Surgical approaches and postoperative outcomes in zygomatic fractures: a systematic review

Zygomaticomaxillary complex (ZMC) fractures are common facial injuries that often require surgical intervention to restore both function and aesthetics. A variety of surgical approaches, including traditional open reduction and more minimally invasive techniques, have been proposed. This review aims to evaluate the functional, aesthetic, and postoperative outcomes associated with these surgical treatments, based on studies conducted from 2014 to 2024. A systematic search of MEDLINE, EMBASE, and Cochrane databases was conducted until October 2024. Twelve studies, published between 2014 and 2024, focusing on ZMC fractures and using open or minimally invasive approaches, were included. These studies, both retrospective and prospective, provided data on patient demographics, surgical approaches, complications, recovery times, and functional and aesthetic outcomes, which were extracted and analysed. The review found that surgical approaches for ZMC fractures generally led to favourable functional and aesthetic outcomes, with no major complications such as infections or malunion. Both open and minimally invasive approaches effectively restored facial function, including ocular motility and nerve recovery, with minimal recovery times. Minimally invasive procedures showed better aesthetic outcomes, with less scarring and faster recovery. Functional outcomes, including sensory recovery, were similar across techniques, with minimally invasive methods having a slight advantage in recovery time. Both traditional open reduction and minimally invasive techniques are effective for managing ZMC fractures, with minimal complications and favourable functional and aesthetic outcomes. Endoscopically-assisted techniques in particular offer superior cosmetic results and shorter recovery times. Future studies with standardised protocols and long-term follow up are needed to assess the durability of these outcomes and better understand factors affecting nerve recovery and facial aesthetics.