When Conservative Management Fails: Late Surgical Repair of Zygomatic Arch Fracture and TMJ Dysfunction, There is Still Hope for Success.

BACKGROUND

Zygomatic arch fractures are often managed conservatively, but may result in persistent functional limitations, including temporomandibular dysfunction (TMD). This case highlights the challenges associated with delayed surgical intervention in cases with conservative management failure.

CASE REPORT: We present a 60-year-old man who sustained zygomatic arch and lateral orbital wall fractures after a fall. The initial fracture showed minimal displacement with no coronoid process impaction, and conservative treatment with NSAIDs, muscle relaxants, physiotherapy, and dietary modifications was instituted. Despite 45 days of follow-up, the patient experienced persistent pain, trismus, and progressive masticatory dysfunction. Open reduction and internal fixation (ORIF) using the Al-Kayat approach successfully restored mandibular function.

CONCLUSION

Even after initial conservative management, persistent functional limitations should prompt reassessment. Late surgical intervention remains a safe and effective option, particularly when muscle-related dysfunction is present. The Al-Kayat approach provides excellent exposure with minimal complications, enabling full functional recovery.