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Related Experiment Video

Updated: Jul 17, 2025

Real-Time Dynamic Navigation System for the Precise Quad-Zygomatic Implant Placement in a Patient with a Severely Atrophic Maxilla
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Direct or Indirect Surgical Approach of Zygomatic Complex Fracture: A Comparative Study.

Muamer E Alshalah1, Hamid H Enezei2, Osamah M Aldaghir3

  • 1Department of Oral and Maxillofacial Surgery, College of Dentistry, Al Kunooz University College, Basrah.

The Journal of Craniofacial Surgery
|August 30, 2023
PubMed
Summary

This study on zygomaticomaxillary complex fractures found that both direct and indirect surgical approaches yield excellent patient satisfaction and low complication rates. Road traffic accidents were the leading cause, with males aged 18-40 most affected.

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Trauma Surgery
  • Plastic Surgery

Background:

  • Zygomaticomaxillary complex fractures (ZCFs) are common due to the zygoma's prominent facial position.
  • Treatment options include conservative management or surgical reduction (closed or open).

Purpose of the Study:

  • To evaluate demographic and clinical characteristics of ZCF patients.
  • To compare direct versus indirect surgical approaches for ZCF management.
  • To assess patient satisfaction and complication rates associated with different treatment methods.

Main Methods:

  • A 6-year retrospective observational study (2016-2021) involving 265 patients across four hospitals in Iraq.
  • Patients were categorized based on management approach: direct or indirect.
  • Data collected included demographics, clinical presentation, fracture type, treatment method, patient satisfaction, and complications.

Main Results:

  • Males (78.9%) aged 18-40 (51.7%) were most affected, with road traffic accidents being the primary cause (31.7%).
  • Cheek flattening (73.6%) was the most frequent sign; single fractures (72.1%) predominated.
  • The direct approach was more common for both isolated (65.4%) and multiple fractures (62.2%).
  • Overall patient satisfaction was excellent in the majority of cases, with no significant difference between direct and indirect approaches (P > 0.05).
  • Poor satisfaction was linked to older age groups (>40 years) and male patients.
  • Statistically significant differences in patient satisfaction were observed concerning age and complications (P < 0.05).
  • Ophthalmic complications were the most common (2.56%).

Conclusions:

  • Both direct and indirect surgical approaches are safe and effective for treating zygomaticomaxillary complex fractures.
  • High patient satisfaction and low complication rates support the use of these methods.
  • Understanding demographic and clinical factors is crucial for optimizing treatment outcomes in ZCF management.