Refining Operative Indications For Zygomaticomaxillary Complex Fracture Repair
Rachna Goli, BS, Vinay Rao, MD, Joseph Crozier, BS, Albert S. Woo, MD FACS.
Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA.
Purpose: Although zygomaticomaxillary complex (ZMC) fractures are among the most common facial injuries, the optimal approach to management remains controversial. This study seeks to analyze the relationship between impaction measures derived from pre-operative CT imaging and clinical symptomatology (malar flattening, appreciable displacement, malocclusion) to create a model that predicts need for surgical intervention.
Methods: A retrospective analysis was conducted on patients with ZMC fractures seen at a single institution between 2015 and 2020. Patients with concomitant midfacial fractures were excluded. Patient demographics, CT characteristics (degree of anatomic displacement and rotation), and symptoms requiring surgery were recorded from the medical record. Logistic regression analyses were conducted to determine which CT characteristics predicted symptomatology necessitating surgery.
Results: A total of 95 patients with ZMC fractures were analyzed. Malar flattening or asymmetry was significantly predicted by maxillary wall impaction (OR=21.9, p=0.0002) and anterior-posterior displacement (OR=5.5, p=0.01). Visually appreciable displacement was significantly predicted by maxillary wall impaction (OR=7.9, p=0.005). Vertical displacement (OR=48.2, p=0.03) most strongly predicted complaint of malocclusion (Table 1).
Conclusions: Our final regression model indicates that certain CT characteristics of ZMC fractures, including maxillary wall impaction, anterior-posterior displacement, and vertical displacement, reliably predict a patient's likelihood of developing symptoms indicating surgical intervention. We hope the development of this predictive tool will aid a more standardized and nuanced approach to the management of ZMC fractures.
Back to 2022 Posters