ORIGINAL RESEARCH www.ijcmr.

com

A Study on Assessing the Etiology and Different Treatment

Modalities of Zygomaticomaxillary Complex Fracture
Ashwin D P1, Rohit2, Rajkumar G C3

zygomatic complex is important in the function of the globe,

ABSTRACT facial symmetry and also gives passage to infra orbital nerve
Introduction: Fracture of the zygomatic complex is amongst that innervates the mid facial region. Fractures of zygomatic
the most frequent in maxillofacial trauma, due to its prominence complex are among the most frequent in maxillofacial trauma
which predisposes it to bear the brunt of facial injuries, the pattern and are involved in 42% of facial fractures and accounts for 64%
of which may vary geographically. Fracture pattern ranges from of all middle third fracture.1 They are the second most common
simple to comminuted and from minimally displaced to severely fractures of the face after nasal injuries.3
displaced depending on the impact of injuries sustained by various The architectural pattern of the zygomatic bone allows it to
modes. Study aimed to assess the etiology and different treatment
withstand blows of great forces without fracturing. Traditionally
modalities depending on severity of displacement of zygomatic
referred to as a “tripod” fracture, a ZMC fracture actually
fracture.
Material and methods: 46 patients with zygomaticomaxillary involves disruption at four sites: the lateral orbital rim, the
complex fracture reporting during November 2012 to April inferior orbital rim, the Zygomaticomaxillary buttress and the
2014 were included in the study. On the basis of radiographic zygomatic arch. It may be separated from its four articulations,
evaluation severity of displacement was assessed and different resulting in zygomatico-maxillary complex, zygomatic
treatment modalities were selected. complex, or orbito zygomatic fracture depending on the severity
Results: Road traffic accident accounted as the leading cause of of injury. Fractures of zygomatico-maxillary complex are one of
fracture (60.9%) followed by self-fall (28.3%), assault (6.5%). the most common types of maxillofacial injuries to treat.4
Open reduction and internal fixation was carried out in (73.9%), The information about the incidence, etiology, age and gender
out of which 1-point fixation in (28.3%), 2-point fixation in concerning this type of fractures varies according to the social,
(32.6%) and 3-point fixation in (13%).
economic, cultural and environmental factors.1 Most of the
Conclusion: This study on assessment of etiology and various
cases indicate a predilection for males with a 4:1 proportion in
treatment modalities of zygomatic bone fracture showed that
the majority of the patients were young adult men. Road traffic relation to females. Variety of etiologies including aggressions,
accident was the leading factor causing zygomatic bone fracture. automobile accident, falls, industrial accidents and sports are
Our study showed that displacement at any of the fractured site important factors for this injury.
on the occipitomental radiograph can be used as a criteria for The diagnosis is made through clinical examination and
to assign patient to either open reduction and fixation group or adequate radiological evaluation. Plain radiograph commonly
conservative management group. used is Occipito- mental or Water’s view which can clearly
demonstrates the bone discontinuity in the Zygomaticomaxillary
Keywords: Etiology, Modalities of Zygomaticomaxillary,
buttress, Infraorbital rim and Frontozygomatic region. The
Complex Fracture
submentovertex view more clearly detects fracture of the
zygomatic arch.5
The treatment of the zygomatic complex fractures is
INTRODUCTION controversial, as we can see in the different philosophies in
Fracture of the zygomatic complex are among the most literature. This treatment had varied from a simple observation,
frequent in maxillofacial trauma, due to its prominence which up to a surgical approach for an internal rigid fixation. Although
predisposes it to bear the brunt of facial injuries, the pattern of it has been suggested that all displaced ZMC fractures require
which may vary geographically. Fracture pattern ranges from surgical intervention, conservative management is frequently
simple to comminuted and from minimally displaced to severely employed in cases of minimal displacement, asymptomatic
displaced depending on the impact of injuries sustained by injury, and patient noncompliance.6
various modes. Although a great volume of literature exists for
the management of these injuries which include conservative 1
Associate Professor, 3Professor, Department of Oral and Maxillofacial
management to routine exposure and fixation of at least one,
Surgery, Vokkaliagara Sangha Dental College and Hospital, Kr Road,
two, three of the four articulations, depending on the degree of VV Puram, Bangalore-04, 2Senior Resident, Oral and Maxillofacial
displacement. Surgery, MGM Government Hospital, Jamshedpur, India
Zygomatic bone contributes significantly to the strength and
stability of the mid face. Zygoma is a strong buttress of lateral Corresponding author: Dr Rohit, Flat No: B/302, Arbindo
portion of middle third of facial skeleton1 and it forms the cheek Madhusudan Complex, Dimna Basti, Near Shiv Mandir, NH 33, Pin
-831018, Jamshedpur, Jharkhand, India
prominence, part of the lateral and inferior orbital rim and
the orbital floor. Due to its prominent position it is frequently How to cite this article: Ashwin D P, Rohit, Rajkumar G C. A
subjected to fracture and dislocation either alone or in study on assessing the etiology and different treatment modalities
combination with other structures of midface such as maxilla, of zygomaticomaxillary complex fracture. International Journal of
nasoethmoidal and orbital area.2 Contemporary Medical Research 2017;4 (6):1423-1430.

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Ashwin, et al. Zygomaticomaxillary Complex Fracture

Treatment options for the reduction of isolated zygomatic bone fixation was done under general anesthesia.
fracture ranges from closed reduction without fixation to open
STATISTICAL ANALYSIS
reduction and multiple point of exposure and fixation.3 Study
aimed to assess the etiology and different treatment modalities Microsoft office 2007 was used for the statistical analysis.
depending on severity of displacement of zygomatic fracture. Descriptive statistics like mean and percentages were used for
the analysis.
MATERIAL AND METHODS
RESULTS
Study was done in the Department of Oral and Maxillofacial
surgery at V.S Dental College and hospital and Kempegowda During two years of study from November 2012 to October
institute of medical sciences, Bangalore. All patients who had 2014 which included follow up period also, 46 patients with
sustained zygomaticomaxillary complex fracture reporting to ZMC fracture were treated, of which 91.3% (n=42) male and
the Department of Oral and Maxillofacial surgery at V.S Dental 8.7% (n=4) females with Male: Female ratio of 11.5:1 (Table-1).
College and hospital and Kempegowda institute of medical In the population studied, road traffic accident was found to
be the most common etiology of the zygomatic bone fracture
sciences, Bangalore were included in the study. Study duration
accounting for 60.9% (n=28) of the cases followed by,
was from from November 2012 to April 2014 and 46 Patients
accidental self fall representing 28.3% (n=13) of the cases,
were included in the study. Various inclusion and exclusion
assault (inter personal violence) 6.5% (n=3) and work related
criteria was decided which are as follow.
injuries (construction workers) accounting for 4.35% (n=2)
Inclusion criteria (table-2).
• Patients above the age of 15 years Data regarding clinical presentation during the initial
• Zygomaticomaxillary complex fracture examination of the patients were recorded and are displayed in
• Displaced and undisplaced fracture of the zygomatic bone Table. Patients presented with circumorbital ecchymosis and
• Fractures less than 5 weeks old perioorbital edema which was the most common sign evident
• Closed type of fractures in 73.9% (n=34), subconjunctival ecchymosis in 71.7% (n=33),
Exclusion criteria chemosis in 34.8% (n=16), flattening of the cheek was seen in
• Orbital fractures, where additional procedure is required 60.9% (n=28) and rest displayed in (Table 3).
for reconstruction of orbital floor Study showed that zygomatic bone was fractured at single process
• Fractures more than 5 weeks old in 54.35% (n=25) and more than one process was involved
• Isolated zygomatic arch fracture in 44.65% (n=21). In patients with single process fracture
• Patients with systemic disorder where surgery is infraorbital rim was most commonly involved accounting for
contraindicated. 21.74% (n=10), followed by zygomatic maxillary buttress
The criteria used to determine the need of surgical correction 17.39% (n=8) and frontozygomatic suture region 15.2% (n=7)
consisted of both clinical and radiological assessement.
Clinical assessment included detailed case history and physical Gender N %
examination of the patient. Malar asymmetry, neurological Male 42 91.3
deficit of the infra orbital nerve was recorded, ocular changes, Female 4 8.7
palpable step deformity at the infraorbital rim, tenderness at the Total 46 100
fractured points, visible depression of the prominence of the Table-1: Gender distribution in study sample
cheek.
Radiological assessment was done using PNS or water’s view Etiology Number of Patients %
which can clearly demonstrate the bone discontinuity in the RTA 28 60.9
Zygomaticomaxillary buttress region, Frontozygomatic region Self-fall 13 28.3
and Infraorbital rim. The SMV which can clearly detect fractures Assault 3 6.5
of the zygomatic arch and CT scan with its 3D applications for Work related 2 4.3
visualization of the orbit if the orbital portion of zygomatic Total 46 100
fracture was suspected or in comminuted fracture of zygomatic Table-2: Etiology of zygomatic bone fracture
bone and also to assess the degree of displacement.
Depending on the different patterns of zygomatic bone fracture Signs Count %
which ranged from simple fracture to comminuted and from Periorbital Edema 34 73.9%
minimally displaced to severely displaced, treatment options Sub-ecchymosis 33 71.7%
were decided. Undisplaced zygomatic bone fracture were Chemosis 16 34.8%
managed conservatively and were recalled for regular follow Flatting of cheek 28 60.9%
up while displaced and comminuted fractures of zygoma were Infra orbital Nerve paresthesia 32 69.6%
surgically corrected. Most of the patients were treated on an Step deformity 16 34.8%
in-patient basis. Varieties of surgical approaches were used Bony crepitations 14 30.4%
depending on the degree of displacement of zygoma. Operative Diplopia 2 4.3%
procedure involved open reduction and internal fixation using Trismus 10 21.7%
1.5 mm stainless steel mini plates and screws with multiple Occlusal discrepancies 15 32.6%
points of exposure and fixation at 1-point, 2-point and 3-point Table-3: Signs, count & percentage

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Ashwin, et al. Zygomaticomaxillary Complex Fracture

(Table 4a.) sclera show (ectropion), entropion was encountered during

When zygomatic bone was fractured at more than one process, post-operative follow up in few cases. (Table 8)
fracture at two processes was found in 32.60% (n=15) of the
DISCUSSION
patients. Three process fractures (tripod) were seen in 13.0%
(n=6) of cases. In patients with two process fracture, the The zygomaticomaxillary complex functions as a buttress
infraorbital rim and zygomatic buttress was the most common for the face and is the corner stone to a person’s aesthetic
site of fractures accounting for 21.74% (n=10). Zygomatic appearance by both setting mid facial width and providing
arch fracture along with body fracture of zygoma was seen in
21.73% (n=10) (Table 4b). Sites of fracture Frequency percentage
Out of 46 patients, 26.1% (n=12) were diagnosed with IOR 10 21.7
undisplaced zygomatic fracture who did not require any surgical ZMB 8 17.4
intervention and were managed conservatively with periodic FZ 7 15.2
follow ups. In 73.9% (n=34), open reduction and internal Table-4a: Sites of fracture
fixations were carried out under general anesthesia (Table 5).
Various surgical approaches were made to access the fractured
Sites of fracture Frequency Percentage
ends such as subcilliary, Transconjunctival, lateral brow,
IOR + ZMB 10 21.7
intraoral maxillary vestibular incision or through existing IOR+ FZ 4 8.7
laceration. (Table 6) FZ+ ZMB 1 2.2
Depending on the severity of the injury, degree of displacement IOR+ FZ+ ZMB 6 13.0
and stabilization required after reduction, fixation was done at Table-4b: Two process and Three process fracture site
either1-point, 2-point or 3-point. 1-point fixation was done in
28.3% (n=13) of the cases; 2-point fixation was done in 32.6%
Treatment options Frequency Percentage
(n=15) of the cases and 3-point fixation in 13.1% (n=6) of the
Conservative management 12 26.1
cases. (Table7)
Open reduction and internal fixation 34 73.9
In 1-point fixation cases ZMB was fixed in 53.8% (n=7) while
Table-5: Treatment Options
in 2-point fixation IOR and ZMB was fixed in 66.6% (n=10)
cases (Figure-5).
During the period of postoperative follow up period, no cases Surgical approach Frequency percentage
were encountered with incidence of mobility of fractured Lateral brow 12 26.1
segments. Complications such as facial asymmetry, occlusal Transconjunctival 14 30.4
Subcilliary 8 17.4
discrepancies, persistent infra orbital sensory nerve disturbance,
Maxillary vestibular (Keen’s) 23 50
Existing laceration 4 8.7
Table-6: Surgical approaches

Fixation points Frequency Percentage

1-point 13 28.3
2-point 15 32.6
3-point 6 13.0
Table-7: Different point of fixation for ZMC fracture

ZMB 7 53.8
IOR 4 30.8
FZ 2 15.4
Table-7a: Fixation site for 1-point fixation

Figure-1: Etiology of ZMC fracture

ZMB+IOR 10 66.6
FZ+ZMB 1 6.6
IOR+FZ 4 26.6
Table-7b: Fixation site for 2-point fixation

Postoperative complications Frequency

Facial asymmetry 4
Ectropion (scleral show) 2
Intropion 1
Infraorbital nerve paresthesia 16
Occlusal discrepancy 6
Wound dehiscence 3
Figure-2: Clinical signs and symptoms Table-8: Postoperative complications

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Ashwin, et al. Zygomaticomaxillary Complex Fracture

Kovacs FA et al 6.42:1
Sulliven STO et al 8.9:1
Bouguila J et al 9:1
The reasons could be greater social and economic involvement
of young adult males. The age group most commonly involved
in this study was from 3rd decade followed by 2nd and 4th, the
lowest incidence was found in 7th decade. Studies reported by
Chowdhury et al2, Motamedi MH, Ozemene et al54, AL Ahmad
HE et al and Fasola et al showed that zygomatic bone fracture
are common in 3rd decade.
The etiology of facial fractures has changed over decades
Figure-3: Sites of fracture
and they continue to do so.55 The developed countries show a
striking reduction in broad category in road traffic accidents and
increased influence of inter personal violence.55 However, road
traffic accident was the most common cause of the zygomatic
bone fracture in present study. Similar high percentage of road
traffic accidents were reported by Chowdhury and Menon
86.20%, Fasola et al 81.6%, Ozemene 81%. However, Kovacs
et al 46.2%, Zingg et al18 29% reported interpersonal violence as
the leading cause of zygomatic fracture. Interestingly Sulliven
STO et al reported Sports injury as 27.5%. Gomes PP et al56
Figure-4: Surgical approaches reported accidental self fall as 21.83% as a most common cause
of zygomatic fracture.
The zygomatic bone provides height, width and projection to the
face and forms a part of the bony orbit. It also provides attachment
to the suspensory ligament of lockwood which support the
globe.34 An inferiorly displaced fracture of the zygoma produces
an antimongoloid slant and accentuation of the supratarsal fold
of the upper eyelid and may result in disturbed ocular functions,
orbital shape and facial esthetics.34 Evaluation of a patient
with a ZMC fracture included evaluation of bony injuries and
status of surrounding soft tissues i.e eyelids, canthal ligament
globe cranial nerve II to VI. Visual acuity was ascertained and
ophthalmological consultation was obtained in doubtful case.
Figure-5: Point fixations However in our study none of the patient presented with altered
visual acuity both pre and postoperatively.
prominence to the cheek.36 It can best be anatomically described Detailed history and close inspection, palpation of the orbital rim
as “tetrapod” as it maintains four points of articulation with the and the zygoma was done in orderly fashion. Tenderness, a step-
frontal bone, temporal bone, maxilla, grater wing of sphenoid, at off or discontinuity of the bony frame indicated possibility of
the zygomatico frontal (ZF) suture, zygomatico temporal (ZT) fracture. As reported by Taicher et al57 there may be paresthesia,
suture, zygomaticomaxillary buttress (ZMB), and zygomatico over the cheek, lateral nose, upper lip and maxillary anterior
sphenoid (ZS) suture respectively.36 This tetrapod configuration teeth resulting from the injury to the infraorbital nerve, the
lends itself to complex fractures. Due to the prominent, mid reported incidence of which is about 30 to 80%. The infraorbital
face location of the cheek fracture of the ZMC represent the nerve involvement in our study compared to the reported
second most common type of facial fracture after nasal bone incidence was 69.6%.
fracture.6 The majority of ZMC fractures are closed, displaced Intraorally ecchymosis in the buccal vestibule, tenderness or
and non- comminuted. Although the typical resultant deformity disruption in the zygomatic buttress was elicited. The range of
is the mid face depression, with posterior positioning of the mandibular movement was evaluated to rule out impingement
malar prominence, a range of displacements, including anterior of the zygoma or the arch or the coronoid process of mandible.
positioning of zygoma may occur depending on the mechanism In our study trismus was seen in 21.7% of the patient
of trauma.6 preoperatively.
Our study recorded that more males than female (11.5:1) In this study almost all the zygomatic bone fractures was
sustained ZMC fracture. Similar findings were found in other diagnosed and confirmed using PNS and SMV view.
studies however, the relative ration of male to female (11.5:1) is Radiographic evaluation of ZMC fracture is complicated
higher in the present study. Some of the reported male to female by difficulties in translating a three-dimensional rotation
ratios is given below1: and displacement into two-dimensional imaging modalities.
Ozemene et al54 3.2:1 CT scans (Axial and coronal view) with 3D applications of
Ajabe HA et al 4.7:1 the mid face helps to visualize and quantify malar eminence
Chowdhury LCSR et al2 5.2:1 displacement in the anterior-posterior, medial-lateral, and

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Ashwin, et al. Zygomaticomaxillary Complex Fracture

superior- inferior dimensions.6 zygomatic fractures are necessary to ensure proper healing and
This study showed isolated processes fracture in 54.35%, prevent post-operative complications. The number of surgical
two processes fracture in 32.6% and tripod fracture in 13.1%. approaches and sites of fixation necessary to ensure this varies
Zing et al18 reported single process fracture in 31% cases and based on the type of injury.6 Not every articulation needs to be
tripod fracture in 51% cases which is high as compared to this addressed to achieve an acceptable reduction however, at least
study. Isolated frontozygomatic fracture was found in 15.2% one, two or three articulations out of four must be addressed
cases, isolated infraorbital rim fracture was seen in 21.7% intra operatively to reduce these fractured segments accurately.36
and zygomaticomaxillary buttress in 17.4%. In the present There are various treatment strategies for the treatment of
study combination of IO and ZMB was seen in 21.7%while zygomatic bone fracture as described in literatures, such as
combination of FZ process and ZMB was fractured in 2.2% Temporal approach, Elevation with hook, External pin fixation,
cases, however, Obuekwe et al54 reported 38.8%.The time intra oral approach, Antral packing with gauge, Intraosseous
elapsed from trauma to first examination and surgical treatment wiring and bone plating.24 All these procedures have their own
varied in the study. Factors that influenced the treatment advantage and disadvantages. The lack of directional control
modalities included timing of presentation, age of the patient, and factors like insufficient contact area, fracturing of bone in
function loss, aesthetic concern, finances and associated excessive tightening and healing by secondary intention were
systemic disease. the problem areas in the management of ZMC fracture initially
According to Zachariades et al24 the management of zygomatic with wire osteosynthesis.34 The development of monocortical
complex fracture depends on the degree of displacement and miniplates and screws which consisted of plates which were
the resultant esthetical and functional deficit. Management may malleable and miniaturized for maxillofacial fracture fixation
therefore range from simple observation of resolving edema, resolved the problem associated with wire osteosynthesis. In
diplopia and paresthesia to a more aggressive open reduction our study for exposure of the fractured site we used lateral brow
and internal fixation. incision (26.1%) for the reduction and fixation of fractured ends
Pozatek et al58 proposed criteria for selection of patients at FZ area, subcilliary (17.4%) and transconjunctival (30.4%)
with zygomatic complex fracture for surgical intervention. approaches on and for exposure at infraorbital rim, intraoral
Depending on the intensity of impact, the fractures of the maxillary vestibular (50%) approach was used for reduction and
zygomatic complex could be isolated, single and undisplaced fixation of ZMB region. In few cases fractured site was reached
as seen in low energy impact cases or they could be displaced through existing laceration.
and rotated at one or more points around vertical and horizontal In 2 patients with infraorbital rim fracture, were exposure
axis as seen in medium and high velocity injuries. The fracture was done via subcilliary approach had slightly more scleral
may be dislocated enbloc or comminuted which may be further show (ectropion). Some patients also complained of epiphora
aggravated by the pull of the attached muscle, thus making present on immediate postoperative follow up, which gradually
closed reduction of these fracture ineffective. subsided. While Patients who underwent transconjunctival
Although it has been suggested that all displaced ZMC fracture approach had very minimal postoperative complaint, except for
require surgical intervention, conservative management one case where moderate degree of entropion was evident.
is frequently employed in cases of minimal displacement, One of the most controversial topics in maxillofacial trauma
asymptomatic injury, patient noncompliance, or medical is how much fixation is enough to prevent post reduction
contraindication to surgery.6 No standard classification scheme displacement of the fractured ZMC.3 Recommendations for
currently exists to assist in the assessment of ZMC fracture fixation have varied from none to the placement of three or four
severity and need for surgical treatment. bony plates at different locations. The reason for this disparity
The decision to intervene surgically should be primarily based is multifactorial and includes many intangibles such as type of
on displacement and rotation of the malar complex. As a general injury being treated i.e simple versus comminuted fractures,
rule, non- displaced or minimal displaced fracture can usually grossly displaced versus minimally displaced fractures, grossly
be treated conservatively and regular follow up should be done displaced versus minimally displaced.
to assess for any late displacement.36 In the present study, 26.1% In our study 73.9% cases were treated by open reduction and
patients did not require any treatment and were followed up for internal fixation using minipplates. One-point fixation was
variable period of time. All the patients in this category had done in 28.3% of cases in which fixation at ZMB was done in
undisplaced fracture at zygomatic buttress, infraorbital rim and 7cases followed by 4cases at IOR margin and in 2 cases FZ
frontozygomatic region. Similar results were reported by Larsen was stabilized and fixed. Two-point fixation was done in 32.6%
and Thompson et al and Ellis et al.23 Gomes PP et al56 reported cases in which 10 cases were fixed at IOR and ZMB region, 4
a high number of zygomatic bone fracture (56.6%) that did not cases at IOR and FZ and 1 case at FZ and ZMB region. Three-
require any treatment. We did not encountered any case with point fixation was carried out in 6 patients accounting for 13%.
late displacement or rotation during follow up. Persistent infra Different point of fixation in our study was based on severity
orbital nerve paresthesia was present in 16 patients during 6 of displacement. Fracture only at one process with minimal
months follow up. displacement was managed conservatively while moderate to
In contrast, displaced fracture should be surgically reduced severe displacement were operated. Fracture at two process
and stabilized. The degree of displacement can be easily and three processes were addressed and fixation was done
checked by assessing the status of the normal articulation of accordingly depending on the sites involved.
the ZMC with the craniofacial skeleton on PNS radiograph Champy et al in his study reported satisfactory results with a
and CT scan. Accurate reduction and fixation of displaced single point fixation of the zygomatic complex fracture at the FZ

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Ashwin, et al. Zygomaticomaxillary Complex Fracture

region. Ji Heui kim et al46 concluded that one-point fixation at and other studies, a variety of methods can be used successfully
the ZMB through a gingivobuccal sulcus incision was effective to stabilize ZMC fracture. Treatment modalities for zygomatic
for isolated fracture of zygoma without comminution of lateral bone fracture depends on various characteristics of the fracture
orbital rim. Hwang suggested that one-point fixation of tripod and open reduction with internal fixation using miniplates is
fractures through a lateral brow incision can apply to cases with most stable and reliable modality providing three dimensional
minimal or moderate displacement of the infraorbital rim.35 stability.50-65
However, because the ZMB plays a key role in withstanding
CONCLUSION
contraction of the masseter muscle and supporting zygoma,
rigid fixation at the ZMB is important in treatment of isolated Optimal management of ZMC fractures begin with accurate and
zygomatic fracture. Further studies concluded that a single point expedient diagnosis followed by formulations of a treatment
of fixation failed to address the three dimensional rotation of plan that account for proper reduction of fractured segments to
zygoma. restore facial balance. The conflicts which still persist in relation
Biomechanics of the facial skeleton was investigated and to the applied treatment modality concerns about the best way
discussed by Rudderman and Mullen. According to them, for surgical reduction of fractures, necessity to fix them or not
fractured zygomatic segments has six possible direction of after the reduction and lastly for the number of fixation points
motion: translation across x, y, z axis and; rotation about necessary so that the fractured ends are stabilized.
x,y,z axis.30 A miniplate applied across the FZ suture will In our study fixation points were either 1-point, 2-point and
resist translatory movement and also rotation along an axis 3-point depending on the displacement at the fractured sites.
perpendicular to the plane of miniplate because of the width of Two-point fixation being the most common,to determine
the plate. At the same time, it will offer little resistance to rotation whether there was any post-surgical change in the orientation
along the linear axis of plate. To improve the stabilization, an of plates or displacement of ZMC, immediate post-operative
additional plate is to be applied in a manner where the weak images were compared with those obtained later after one
axis of both the plane doesn’t coincide with a line connecting month.There was no incidence of any change among the treated
them.19,30-40 group.
Paik-kwoon Lee et al stated that two point miniplate fixation Based on our experience and the data generated from our study,
at the infraorbital rim and frontozygomatic region provide a variety of methods can be used successfully to stabilize ZMC
significant amount of stability, provided the comminution of fracture We conclude that treatment modalities for zygomatic
zygoma is not severe. Davidson et al stated that the two-point bone fracture depends on the characteristics of the fracture and
fixation using miniplate alone conferred a degree of stability open reduction and internal fixation with miniplates is the most
comparable to most methods of three-point fixation regardless reliable modality providing three dimensional stability.
of the site in which the miniplates were applied.27 REFRENCES
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