Refining Indications for Orbital Floor Reconstruction in Zygomaticomaxillary Complex Fractures

Zygomaticomaxillary complex (ZMC) fractures are common, accounting for ∼40% of all facial fractures. Given the integral component the ZMC plays in the formation of the orbit, all fractures to the ZMC entail some degree of injury to the orbital floor itself. Standard treatment involves open reduction and internal fixation, but the necessity of orbital floor exploration in these cases remains debated. This study utilizes a statistical algorithm to identify clinical and radiographic characteristics that portend the need for this procedure.

A retrospective review of a prospectively maintained Research Electronic Data Capture (REDCap) database was performed for all patients with ZMC fractures at a tertiary academic center. Demographic, clinical, and imaging data were examined for each patient, including zygoma body rotation angle (ZBRA), anterior-posterior (A-P) displacement, vertical displacement, and lateral-medial displacement. Patients were stratified into those who did and those who did not receive orbital floor repair. Naïve Bayesian estimates were used to discern characteristics that increased the likelihood of orbital floor reconstruction.

Of 232 patients with ZMC fractures, 14 underwent orbital floor exploration and repair. Patients with symptoms of orbital dystopia (RR=46.7, P<0.001) or malar flattening (RR=2.3, P=0.025) were significantly more likely to require repair. Concomitant facial fractures also portended need for floor reconstruction. Patients with posterior zygoma displacement <1.72 mm demonstrated no need for orbital floor management, while those with impaction ≥3.02 mm had a 40% probability of requiring surgical intervention.