Refining Indications for Orbital Floor Reconstruction in Zygomaticomaxillary Complex Fractures

Area of Science:

• Maxillofacial surgery
• Ophthalmology
• Trauma surgery

Background:

• Zygomaticomaxillary complex (ZMC) fractures constitute approximately 40% of all facial fractures.
• ZMC fractures invariably involve some degree of orbital floor injury.
• The necessity of routine orbital floor exploration in ZMC fractures is debated.

Purpose of the Study:

• To identify clinical and radiographic predictors for orbital floor exploration in ZMC fractures.
• To utilize a statistical algorithm to guide surgical decision-making.
• To optimize treatment strategies for ZMC fractures involving the orbit.

Main Methods:

• Retrospective review of a prospectively maintained database of ZMC fracture patients.
• Analysis of demographic, clinical, and imaging data, including ZBRA, A-P, vertical, and lateral-medial displacement.
• Stratification of patients based on orbital floor repair and application of Naïve Bayesian estimates.

Main Results:

• 14 out of 232 patients with ZMC fractures underwent orbital floor exploration and repair.
• Orbital dystopia (RR=46.7) and malar flattening (RR=2.3) significantly increased the likelihood of repair.
• Posterior zygoma displacement <1.72 mm did not require repair, while impaction ≥3.02 mm correlated with a 40% probability of intervention.

Conclusions:

• Clinical signs like orbital dystopia and malar flattening are strong indicators for orbital floor repair in ZMC fractures.
• Radiographic measurements, particularly posterior zygoma displacement, can help predict the need for surgical intervention.
• A statistical approach aids in determining the necessity of orbital floor exploration for ZMC fractures.