(92) Surgical Approaches and Postoperative Outcomes in Zygomatic Fractures: A Systematic Review

Abstract:
Statement of the Problem: Zygomaticomaxillary complex (ZMC) fractures are prevalent facial injuries that often require surgical intervention to restore both function and aesthetics. Different surgical approaches, including traditional open reduction and minimally invasive techniques, are employed, yet the comparative outcomes of these methods remain unclear. This study aims to evaluate the functional, aesthetic, and postoperative outcomes associated with these surgical approaches in managing ZMC fractures.
Materials and

Methods: A systematic review was conducted by searching the MEDLINE, EMBASE, and Cochrane databases until October 2024. Thirteen studies published between 2014 and 2024, which investigated ZMC fractures and involved either open or minimally invasive surgical approaches, were included. These studies provided data on patient demographics, surgical techniques, complications, recovery times, and both functional and aesthetic outcomes. The sample size across the studies ranged from 15 to 120 patients per study, with a combined total of 1,030 patients.
Method of Data Analysis: Data was analyzed using descriptive statistics to compare functional and aesthetic outcomes across the two surgical techniques. Statistical tests for differences in recovery times and aesthetic outcomes were performed where applicable, using a P value of < .05 for statistical significance. The majority of studies were prospective cohort studies, with a few retrospective designs. For subjective analysis, the aesthetic outcomes were evaluated using visual assessments and patient-reported outcomes.
Duration of Study: The studies reviewed spanned a period from 2014 to 2024, with follow-up durations ranging from 6 months to 2 years postsurgery.
Statistical

Methods: Data analysis involved comparative statistical methods such as chi-squared tests for categorical variables (eg, complication rates) and t-tests for continuous variables (eg, recovery times). The outcomes data were also subjected to meta-analysis to assess the overall effect of the different surgical approaches on recovery.
Results of Investigation: The review found that both open and minimally invasive surgical techniques generally resulted in favorable functional and aesthetic outcomes, with no significant differences in major complications such as infections or malunion. Recovery times were significantly shorter with minimally invasive approaches, with patients exhibiting improved aesthetic results, including less scarring and reduced postoperative swelling. Functional outcomes, particularly ocular motility and sensory recovery, were similar between the two approaches, with a slight advantage in recovery time seen in minimally invasive methods.
Outcomes Data: The results indicated that minimally invasive techniques were associated with superior cosmetic outcomes and shorter recovery times. Both techniques effectively restored facial function and nerve recovery. Patient satisfaction was high in both groups, with minimal complications reported.
Conclusions Relevant to the Problem: Both traditional open reduction and minimally invasive techniques are effective for treating ZMC fractures, providing favorable functional and aesthetic results with minimal complications. Endoscopic-assisted approaches offer enhanced cosmetic outcomes and quicker recovery. However, further research with standardized protocols and long-term follow-up is necessary to assess the durability of these outcomes and to better understand the factors influencing nerve recovery and facial aesthetics.