# Postoperative Outcomes and Complication Risk Factors in Zygomaticomaxillary Complex (ZMC) Fractures: A One-Year Retrospective Study of Surgical Management Approaches

## TL;DR

This study examines outcomes and risk factors for complications after surgery for zygomaticomaxillary complex fractures, focusing on demographics, causes, and surgical approaches.

## Contribution

The study identifies specific risk factors for postoperative complications using multivariate analysis and survival methods in ZMC fracture patients.

## Key findings

- ZMC fractures predominantly affect young adult males, with road traffic accidents and assaults as common causes.
- Infraorbital paresthesia was the most frequent complication, and older age and alcohol-related trauma increased complication risks.
- Open reduction and internal fixation showed a favorable safety profile despite some persistent complications like hemianopia.

## Abstract

Background

Zygomaticomaxillary complex (ZMC) fractures are among the most frequently encountered midfacial injuries, often resulting from high-energy trauma such as road traffic accidents or assaults. Effective management requires a balance between aesthetic reconstruction and functional rehabilitation. Despite advancements in surgical techniques, postoperative complications remain a concern. This study aims to evaluate demographic patterns, etiological factors, fracture distribution, and surgical approaches, and to identify predictors of postoperative complications using multivariate analysis and survival methods.

Methods

A retrospective observational study was conducted on 77 patients surgically treated for ZMC fractures between 2021 and 2024. Data regarding patient demographics, mechanism of injury, fracture classification, incision type, and postoperative complications were extracted from hospital records. Chi-square tests and multivariate logistic regression were employed to assess associations between clinical variables and complication risk. Time-to-resolution of complications was analyzed using Kaplan-Meier (KM) survival curves. Relative risks (RR) were computed for each surgical incision type.

Results

ZMC fractures predominantly affected males (n=69, 90%), most frequently in the 20-29-year age group (n=22, 28.6%). Road traffic accidents, assaults, and falls were the primary causes. Maxillary fractures were most common (n=25, 32.4%), and the buccal sulcus incision was preferred (n=36, 46.7%). Infraorbital paresthesia was the most frequent complication (n=5, 27%). Significant predictors of complications included age ≥50 years, infraorbital fractures, infraorbital incisions, and alcohol-related trauma (p < 0.05). KM analysis revealed delayed resolution of paresthesia and diplopia; hemianopia persisted at 12 weeks. Overall, open reduction and internal fixation (ORIF) demonstrated a favorable safety profile.

Conclusions

ZMC fractures primarily affect young adult males and are most often trauma-induced. While ORIF remains the standard for managing displaced fractures, increased complication risks in older adults and alcohol-related injuries highlight the need for individualized surgical planning and targeted postoperative care.