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

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.

Three-dimensional analysis of facial asymmetry after zygomaticomaxillary complex fracture reduction: a retrospective analysis of 101 East Asian patients

“…We did not perform more than two fixations for reduction surgery. Nasr et al [ 20 ] reported no significant difference between 2-point fixation and 3-point fixation for ME asymmetry, including zygomatic projection and width. In radiological assessment using CT scan 3 months after surgery to evaluate post-reduction displacement, backward displaced zygoma reduction in axial view was significantly better in the 2-point fixation group than in the 3-point fixation group.…”

Estabilização de fratura de complexo zigomático-orbitário com dois pontos de fixação: relato de caso

“…Poucos trabalhos clínicos discutem e analisam os resultados do emprego de um, dois e três pontos de fixação em pacientes com fraturas de CZO 8,17 . Em 2017, Nasr et al 18 compararam a utilização de dois e três pontos de fixação em pacientes com fraturas de zigoma. Os autores relatam que a fixação de três pontos é a técnica padrão, contudo a modalidade com dois pontos é efetiva, clinicamente imperceptível e quase tão eficaz quanto à fixação de três pontos impedindo a rotação ou deslocamento ósseo, alem de ter menor custo.…”

Biomechanics of Maxillofacial Trauma and Fractures

“…Because maxillofacial buttresses represent the bars that support the maxillofacial skeleton building, they serve as the prime locations for plate fixation during repair [1][2][3].…”

“…The masseter muscles can also affect the ZMC fracture. Thus, by masseter muscles, action on the fractured segment displaces the fractured zygoma mainly downward inward with medial rotation [1][2][3].…”