A Novel Classification Method of Zygomaticomaxillary Complex Fractures by Suture Comminution to Better Predict Clinical Outcomes

Abstract

Purpose: To assess a novel technique for classifying zygomaticomaxillary complex (ZMC) fractures by its ability to predict clinical outcomes and reoperations when compared to a well-established classification method. Methods: The investigators conducted a retrospective cohort study over a 7-year period composed of patients with unilateral and bilateral fractures of the ZMC. Fractures were graded according to the Zingg method and a CT-based comminution method. Outcomes were classified into 3 groups: orbital complications, facial complications, and reoperation. Orbital complications consisted of enophthalmos and diplopia. Facial complications consisted of lagophthalmos, ectropion, ptosis, facial motor weakness, trismus, and malar depression. Other variables included demographics, mechanism of injury, and preoperative symptoms. Results: A total of 159 patients were identified producing a total of 204 ZMC fractures. The mean age was 40.2 ± 16.5 years and the most common mechanism of injury was motor vehicle accidents in 49.7% of patients. By the Zingg classification, B-type fractures were the most common in 46% of patients. The average total comminution score was 2.9 ± 2.4. Univariate analysis showed an association between increased age and reoperation ( P = .01). After adjusting for demographic and clinical variables on multivariate analysis, total comminution score was a significant predictor of facial complications and reoperation. The Zingg method did not demonstrate significance as a predictor for facial complications or reoperation. Neither classification method was predictive of orbital complications. Conclusion: The results of this study suggest that total comminution scoring is a viable method for categorizing ZMC fractures to better predict clinical outcomes.

Automated 3D Analysis of Zygomaticomaxillary Fracture Rotation and Displacement

“…Granted, there is typically a latency period between injury and surgery, 15,22 which may allow for application of this method as part of the surgical plan. Nonetheless, previously established ZMC classification schemata 4,8 may be more clinically applicable. In terms of objectivity, our method falls short of being completely objective, as the predefined suture points and zygomatic body selection is a user-selected process.…”

“…Several schematics have been developed to rapidly categorize ZMC fractures using fracture patterns or imaging to assess their clinical implications. [4][5][6][7][8] Improved image quality and slice thickness secondary to advancements in CT resolution have allowed for complex analyses using 3D renderings. There have only been a few reports that studied the ZMC using three-dimensional analytics.…”

Prevalence and Pattern of Zygomatic Complex Fracture in a Tertiary Care Hospital of Central Nepal

“…This complicated articulation makes the Zygomatico-Maxillary complex (ZMC). 4 Various studies on ZMC fractures were carried out to describe incidence and distribution on age, gender, society and aetiology. [5][6][7][8] However, study on the pattern of the zygomatic bone fracture is ill defined.…”

Evaluation of Zygomaticosphenoidal Angle in Patients With Unilateral Zygomaticomaxillary Complex Fracture

“…its anterolateral protrusion establishes the malar prominence which has a major role in facial aesthetics. Furthermore, it forms the orbital floor and lateral wall, whereas sustaining the associated facial compartments 1–3 . As a consequence of the forward projection of the ZMC, 4 its fracture is the second most common fracture after nasal bone fracture in head and neck traumatic injuries 4–6 .…”

“…The aesthetical complications are related to loss of facial symmetry like depressed cheekbones and widened and malformed cheeks. As for the functional flaws, complications include eye displacement, vision loss, nerve injuries, encroachment on adjacent tissues, and muscles 1,7,8 …”