Zygoma Fractures: When Should You Repair the Orbital Floor?

The zygomaticomaxillary complex (ZMC) is one of the most commonly fractured areas of the midface. As the zygoma is an inherent component of the orbit, any fracture of the ZMC naturally involves the orbital floor. Previous research has focused on the surgical outcomes and complications of zygomatic fractures, but few have explored indications for orbital floor exploration alongside zygoma reduction. This study evaluates whether specific clinical and radiographic parameters predict the need for orbital floor reconstruction.

A retrospective review was conducted of all patients with zygoma fractures managed by the plastic surgery service from 2015 to 2023. All patients underwent orbital floor exploration at the time of ZMC reconstruction, with implants placed when determined necessary. Computed tomography imaging was assessed for the presence of co-occurring fracture elements: zygomatic displacement at the infraorbital rim, zygomaticomaxillary buttress, zygomaticofrontal suture, and zygomaticotemporal suture; and orbital floor displacement in the anterior-posterior, inferior-superior, and transverse directions. Logistic regression models were used to assess the adjusted effects of age and sex on implant placement.

Seventy-nine zygomatic fracture cases met the study criteria, with 43 receiving an implant after orbital floor exploration. For every 1 mm increase in zygomatic displacement in the anterior-posterior direction, patients had 1.30 times higher odds of receiving an orbital implant ( P =0.015). Rectus rounding and orbital floor defect volume were similarly among the strongest indications for orbital floor implant placement ( P <0.001).