Primary Infraorbital Foramen Decompression for the Zygomaticomaxillary Complex Fracture: Is It Essential?

The frequency of zygomaticomaxillary fracture is second only to nasal bone fracture. Up to 30% to 80% of zygomaticomaxillary fracture patients complain of sensory disturbance results from infraorbital nerve injury. The objective of this study was to detect what factors are related to infraorbital nerve recovery and specifically to investigate decompression of infraorbital foramen improves sensory recovery.

A total of 257 patients were assessed with unilateral zygomaticomaxillary complex fracture, treated with open reduction and internal fixation with orbital floor reconstruction. Of these, 166 patients followed up over 6 months were included in this study. The data collected included age, sex, pre, and postoperative sensory score measured by visual analogue scale (range: 0-10). Sensory score was measured at the infraorbital nerve innervation. The impact of decompression operation on the change of sensory score was compared. Statistical analysis was performed using SPSS 18.0 software (SPSS Inc, Chicago, IL).

In patients with preoperative hypoesthesia, difference between postoperative and preoperative sensory score was 3.2 (decompression group), 4.4 (nondecompression group), respectively, but not significant (P > 0.05). In patients without preoperative hypoesthesia, difference between postoperative and preoperative sensory score was -0.2 (decompression group), -0.3 (nondecompression group), respectively, and did not show significant association (P > 0.05).

Based on this result, in patients with preoperative hypoesthesia, infraorbital decompression operation is not useful for sensory recovery. This result indicates infraorbital sensory disturbance occurs from not only pinched nerve injury at the infraorbital foramen but also traction nerve injury at the other part of the nerve.