Evaluation of the Radiological Results Between Local and Coronal Incisions in the Treatment of Zygomaticomaxillary Complex Fractures.

Background: Zygomaticomaxillary complex (ZMC) fractures are commonly treated using either local or coronal incisions, each approach having distinct advantages and disadvantages.

Purpose: The purpose of this study was to compare treatment outcomes by imaging measurements in zygomatic fractures treated with local or coronal incision surgery.

Study design, setting, sample: This retrospective cohort study analyzed surgically treated ZMC fractures at the Second Hospital of Lanzhou University (2021 to 2023). Inclusion criteria were as follows: patients had displaced fractures (≥1 mm) with zygomatic partial rotation secondary to trauma. Exclusions were as follows: patients with minimal displacement, incomplete data, or inadequate imaging.

Predictor variables: The primary predictor variable was the surgical approach to the ZMC fracture: localized or coronal incision.

Outcome variables: The primary outcome variable was fracture repair quality. We had measured the bilateral distance differences from anatomical landmarks as quality of fracture repair using computed tomography imaging. Quality of fracture repair was graded as follows: <1 mm (excellent), 1 to 2 mm (good), and >2 mm (general).

Covariates: The covariates included age, gender, trauma mechanism, preoperative waiting time, classification of ZMC fractures, eye injury, and accompanied other maxillofacial fractures.

Analyses: Statistical analyses were performed by t-test and the χ² test for bivariate analysis. Statistical significance was set at P < .05.

Results: The study included 75 subjects with a mean age of 37 ± 4 years, comprising 52 males (69.3%) and 23 females (30.7%). Local and coronal incisions were used in 40 (53%) and 35 (47%) subjects, respectively. There was a statistically significant difference between surgical approach (local vs coronal) and fracture repair quality (P < .0001). There was a statistically significant difference in the distance of the foramen magnum to the zygomatic surface between coronal incision (0.78 ± 0.62 mm) and local incision (1.34 ± 0.98 mm) (P = .003). Similarly, significant differences were observed in the distance from the midline to the zygomatic surfaced (coronal: 0.73 ± 0.40 mm vs local: 1.38 ± 1.21 mm; P = .005) and D-FZA (coronal: 0.65 ± 0.34 mm vs local: 1.29 ± 0.81 mm; P < .0001).

Conclusion and relevance: The local incisions can achieve satisfactory outcomes in ZMC fracture surgery while avoiding additional incisions. Compared to local incisions, coronal incisions offer the advantage of accurate anatomical reduction and improved fracture repositioning.