Despite the prevalence of zygomaticomaxillary complex (ZMC) fractures, there is no consensus regarding the best approach to management. The aim of this study is to determine differences in ZMC fracture treatment among various surgical specialties. A survey was conducted regarding treatment of patients with different ZMC fractures that included a minimally displaced fracture (Case 1), a displaced fracture without diplopia (Case 2), a displaced fracture with diplopia (Case 3), and a complex comminuted fracture (Case 4). The survey was distributed to members of plastic surgery, oral maxillofacial surgery, and otolaryngology societies. The rates of surgical treatment, exploration of the orbital floor, and plating three or more buttresses were analyzed among the specialties. A total of 173 surgeons participated (46 plastic and reconstructive surgeons, 25 oral and maxillofacial surgeons, and 102 otolaryngologists). In Case 1, a significantly higher percentage of plastic surgeons recommend an operation (p < 0.01) compared with other specialties. More than 90% of surgeons would perform an operation on Case 2. Plastic surgeons explored the orbital floor (p < 0.01) and also fixated three or more buttresses more frequently (p < 0.01). More than 93% of surgeons would operate on Case 3, with plastic surgeons having the greatest proportion who fixed three or more buttresses (p < 0.01). In Case 4, there was no difference in treatment patterns between specialties. Across the specialties, more fixation was placed by surgeons with fewer years in practice (<10 years). Conclusion There is no consensus on standard treatment of ZMC fractures, as made evident by the survey. Significant variability in fracture type warrants an individualized approach to management. A thorough review on ZMC fracture management is provided.
BogusiakKArkuszewskiPCharacteristics and epidemiology of zygomaticomaxillary complex fracturesJ Craniofac Surg20102141018–1023
2.
MarinhoROFreire-MaiaBManagement of fractures of the zygomaticomaxillary complexOral Maxillofac Surg Clin North Am2013254617–636
3.
EllisEIIIel-AttarAMoosKFAn analysis of 2,067 cases of zygomatico-orbital fractureJ Oral Maxillofac Surg1985436417–428
4.
FonsecaRJBarberHDPowersMPFrostDEOral and Maxillofacial TraumaSaint Louis, MOElsevier Health Sciences2013354–450
5.
RoweNKilleyHFractures of the Facial SkeletonBaltimore, MDWilliams & Wilkins1955205–451
6.
EllisEIIIKittidumkerngWAnalysis of treatment for isolated zygomaticomaxillary complex fracturesJ Oral Maxillofac Surg1996544386–400, discussion 400–401
7.
CzerwinskiMMartinMLeeCQuantitative comparison of open reduction and internal fixation versus the Gillies method in the treatment of orbitozygomatic complex fracturesPlast Reconstr Surg200511571848–1854, discussion 1855–1857
8.
ChoiKYRyuDWYangJDChungHYChoBCFeasibility of 4-point fixation using the preauricular approach in a zygomaticomaxillary complex fractureJ Craniofac Surg2013242557–562
9.
ChampyMLoddeJPKahnJLKielwasserPAttempt at systematization in the treatment of isolated fractures of the zygomatic bone: techniques and resultsJ Otolaryngol198615139–43
10.
FujiokaMYamanotoTMiyazatoONishimuraGStability of one-plate fixation for zygomatic bone fracturePlast Reconstr Surg20021092817–818
11.
HolmesKDMatthewsBLThree-point alignment of zygoma fractures with miniplate fixationArch Otolaryngol Head Neck Surg19891158961–963
RohrichRJWatumullDComparison of rigid plate versus wire fixation in the management of zygoma fractures: a long-term follow-up clinical studyPlast Reconstr Surg1995963570–575
15.
RinehartGCMarshJLHemmerKMBresinaSInternal fixation of malar fractures: an experimental biophysical studyPlast Reconstr Surg198984121–25, discussion 26–28
16.
DavidsonJNickersonDNickersonBZygomatic fractures: comparison of methods of internal fixationPlast Reconstr Surg199086125–32
17.
RodriguezEDLoseeJENeliganPCPlastic Surgery: Volume 3: Craniofacial, Head and Neck Surgery, Pediatric Plastic Surgery, 3rd edNew YorkElsevier Health Sciences201249–88
18.
ThorneCHGrabb and Smith's Plastic Surgery, 7th edPhiladelphia, PAWolters Kluwer Health2013311–326
19.
PapelIDFacial Plastic and Reconstructive Surgery, 3rd edNew YorkThieme2009945–976
EllisEIIIPerezDAn algorithm for the treatment of isolated zygomatico-orbital fracturesJ Oral Maxillofac Surg201472101975–1983
22.
LangsdonPRKnipeTAWhatleyWSCostelloTHTransconjunctival approach to the zygomatico-frontal limb of orbitozygomatic complex fracturesFacial Plast Surg2005213171–175
23.
RohrichRJJanisJEAdamsWPJrSubciliary versus subtarsal approaches to orbitozygomatic fracturesPlast Reconstr Surg200311151708–1714
24.
YoneharaYHirabayashiSTachiMIshiiHTreatment of zygomatic fractures without inferior orbital rim fixationJ Craniofac Surg2005163481–485
25.
de Souza CarvalhoACPereiraCCQueirozTPMagro-FilhoOIntraoral approach to zygomatic fracture: modified technique for infraorbital rim fixationJ Craniofac Surg2012232537–538
26.
MansonPNClarkNRobertsonBCrawleyWAComprehensive management of pan-facial fracturesJ Craniomaxillofac Trauma19951143–56
27.
RidgwayEBChenCLeeBTAcquired entropion associated with the transconjunctival incision for facial fracture managementJ Craniofac Surg20092051412–1415
28.
RidgwayEBChenCColakogluSGautamSLeeBTThe incidence of lower eyelid malposition after facial fracture repair: a retrospective study and meta-analysis comparing subtarsal, subciliary, and transconjunctival incisionsPlast Reconstr Surg200912451578–1586
29.
RaschkeGFRiegerUMBaderRD, et al. The zygomaticomaxillary complex fracture - an anthropometric appraisal of surgical outcomesJ Craniomaxillofac Surg2013414331–337
30.
LeeEIMohanKKoshyJCHollierLHJrOptimizing the surgical management of zygomaticomaxillary complex fracturesSemin Plast Surg2010244389–397
31.
AlviACarrauRLThe bicoronal flap approach in craniofacial traumaJ Craniomaxillofac Trauma19962240–55
32.
RohnerDTayAMengCSHutmacherDWHammerBThe sphenozygomatic suture as a key site for osteosynthesis of the orbitozygomatic complex in panfacial fractures: a biomechanical study in human cadavers based on clinical practicePlast Reconstr Surg200211061463–1471, discussion 1472–1475
33.
KimJHLeeJHHongSMParkCHThe effectiveness of 1-point fixation for zygomaticomaxillary complex fracturesArch Otolaryngol Head Neck Surg20121389828–832
34.
HwangKOne-point fixation of tripod fractures of zygoma through a lateral brow incisionJ Craniofac Surg20102141042–1044
35.
O'HaraDEDelVecchioDABartlettSPWhitakerLAThe role of microfixation in malar fractures: a quantitative biophysical studyPlast Reconstr Surg1996972345–350, discussion 351–353
36.
DeveciMEskiMGursesSYucesoyCASelmanpakogluNAkkasNBiomechanical analysis of the rigid fixation of zygoma fractures: an experimental studyJ Craniofac Surg2004154595–602
37.
HanemannMJrSimmonsOJainSBarattaRGuerraABMetzingerSEA comparison of combinations of titanium and resorbable plating systems for repair of isolated zygomatic fractures in the adult: a quantitative biomechanical studyAnn Plast Surg2005544402–408
38.
Dal SantoFEllisEIIIThrockmortonGSThe effects of zygomatic complex fracture on masseteric muscle forceJ Oral Maxillofac Surg1992508791–799
39.
ZinggMLaedrachKChenJ, et al. Classification and treatment of zygomatic fractures: a review of 1,025 casesJ Oral Maxillofac Surg1992508778–790
40.
EppleyBLZygomaticomaxillary fracture repair with resorbable plates and screwsJ Craniofac Surg2000114377–385
41.
SinghVSharmaBBhagolAEvaluating the applicability of a biodegradable osteosynthesis plating system in the management of zygomatico-maxillary complex fracturesOtolaryngol Head Neck Surg20111456924–929
42.
KangIGJungJHKimSTChoiJYSykesJMComparison of titanium and biodegradable plates for treating midfacial fracturesJ Oral Maxillofac Surg2014724762.e1–762.e4
43.
YabKTajimaSOhbaSDisplacements of eyeball in orbital blowout fracturesPlast Reconstr Surg199710061409–1417
44.
TaherniaAErdmannDFollmarKMukundanSGrimesJMarcusJRClinical implications of orbital volume change in the management of isolated and zygomaticomaxillary complex-associated orbital floor injuriesPlast Reconstr Surg20091233968–975
45.
HawesMJDortzbachRKSurgery on orbital floor fractures. Influence of time of repair and fracture sizeOphthalmology19839091066–1070
46.
GartMSGosainAKEvidence-based medicine: orbital floor fracturesPlast Reconstr Surg201413461345–1355
47.
ChristensenBJZaidWInaugural survey on practice patterns of orbital floor fractures for American oral and maxillofacial surgeonsJ Oral Maxillofac Surg2016741105–122
48.
SchoumanTCourvoisierDSVan IssumCTerzicAScolozziPCan systematic computed tomographic scan assessment predict treatment decision in pure orbital floor blowout fractures?J Oral Maxillofac Surg20127071627–1632
49.
ChiassonGMaticDBMuscle shape as a predictor of traumatic enophthalmosCraniomaxillofac Trauma Reconstr201033125–130
50.
BanerjeeAMooreCCTseRMaticDRounding of the inferior rectus muscle as an indication of orbital floor fracture with periorbital disruptionJ Otolaryngol2007363175–180
51.
HeilandMSchulzeDBlakeFSchmelzleRIntraoperative imaging of zygomaticomaxillary complex fractures using a 3D C-arm systemInt J Oral Maxillofac Surg2005344369–375
52.
WildeFLorenzKEbnerA-KKraussOMaschaFSchrammAIntraoperative imaging with a 3D C-arm system after zygomatico-orbital complex fracture reductionJ Oral Maxillofac Surg2013715894–910
53.
StanleyRBJrUse of intraoperative computed tomography during repair of orbitozygomatic fracturesArch Facial Plast Surg19991119–24
54.
GellrichNCSchrammAHammerB, et al. Computer-assisted secondary reconstruction of unilateral posttraumatic orbital deformityPlast Reconstr Surg200211061417–1429
55.
BellRBMarkiewiczMRComputer-assisted planning, stereolithographic modeling, and intraoperative navigation for complex orbital reconstruction: a descriptive study in a preliminary cohortJ Oral Maxillofac Surg200967122559–2570
56.
MarkiewiczMRDierksEJPotterBEBellRBReliability of intraoperative navigation in restoring normal orbital dimensionsJ Oral Maxillofac Surg201169112833–2840
57.
WildeFSchrammAIntraoperative imaging in orbital and midface reconstructionFacial Plast Surg2014305545–553
58.
SusarlaSMMundingerGSO'Brien-CoonD, et al. Does training background influence decision-making in the management of zygomaticomaxillary complex fractures?J Oral Maxillofac Surg2016745995–1012
