Introduction
In the scenario of facial trauma, fractures of the Zygomatic-maxillary
complex (ZMC) are common facial fractures. Annually 5.8 million people
die from trauma worldwide [1]. Trauma mortality accounts for 10% of
all causes of death. Thus, trauma is a worldwide public health problem.
Still, trauma is the main cause of death among patients aged 1 to 44
years and the fourth major cause considering all age groups. According
to WHO data, head and face injuries can represent half of traumatic
deaths [1].
In this context, the ZMC is an important structure, serving as an
important buttress of the middle third of the face. The ZMC also
aesthetically projects anterolaterally to form the malar eminence and
establish the width and medial-facial contour of the orbital border
[2]. Attempts to treat ZMC fractures are to achieve stability and
restore aesthetic appearance through three-dimensional reduction and
rigid fixation. After adequate fracture reduction, it is important to
maintain stability and rigid fixation to avoid functional impairment and
aesthetic sequelae. Thus, open reduction and internal fixation have been
used as a standard method for the treatment of these fractures [3].
Therefore, several surgical and technical procedures, including fixation
of one, two and three points are used according to the severity and
extent of ZMC fractures [4]. Among these techniques, some authors
argue that fixation of just one point provides sufficient stability of
the ZMC fracture when the ZMC fracture is not crushed [5,6]. At the
moment, it is not yet clear which treatment, fixation of one point,
fixation of two points or fixation of three points, is better [7].
In addition, there is a growing interest in minimally invasive
procedures and concerns about scarring, further highlighting the use of
fixing a point. Thus, fixing a point of the zygomatic- maxillary (ZM)
buttress through a gingivobuccal incision has the advantage of not
leaving an external scar [8,9].
In this sense, the main indications for the use of fixation at 1 point
of the tripod fracture are minimal or moderate displacement of the
infra-orbital border in the zygoma tripod fracture, no ocular sign of
diplopia or enophthalmia and comminuted infraorbital edge fractures in
which internal fixation is difficult [10]. Successful repair
requires not only an accurate diagnosis, but also a careful
consideration of the complex three-dimensional anatomy, because even
minimally displaced fractures in the ZMC can result in functional and
aesthetic deformities [10].
Therefore, the present study aimed to analyze, through a meta-analysis,
the success rates of fracture stability of the Zygomatic-maxillary
complex, incidences of complications and aesthetic satisfaction after
1-point fixation.