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Scientific Oral Presentations

Facial Plastic and Reconstructive Surgery

Session: Scientific Oral Presentation 2 - Facial Plastics and Reconstructive Surgery

Zygomaticomaxillary Complex Fractures: An Evidence-Based Management Protocol from Clinical Observation to Three-Point Fixation

Monday, October 13, 2025
9:36 AM - 9:42 AM EDT
Location: 137
Introduction: Zygomaticomaxillary complex (ZMC) fractures are often complex and heterogenous, complicating the data on ideal reconstructive approaches. This study was designed to develop an evidence-based treatment protocol from observation through open and reduction internal fixation (ORIF) with various points of fixation.

Methods: A single-institution cohort study was performed on consecutive, complete (Zingg class B or C) ZMC fractures from June 2021 through March 2023. Patients were stratified by intervention: ORIF versus Observation. Fixation points included the zygomaticomaxillary (ZM) and zygomaticofrontal (ZF) sutures, inferior orbital rim (IOR), and zygomatic arch (ZA). Demographics, fracture details, concomitant facial fractures, and postoperative outcomes were compared via odds ratios (OR) with 95% confidence intervals (CI).

Results: 112 patients were included (median age, 36 [range: 18-80]; male, 92 [80.5%]), including 39 undergoing ORIF (34.8%) and 73 observed (65.2%). Comminution was common and similar between management groups (84.2% versus 67.6%; OR 2.56, 95% CI: 0.94 – 6.97), but displaced fractures were associated with ORIF (73.0% versus 42.3%; OR 3.69, 95% CI: 1.55 – 8.76). Fixation was often performed at the ZF (76.9%), ZM (76.9%), and IOR (66.7%), but rarely the ZA (5.1%). Most ORIF patients underwent two-point (46.2%) or three-point (41.0%) fixation, with the ZF plated first (70.6%). The decision to place a third plate was determined intra-operatively based on fracture reduction and stability. A third plate was more common in patients with concomitant facial fractures compared to isolated ZMC fractures (93.8% versus 66.7%, p=0.051). Postoperative infection, visual impairment, trismus, and aesthetic dissatisfaction were similar between all management approaches (p>0.05 for all tests).

Conclusions: Most ZMC fractures can be adequately managed with observation, but displaced fractures should undergo ORIF. Intraoperative reduction and stability determines the need for two- versus three-points of fixation, with three-points more common when concominant facial fractures are present.

    Presenting Author(s)

  • AZ

    Aaron L. Zebolsky, MD

    Resident Physician
    University of Tennessee
    Memphis, TN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Mohammad Almomani, MD

    Resident physician
    SSM/ SLU
    Memphis, Tennessee, United States

    Disclosure information not submitted.

  • Haleigh G. Isanhart, N/A

    Medical student
    UTHSC
    Memphis, TN, United States

    Disclosure information not submitted.

  • Emily R. Baker, MD

    Resident Physician
    Vanderbilt University Medical Center
    Memphis, Tennessee, United States

    Disclosure information not submitted.

  • Travis Jonathan Clarke, MD

    Resident Physician
    University of Tennessee
    Memphis, TN, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Anas A. Eid, MD

    Assistant Professor
    University of Tennessee, Department of Otolaryngology--Head and Neck Surgery
    Memphis, TN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.