OPEN REDUCTION AND INTERNAL FIXATION OF ZYGOMATICOMAXILLARY COMPLEX FRACTURES: A CASE SERIES AND REVIEW OF CURRENT CONCEPTS

Abstract

Background: Zygomaticomaxillary complex (ZMC) fractures are common midface injuries that may compromise facial projection, orbital anatomy, and maxillary sinus integrity. Because the ZMC forms important vertical and horizontal facial buttresses and borders the maxillary sinus, associated sinus involvement may accompany skeletal disruption. This case series describes the clinical presentation, computed tomography findings, surgical approaches, and fixation strategies used for the management of ZMC fractures with open reduction and internal fixation (ORIF). Case Presentation: Four male patients aged 16–31 years presented with ZMC fractures following road traffic accidents or fall-related trauma, 4 days to 1 week after injury. All patients had periorbital ecchymosis and/or subconjunctival haemorrhage with a palpable facial step deformity. None had diplopia, restricted extraocular movements, or enophthalmos at presentation. Computed tomography confirmed the fracture pattern and guided operative planning. All patients underwent ORIF using titanium miniplate fixation. Surgical exposure was individualized according to fracture configuration and included the Gillies temporal, subciliary, and maxillary vestibular approaches, either individually or in combination. Fixation ranged from two-point to five-point constructs depending on fracture stability, displacement, and comminution. Discussion: The cases demonstrate the heterogeneity of ZMC fracture patterns and the need to tailor surgical exposure and fixation to individual fracture characteristics. Less complex fractures were managed with limited exposure and two point fixation, whereas more unstable or comminuted fractures required multiple approaches and additional fixation points. The close anatomical relationship between the ZMC and maxillary sinus also highlights the importance of assessing sinus involvement on preoperative computed tomography. However, the present four-patient series cannot establish whether routine endoscopic drainage of traumatic hemosinus improves clinical outcomes. Conclusion: Individualized ORIF with titanium miniplate fixation provided satisfactory reduction across the range of ZMC fractures represented in this case series. Surgical approach and fixation should be guided by fracture displacement, stability, and comminution. Preoperative assessment should also include careful evaluation of associated maxillary sinus involvement. Larger prospective studies are required to determine the clinical significance of traumatic hemosinus and the role of routine ENT intervention.