Copyright @ 2010 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. Surgical Approaches and Fixation Patterns in Zygomatic Complex Fractures Sergio Olate, MS, Sergio Monteiro Lima Jr, DDS, Renato Sawazaki, PhD, Roger Willian Fernandes Moreira, PhD, and Ma ´rcio de Moraes, PhD Abstract: The aim of this research was to analyze the surgical approaches and methods of rigid fixation used to treat zygomatic complex (ZC) fractures over a 10-year period. One hundred fifty- three patients who underwent surgery to treat ZC fractures between 1999 and 2008 were retrospectively evaluated. Demographic infor- mation, signs, and symptoms of the fractures, classification, surgical approaches, and methods of internal fixation were obtained from the medical records. The data were analyzed using statistical descriptive analysis and W 2 test (P G 0.05). The mean age of the sample was 31 years, and males were predominant (82.3%). In 60.1% of the patients, one surgical approach was used to treat the ZC fractures, whereas 2 surgical approaches were used in 24.8% of the patients. The zygomaticomaxillary buttress was fixed in 86.9% of the patients, followed by infraorbital rim fixation and zygomaticofrontal. There was a statistical significance between fracture displacement and sur- gical approach for the infraorbital rim (P G 0.0001) and zygomatico- frontal suture (P G 0.0001). Considering that adequate reduction and fixation should be performed and that we try to minimize the amount of scarring, the intraoral zygomaticomaxillary buttress approach is the first choice to treat ZC fractures. In cases of displacement bigger than 5 mm, approaches to 3 of 4 points of the ZC are mandatory to reduce the fractures. The infraorbital rim and zygomaticofrontal suture approaches are indicated to treat displaced fractures. Key Words: Zygomatic bone fracture, surgical approach, open reduction and rigid fixation (J Craniofac Surg 2010;21: 1213Y1217) Z ygomatic complex (ZC) fractures are common maxillofacial injuries. Their prevalence is related to different conditions, and the surgical treatment with adequate reduction is a permanent challenge for surgeons. 1 Anatomically, the zygoma constitutes most of the lateral or- bital wall and part of the orbital floor lateral to the infraorbital groove. Therefore, a ZC fracture by definition is also an orbital floor fracture. 2 Because there are 4 suture lines, the fractures become sep- arated from adjacent bones or near these suture lines. The complex facial anatomy suggests that reduction of the zygoma, orbital floor, and zygomatic arch are necessary to reestablish facial symmetry and position of the eye globe and ensure adequate movement of the mandible. 2,3 Historically, wire fixation of ZC fracture was used with un- satisfactory results because displacement of the fracture ends were expected and the reduction and fixation of small fragments could not always be achieved. 4,5 In the last decades, rigid internal fixa- tion (RIF) altered these methods of treatment and miniplates be- came the standard in maxillofacial fractures treatment because of better stability of reduction and low complication rates. Miniplates are also easy to adapt and support tension and flexion movements of the bone structure. 6,7 Beccelli et al 6 showed immediate and firm stabilization of the osseous segments in the 3 planes in delaying treatment of the ZC fracture. On the other hand, the application of biodegradable material has gained acceptance in the management of maxillofacial trauma and has been indicated for fixation of ZC fractures because this region is a low load-bearing area. 8 In fact, the load related to ZC fracture is not associated to masseteric muscle, and only minor zygomatic muscles can submit some force in this bone. This muscle is related to facial expression with low force activity for fracture dislocation. For this reason, the anatomic position of the ZC fracture is principally related to a surgical pro- cedure with proper reduction and stabilization of fracture. 9 Lacking that, an important volume of literature exists on the treatment of this injuries, but without consensus. Different kinds of treatments were used for ZC fracture 10 ; some researches show variations in auxiliary examinations for ZC fracture diagnoses and variations in treatment; these methods should be effective in the management of ZC fracture, considering each one of the individual case, age, sex, energy of trauma, functional and aesthetic consid- erations, complications, and others. Some of these variations are related to fracture exposition in 3-point and liberal fixation 11 or related exposition and fixation of 2 points for reduction and stabi- lization of fracture 12 and others with sequential surgical approach and fixation. 7 Almost all the articles are retrospective researches or experienced work; this type of research presents some deficiencies but can obtain some important data. The aim of this retrospective research was to present our surgical cases treated over a 10-year period and relate some surgical variables like RIF sequence and surgical approach. MATERIALS AND METHODS Data were collected from patients who attended at the Divi- sion of Oral and Maxillofacial Surgery of the State University of Campinas in Brazil from April 1, 1999, to December 31, 2008. Information was obtained retrospectively from clinical notes and surgical records from each patient using a standardized data col- lection form that was specifically developed to investigate the variables and features of ZC trauma. The data recorded included CLINICAL STUDY The Journal of Craniofacial Surgery & Volume 21, Number 4, July 2010 1213 From the Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Brazil, and Division of Biomedical Research, Universidad Auto ´noma de Chile, Chile. Received February 20, 2010 Accepted for publication March 16, 2010. Address correspondence and reprint requests to Ma ´rcio de Moraes, PhD, Departamento de Diagno ´stico Oral, Faculdade de Odontologia de Piracicaba, Avenida Limeira 901, Bairro Areia ˜o, Piracicaba, Sa ˜o Paulo, Brazil; E-mail: mmoraes@fop.unicamp.br or solate@fop.unicamp.br The authors declared that no funding was received for this research. The authors report no conflicts of interest. Copyright * 2010 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0b013e3181e1b2b7