{Vl}\right)}^2+{\left(\text{Dr}-\text{Dl}\right)}^2}$.