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Bradley et al. Plast Aesthet Res 2019;6:11 I http://dx.doi.org/10.20517/2347-9264.2019.06 Page 9 of 13

The average duration (days) between injury to operation was 15.5, 16.7 and 11.7, for one-, two- and three-
point fixations, respectively [Figure 10]. There was no significant correlation between the number of fixation
points and duration from injury to operation.

Immediate and long-term complications
There were no immediate postoperative complications. As previously mentioned, in one case, a polytrauma
patient who had surgery delayed by 49 days due to their concurrent injuries, it was not possible to reduce the
ZMC fracture intra-operatively. A bone graft was therefore taken from the anterior maxillary sinus wall and
secured to zygomatic body to aesthetically improve the cheek flattening from the ZMC fracture. The patient
had an aesthetically satisfactory result and on subsequent outpatient follow-up the patient was pleased with
their improved cheek contour from the bone graft. Another patient had delayed improvement of mouth
opening, which subsequently resolved.

Follow up
Of the 53 surgically managed patients in our cohort, 4 (7.5%) did not attend follow up and in 11 (21%) patients
follow up status was not documented. Twenty (38%) patients were discharged from OMFS after their first
outpatient follow up consultation, 13 (25%) were discharged after their 2nd consultation, and 5 (9%) after
their 3rd. All patients who attended follow up had satisfactory aesthetic and functional outcomes.

DISCUSSION
This article provides an overview of the epidemiology, aetiology, presentation, and management of surgically-
treated cases of ZMC fractures at our major trauma centre over a one year period.

The demographic data showed that the commonest age group (mode) presenting with ZMC fractures was
27 years of age, and the incidence was significantly greater (89%) in men compared to women (11%), which
was in keeping with the current literature . The commonest aetiology was interpersonal violence (53%),
[1-4]
followed by falls, RTCs and sport-related injuries. According to existing literature, aetiology is variable, with
one study in Poland quoting assault as the most common, followed by RTC and other studies from Brazil
and Amsterdam, showing RTCs to be most common, followed by assault [2,4,7,8] . These variations confirm
that the aetiology of ZMC fractures are influenced by multiple factors, including geographical location,
incidence of RTCs and socioeconomic trends. Within our demographics, the majority were low impact
injuries (81%), such as from punch-related assaults or mechanical falls (< 2 m), compared to 15% related to
RTCs, assaults from hard objects, or falls from a significant height (> 2 m) which were considered as high
impact injuries. We are unable to comment on the significance of alcohol or illicit drug use relating to injury
due to inadequate documentation of this in patients’ notes.

Of the 13 patients in our cohort with isolated zygomatic arch fractures, all were treated with indirect
reduction using Gillies lift or Keen’s approach. This was similar to a study in which 26 isolated zygomatic
arch fractures were all managed with indirect reduction .
[4]
Of the thirty-nine ZMC fractures in our cohort, all were treated with ORIF. This is in keeping with a study
of 532 ZMC fractures in which all were treated with ORIF . However, in a retrospective study of 210 cases
[14]
of ZMC fractures, 84% (n = 177) patients had ORIF, whilst 16% (n = 33) had closed reduction . A survey
[4]
answered by over 1600 ENT, OMFS and plastic surgeons that showed 81% would choose ORIF for ZMC
fractures . None of the ZMC fractures in our cohort were treated with closed reduction.
[15]
Out of the 39 ZMC fracture patients included in our study, 10% (n = 4) underwent orbital floor exploration and
7.5% (n = 3) underwent orbital floor repair. Our proportion of ORIF ZMC fractures undergoing associated