Northeastern Society of Plastic Surgeons

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Zygoma Fractures: When Should You Repair the Orbital Floor?
Jesse E. Menville*, Nidhi Shinde, Matthew J. Lee, Albert S. Woo
Division of Plastic and Reconstructive Surgery, Brown University, Providence, RI

Background: The zygomaxillary complex (ZMC) is one of the most commonly fractured areas of the midface, by definition affecting the orbital floor. Previous research has focused on the surgical outcomes and complications of zygomatic fractures, but few have extensively explored indications for orbital floor exploration alongside zygoma reduction. This study evaluates whether specific clinical and radiographic parameters predict the need for orbital floor reconstruction. Methods: A retrospective review was conducted of all patients with zygoma fractures managed by the plastic surgery service from 2015-2023. All patients underwent orbital floor exploration at the time of ZMC reconstruction, with implants placed as needed. Computed Tomography (CT) imaging was assessed for the presence of co-occurring facial fractures; zygomatic displacement at the infraorbital rim, zygomaticomaxillary buttress, zygomaticofrontal suture, and zygomaticotemporal suture; and orbital floor displacement in the anterior-posterior, inferior-superior, and transverse directions. Logistic regression models were used to assess the adjusted effects of age and sex on implant placement, with significance at p < 0.05. Results: 79 cases met study criteria, with 43 receiving an implant following orbital floor exploration. For every 1 mm increase in zygomatic displacement in the anterior-posterior direction, patients had 1.30 times higher odds of receiving an orbital implant (p = 0.015). Rectus rounding and orbital floor displacement in all three directions were similarly significantly associated with implant placement. Conclusion: A regression model evaluating zygoma fractures shows that rectus rounding, zygomatic impaction, and orbital floor defect volume were among the strongest indications for orbital floor implant placement.

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