Evaluation of 3 and 2-point internal fixation in the management of zygomaticomaxillary complex fractures: Case report

Introduction: The ZMC has a prominent shape compared to other parts in the midfacial region, thus small injuries will generate fractures in the ZMC. The management of ZMC fracture depends on the fracture deformity and the surgeon's considerations. Various studies have revealed the success of ZMC reconstruction with one fixation point to 4 fixation points fitting to the tetrapod shape. Case report: We report two cases of ZMC fractures which comparing the efficacy of 3- and 2-point internal fixations for improving clinical outcomes The first patient underwent ORIF which placed at 2 fixation points, the first point in the left ZF suture and the second point in the left ZMB. The second patient underwent ORIF reconstruction at 3 fixation points, the first point in the right inferior orbital rim, the second point in the right ZF suture, and the third point in the right ZMB. Discussion: The most common surgical approach for ZMC fractures is through a gingivobuccal groin incision. This approach is for body exposure of the ZMB, which is the main buttress. The 3-point internal fixation improved the postoperative clinical outcome of fracture fragment stability compared to two-point fixation, but the mean malar height projection, vertical dystopia, and enophthalmos were not different between the two fixation methods. Conclusion: Three-point internal fixation can improve the clinical outcome of fracture fragment stability compared to 2-point fixation; however, it has a mean operative duration 22.2 minutes longer than 2-point fixation, so its application must be considered during the COVID-19 pandemic.