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Incidence of Complications Associated with Zygomaticomaxillary Complex Fractures Before and After Surgical Intervention in Patients Referred to Velayat Hospital, Rasht (2017–2023)
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Roghayeh Karimian Kelishadrokhi   , Seyed Hadi Hoseini * |
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Abstract: (175 Views) |
Background&Aim: Zygomaticomaxillary complex (ZMC) fractures are among the common facial fractures that can be associated with multiple complications. Additionally, some complications may persist after surgery or even arise as a result of the surgical procedure itself. Awareness of the incidence of these complications can provide valuable insights into the surgical prognosis and efforts to manage and minimize them. Therefore, this study evaluated the incidence of complications associated with ZMC fractures before and after surgery.
Materials and Methods:In this descriptive study Patients who underwent surgical treatment for ZMC fractures at Velayat Hospital, Rasht, from 2017 to 2023 were recruited. Complications resulting from these fractures, including ectropion, infraorbital nerve dysfunction, diplopia, blurred vision, enophthalmos, malar depression, trismus, vertical dystopia, infraorbital step, and malocclusion, were assessed following trauma and after surgery.
Results: A total of 153 patients (125 men and 28 women) were evaluated. Motorcycle accidents were the most common cause of these fractures. The incidence of diplopia was 0.65% after trauma and 18.3% after surgery. The incidence of blurred vision was 20.9% after trauma and 1.3% after surgery. The incidence of enophthalmos was 16.3% after trauma and 1.3% after surgery. The incidence of infraorbital neuropathy was 43.7% after trauma and 26.1% after surgery. The incidence of trismus was 21.5% after trauma and 3.2% after surgery. The incidence of malar depression, vertical dystopia, and malocclusion after trauma was 78.4%, 11.1%, and 6.5%, respectively, all of which resolved after surgery. Ectropion had an incidence of 1.3% after surgery, and the incidence of infraorbital step was 34.6% after trauma and 1.9% after surgery.
Conclusion: The results demonstrate a high surgical success rate in significantly reducing complications of ZMC fractures. Given the relatively high incidence of postoperative infraorbital neuropathy, it is recommended that this complication receive greater clinical attention. These findings offer surgeons a more precise understanding of complication patterns before and after surgical intervention. Future studies with larger sample sizes and longer follow-up periods are recommended.
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| Keywords: Zygomaticomaxillary Complex Fractures, Zygomatic Fractures, Orbital Fractures |
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Full-Text [PDF 707 kb]
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Type of Study: original article |
Subject:
oral surgery
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1. Yamsani B, Gaddipati R, Vura N, Ramisetti S, Yamsani R. Zygomaticomaxillary Complex Fractures: A Review of 101 Cases. J Maxillofac Oral Surg. 2016;15(4):417-24. [ DOI:10.1007/s12663-015-0851-9] [ PMID] [ ] 2. Zingg M, Laedrach K, Chen J, Chowdhury K, Vuillemin T, Sutter F, et al. Classification and treatment of zygomatic fractures: a review of 1,025 cases. J Oral Maxillofac Surg. 1992;50(8):778-90. [ DOI:10.1016/0278-2391(92)90266-3] [ PMID] 3. Committeri U, Arena A, Carraturo E, Austoni M, Germano C, Salzano G, et al. Incidence of Orbital Side Effects in Zygomaticomaxillary Complex and Isolated Orbital Walls Fractures: A Retrospective Study in South Italy and a Brief Review of the Literature. J Clin Med. 2023;12(3). [ DOI:10.3390/jcm12030845] [ PMID] [ ] 4. Nastro Siniscalchi E, Lo Giudice G, Calvo A, Marino R, Bonavolontà P, Dell'Aversana Orabona G, et al. Clinical Significance of Diplopia and the Orthoptic Examination in Zygomatic Maxillary Complex Fractures. J Craniofac Surg. 2024;35(5):1531-6. [ DOI:10.1097/SCS.0000000000010356] [ PMID] 5. Shabbir M, Shah R, Ahmad M, Issrani R, Khan Z, Nazal Alotha S, et al. Frequency of Diplopia in Zygomatic Complex Fractures-A Cross-Sectional Descriptive Study. Int J Dent. 2023;2023:7631634. [ DOI:10.1155/2023/7631634] [ PMID] [ ] 6. Hashemi HM, Avval SK. Prevalence of Ocular Complications in Patients with Zygomatic Bone Fractures in an Iranian Population. Front Dent. 2020;17(9):1-4. 7. Starch-Jensen T, Linnebjerg LB, Jensen JD. Treatment of Zygomatic Complex Fractures with Surgical or Nonsurgical Intervention: A Retrospective Study. Open Dent J. 2018;12:377-87. [ DOI:10.2174/1874210601812010377] [ PMID] [ ] 8. Jain SM, Gehlot N, Kv A, Prasad P, Mehta P, Paul TR, et al. Ophthalmic Complications in Maxillofacial Trauma: A Prospective Study. Cureus. 2022;14(8):e27608. [ DOI:10.7759/cureus.27608] 9. Kramer V, Vounotrypidis E, Steinkohl C, Weiß C, Schramm A, Wilde F, et al. Retrospective evaluation of ocular injuries in fractures of the zygomaticoorbital complex in a level I trauma center: is primary specialized ophthalmologic examination always necessary? International Ophthalmology. 2025;45(1):199. [ DOI:10.1007/s10792-025-03566-7] [ PMID] [ ] 10. Mahmood H. Prevalence evaluation of ocular injuries of different kinds as zygomatic fractures consequences in patients referring to department of oral and maxillofacial surgery, Shariati Hospital (Oct 2004-Oct 2006). Journal of Dental Medicine. 2008;21(2):128-31. 11. Rahbin S, Sunnergren O, McBride E, Darabi H, Alinasab B. Does More Invasive Surgery Result in Higher Patient Satisfaction? A Long-Term Follow-Up of 136 Zygomaticomaxillary Complex Fractures. Craniomaxillofac Trauma Reconstr. 2024;17(4):Np271-np80. [ DOI:10.1177/19433875241286544] [ PMID] [ ] 12. Lee EI, Mohan K, Koshy JC, Hollier LH, Jr. Optimizing the surgical management of zygomaticomaxillary complex fractures. Semin Plast Surg. 2010;24(4):389-97. [ DOI:10.1055/s-0030-1269768] [ PMID] [ ] 13. Neovius E, Fransson M, Matthis SP, Persson C, Östlund S, Farnebo F, et al. Persistent diplopia after fractures involving the orbit related to nerve injury. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2015;68(2):219-25. [ DOI:10.1016/j.bjps.2014.10.040] [ PMID] 14. Varghese SP, Victor J, Ramdas S, Lingam PP, Prasanth HR, Jaganathan V, et al. Factors Influencing Outcome of Orbital Floor Reconstruction. Indian J Plast Surg. 2023;56(4):326-31. [ DOI:10.1055/s-0043-1769110] [ PMID] [ ] 15. Choi A, Sisson A, Olson K, Sivam S. Predictors of Delayed Enophthalmos After Orbital Fractures: A Systematic Review. Facial Plast Surg Aesthet Med. 2022;24(5):397-403. [ DOI:10.1089/fpsam.2021.0177] [ PMID] 16. Parameswaran A, Panneerselvam E, Mukherjee B. Association of fracture type with enophthalmos and intraorbital volume correction in orbital fractures: A computed tomographic study. Indian Journal of Ophthalmology. 2025;73(2):238-43. [ DOI:10.4103/IJO.IJO_2803_23] [ PMID] [ ] 17. Latifi N-A, Karimi H, Elyasinia F. Frequency of blindness due to zygomatic fracture in hazrat fatemeh hospital. Surgical Science. 2014;5(12):542-7. [ DOI:10.4236/ss.2014.512083] 18. Dhabaria H, Kolari V, Sequeira J, Shah A. Evaluation of Infraorbital Nerve Recovery and its Effect on Quality of Life following Open Reduction and Internal Fixation of Zygomaticomaxillary Complex Fractures - An Evaluative Study. Ann Maxillofac Surg. 2022;12(2):128-32. [ DOI:10.4103/ams.ams_100_22] [ PMID] [ ] 19. Chang CM, Ko EC, Kao CC, Chang PY, Chen MY. Incidence and clinical significance of zygomaticomaxillary complex fracture involving the temporomandibular joint with emphasis on trismus. Kaohsiung J Med Sci. 2012;28(6):336-40. [ DOI:10.1016/j.kjms.2011.11.016] [ PMID] [ ] 20. Wang X, Kang Y, Zhang Y, An J, Chen S, He Y. Recovery of the Infraorbital Nerve Following Open Reduction and Fixation Surgery of Zygomaticomaxillary Complex Fractures-A Prospective Cohort Study Based on Quantitative Sensory Testing. J Craniofac Surg. 2024;35(7):2083-7. [ DOI:10.1097/SCS.0000000000010481] [ PMID] 21. Dubron K, Verbist M, Shaheen E, Dormaar TJ, Jacobs R, Politis C. Incidence, Aetiology, and Associated Fracture Patterns of Infraorbital Nerve Injuries Following Zygomaticomaxillary Complex Fractures: A Retrospective Analysis of 272 Patients. Craniomaxillofac Trauma Reconstr. 2022;15(2):139-46. [ DOI:10.1177/19433875211022569] [ PMID] [ ] 22. Lakshmi R, Chitra A, Singh A, Pentapati KC, Gadicherla S. Neurosensory Assessment of Infraorbital Nerve Injury Following Unilateral Zygomaticomaxillary Complex Fracture - A Prospective Study. The Open Dentistry Journal. 2022. [ DOI:10.2174/18742106-v16-e2206140] 23. Tabrizi R, Neamati M, Rajabloo S, Latifi F. Does the Lag Time Between Injury and Treatment Affect Recovery of Infraorbital Nerve Disturbances in Zygomaticomaxillary Complex Fractures? Craniomaxillofac Trauma Reconstr. 2020;13(2):105-8. [ DOI:10.1177/1943387520902896] [ PMID] [ ] 24. Han SW, Kim JH, Kim SW, Kim SH, Kang DR, Kim J. Sensory change and recovery of infraorbital area after zygomaticomaxillary and orbital floor fractures. Arch Craniofac Surg. 2022;23(6):262-8. [ DOI:10.7181/acfs.2022.01011] [ PMID] [ ] 25. Mueller CK, Zeiß F, Mtsariashvili M, Thorwarth M, Schultze-Mosgau S. Correlation between clinical findings and CT-measured displacement in patients with fractures of the zygomaticomaxillary complex. Journal of Cranio-Maxillofacial Surgery. 2012;40(4):e93-e8. [ DOI:10.1016/j.jcms.2011.05.009] [ PMID] 26. Anam J, Muhammad J, Alaf K, Tahir Ullah K, Hanif U, Hassan S, et al. FREQUENCY OF TRISMUS AND DIPLOPIA IN PATIENTS WITH ZYGOMATIC COMPLEX FRACTURES. JOURNAL OF KHYBER COLLEGE OF DENTISTRY. 2021;11(01):45-50. [ DOI:10.33279/jkcd.v11i01.165] 27. Arun S, Nayak SS, Chithra A, Roy S. Outcomes of Non-surgical Management of Zygomaticomaxillary Complex Fractures. J Maxillofac Oral Surg. 2023;22(3):634-40. [ DOI:10.1007/s12663-023-01863-1] [ PMID] [ ] 28. van Hout WM, Van Cann EM, Koole R, Rosenberg AJ. Surgical treatment of unilateral zygomaticomaxillary complex fractures: A 7-year observational study assessing treatment outcome in 153 cases. J Craniomaxillofac Surg. 2016;44(11):1859-65. [ DOI:10.1016/j.jcms.2016.09.002] [ PMID] 29. Soliman L, Menville JE, Rhee BS, Hahn M, Stead TS, Sobti N, et al. Refining Indications for Orbital Floor Reconstruction in Zygomaticomaxillary Complex Fractures. J Craniofac Surg. 2025. [ DOI:10.1097/SCS.0000000000011785] [ PMID] 30. Rahbin S, Sunnergren O, McBride E, Darabi H, Alinasab B. Differences Between Patient and Surgeon Perspectives: A Long-Term Follow-Up of 180 Patients With Zygomaticomaxillary Complex Fractures Following Either Conservative or Surgical Treatment. Craniomaxillofac Trauma Reconstr. 2024;17(4):Np121-np30. [ DOI:10.1177/19433875231208463] [ PMID] [ ] 31. Isya Wahdini S, Dachlan I, Seswandhana R, Hutagalung MR, Putri IL, Afandy D. Neglected orbitozygomaticomaxillary fractures with complications: A case report. Int J Surg Case Rep. 2019;62:35-9. [ DOI:10.1016/j.ijscr.2019.07.055] [ PMID] [ ] 32. Malaviya P, Choudhary S. Zygomaticomaxillary buttress and its dilemma. J Korean Assoc Oral Maxillofac Surg. 2018;44(4):151-8. [ DOI:10.5125/jkaoms.2018.44.4.151] [ PMID] [ ] 33. Trevisiol L, D'Agostino A, Gasparini S, Bettini P, Bersani M, Nocini R, et al. Transconjunctival and Subciliary Approach in the Treatment of Orbital Fractures: A Study on Oculoplastic Complication. Journal of Clinical Medicine. 2021;10(13):2775. [ DOI:10.3390/jcm10132775] [ PMID] [ ] 34. Zhou H-H, Lv K, Yang R-T, Li Z, Yang X-W, Li Z-B. Clinical, retrospective case-control study on the mechanics of obstacle in mouth opening and malocclusion in patients with maxillofacial fractures. Scientific Reports. 2018;8(1):7724. [ DOI:10.1038/s41598-018-25519-0] [ PMID] [ ] 35. Goli R, Rao V, Crozier JW, Woo AS. Refining Operative Indications for Zygomaticomaxillary Complex Fracture Repair. Craniomaxillofac Trauma Reconstr. 2024;17(4):Np97-np112. [ DOI:10.1177/19433875241255223] [ PMID] [ ] 36. Kambalimath DH, Kambalimath HV, M.V.V. S, V. Ak, T.G. R, Deepak RM. Retrospective Analysis of Management of Zygomatic Complex Fractures. The Traumaxilla. 2023;5(1-3):20-6. [ DOI:10.1177/26323273231172739] 37. Rohit, Vishal, Prajapati VK, Shahi AK, Prakash O, Ekram S. Etiology, Modalities of Zygomaticomaxillary Complex Fracture, open reduction and fixation. J Clin Exp Dent. 2021;13(3):e215-e20. [ DOI:10.4317/jced.57445] [ PMID] [ ] |
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Ethics code: IR.GUMS.REC.1403.183 Clinical trials code: 5598
Karimian Kelishadrokhi R, Hoseini S H. Incidence of Complications Associated with Zygomaticomaxillary Complex Fractures Before and After Surgical Intervention in Patients Referred to Velayat Hospital, Rasht (2017–2023). J Res Dent Sci 2025; 22 (4) :307-315 URL: http://jrds.ir/article-1-1611-en.html
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