American Association of Plastic Surgeons Meeting 2022

Refining Operative Indications for Zygomaticomaxillary Complex Fracture Repair

Introduction

The zygomaticomaxillary complex (ZMC) is the keystone of the midface.
Although ZMC fractures are among the most common facial injuries, the optimal indications for repair remain controversial.
Clinical symptomatology of ZMC fractures commonly include: malar flattening, facial asymmetry, appreciable displacement, palpable step-off, malocclusion (misaligned teeth), trismus (limited range of motion in the jaw), paresthesias, diplopia, and enophthalmos.
The primary aim of this study is to identify specific pre-operative radiographic findings that relate to injury-specific symptomatology in patients with ZMC fractures.

Methods

Retrospective analysis of patients with ZMC fractures seen at a Level I Trauma Center between 2015 and 2020.
Exclusion criteria: patients with additional midfacial fractures beyond the zygoma.
Variables recorded from the medical record: patient demographics, CT characteristics (degree of anatomic displacement), and symptoms indicating surgical intervention.
Logistic regression analyses elucidated relationships between impaction measurements on CT imaging and symptomatology necessitating surgery.

Results

95 patients with ZMC fractures were included. 31% (n=29) presented with facial asymmetry or malar flattening, 17% (n=16) with trismus, 28% (n=27) with step-off, and 11% (n=10) with malocclusion.
Presentation of malar flattening was significantly predicted by maxillary wall impaction and anterior-posterior fracture displacement. 76% (n=22) of patients with malar flattening were deemed operative.
Maxillary wall impaction on CT also significantly predicted appearance of step-off. 56% (n=15) of patients with step-off were deemed operative.
Vertical displacement most strongly predicted malocclusion. 40% (n=4) of patients with malocclusion were deemed operative.

Conclusions

Our final regression model demonstrates that certain CT characteristics of ZMC fractures reliably predict symptoms requiring surgery. These CT measures include: maxillary wall impaction, anterior-posterior displacement, and vertical displacement.
These findings may be applied to informing patients with ZMC fractures of their risk for developing specific symptoms based on CT imaging of their injuries.
Ultimately, understanding specific relationships between symptomatology and CT impaction measures may guide the development of a standard protocol for surgical management of ZMC fractures.

Refining Operative Indications For Zygomaticomaxillary Complex Fracture Repair