Orbital floor repair and three-point fixation of zygomaticomaxillary complex fractures to restore orbital morphological features and ocular functions: a retrospective observational cohort study.

BACKGROUND: Despite numerous investigations on how to manage zygomaticomaxillary complex fractures (ZMCFs), the best treatment option remains uncertain. The purpose of this study was to investigate the efficacy of three-point fixation with orbital floor reconstruction in restoring orbital morphology and managing post-traumatic ocular complications associated with ZMCFs, as well as to measure the postoperative reduction in orbital volume (OV).

METHODS: A retrospective observational cohort study was conducted on patients with unilateral ZMCFs and orbital floor fractures with a completely intact contralateral orbit. The primary variable was the efficacy of three-point fixation of ZMCFs with orbital floor reconstruction in reducing enlarged OV and restoring ocular functions. The manual segmentation method was used to measure the OV of both orbits on CT scans. The measurements were categorized into OVIntact, OVFractured, and OVRepaired. The outcome variables were the percentages of OV difference and OV change between both orbits, the resolution rate of diplopia, the improvement in restricted extraocular muscle movements (EOMs), and the correction of post-traumatic enophthalmos.

RESULTS: The study included 63 patients (mean age: 28.1 ± 2.6 years), with a male predominance of 60.3%. Post-traumatic enophthalmos and diplopia were observed in 49 (77.8%) patients, while restricted EOMs in upward gaze was noted in 33 (52.4%). The treatment protocol significantly reduced the OVFractured from 26.8 ± 1.6 cc to 21.9 ± 1.3 cc, achieving a correction rate of 97.3% (p < 0.021). Comparison between OVRepaired and OVFractured showed a 20.12% difference and 18.28% change, whereas comparison with the OVIntact revealed a minimal asymmetry, with a 2.78% difference, 2.82% change, and a mean volume difference of 0.6 ± 2.3 cc. Ocular complications were significantly resolved, with a p-value < 0.001. Postoperatively, 54 patients had normal globe position, while three showed enophthalmos and six showed exophthalmos. At the end of the postoperative first month, the resolution rate of diplopia and restricted EOMs were 52.4% and 98.4%, respectively. Diplopia was completely resolved at the end of the postoperative third month.

CONCLUSION: Three-point fixation of zygomaticomaxillary buttresses with orbital floor reconstruction should be considered the standard of treatment for ZMCFs due to its high success rate in restoring orbital morphology and ocular function.