Frequency and Outcome of isolated zygomatic arch fractures (IZAF) in Road traffic accident (RTA) patients
DOI:
https://doi.org/10.59736/IJP.23.04.980Keywords:
Cosmetic Deformity, Facial Nerve Weakness, Isolated Zygomatic Arch Fracture, Maxillofacial Trauma, Road Traffic Accident, TrismusAbstract
Background: The zygomatic arch plays a key role in maintaining midfacial structure and aesthetics. Although isolated zygomatic arch fractures (IZAFs) represent only 5–10% of zygomaticomaxillary complex injuries, they can result in significant functional impairment and aesthetic deformity. This study aimed to evaluate the frequency and clinical outcomes of IZAFs in patients involved in road traffic accidents (RTAs) at a tertiary care hospital in Mardan Khyber Pakhtunkhwa Pakistan.
Methods: A prospective observational study was conducted over six months from August 2024 to Feb 2025 at the Department of Oral and Maxillofacial Surgery, Mardan Medical Complex. A total of 145 patients with IZAFs confirmed by computed tomography CT scan were enrolled using non-probability consecutive sampling. The data were collected regarding the demographic characteristics and clinical presentation (including swelling, cosmetic deformity, trismus, and facial nerve weakness. Patients were followed at 1- and 3-months post-treatment. The outcome measures were evaluated based on mouth opening improvements (interincisal distance), facial contour symmetry restoration, and recovery of facial nerve function.
Results: The mean age of the cohort was 30 ± 8 years. RTAs accounted for approximately 90% of the cases. All patients experienced pain at presentation, 60% had facial swelling, 40% exhibited trismus, 35% demonstrated cosmetic deformity, and 15% showed facial nerve weakness. Following treatment, the mean interincisal distance improved to 35 ± 4 mm at 1 month and 45 ± 3 mm at 3 months (p < 0.001), cosmetic deformity decreased to 10%, and facial nerve weakness reduced progressively from 15% at 4 weeks to 5% at 12 weeks (p < 0.05).
Conclusion: Prompt and appropriate management using minimally invasive techniques leads to improvements in mouth opening, facial contour restoration, and recovery of facial nerve function.
References
Duan J, Cong LY, Luo CE, Luo SK. Clarifying the anatomy of the zygomatic cutaneous ligament: its application in midface rejuvenation. Plast Reconstr Surg. 2022 Feb 1;149(2):198e–208e. doi: 10.1097/PRS.0000000000008716.
Bergeron JM, Hohman MH, Raggio BS. Zygomatic arch fracture. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. 2024 Jan 26.
Jones CM, Schmalbach CE. Zygomaticomaxillary fractures. Facial Plast Surg Clin North Am. 2022 Feb;30(1):47–61. doi: 10.1016/j.fsc.2021.08.004.
Singh V, Chhikara N, Jajodia N. Zygomaticomaxillary complex fractures. In: Maxillofacial Trauma: A Clinical Guide. Singapore: Springer Singapore; 2021 May 3. p. 293–310.
Cil Y. Treatment of isolated zygomatic arch fractures with the Gillies method. Eur J Plast Surg. 2023;46(4):511–4.
Obimakinde OS, Olajuyin OA, Akinbade AO, Ojo KO, Ibidun CO. Zygomatic complex fractures in a Nigerian tertiary hospital: an update on pattern of presentation and care. Niger Stethoscope. 2023 Jun 30;5(1):63–76.
Vos LM, Huddleston Slater JJR, Stegenga B. Arthrocentesis as initial treatment for temporomandibular joint arthropathy: a randomized controlled trial. J Craniomaxillofac Surg. 2014;42(5): e134–9.
Valdés Reyes JM, Zapata Ocampo S. Functional classification of isolated zygomatic arch fracture: new proposal. J Craniofac Surg. 2021 Mar-Apr;32(2):757–8. doi: 10.1097/SCS.0000000000006938.
Frosolini A, Benedetti S, Gennaro P, Gabriele G. Comment on "Proposal for a modified classification of isolated zygomatic arch fractures". Arch Craniofac Surg. 2023 Jun;24(3):143–4. doi: 10.7181/acfs.2023.00192.
Wang MR, Chin MG, McIntire DR, Chang K, Zhao L, Kwan DK. The association of fracture displacement and surgical intervention in isolated zygomatic arch fractures. J Oral Maxillofac Surg. 2025 Jan 20;83(5):565–75. doi: 10.1016/j.joms.2025.01.006.
Jung S, Yoon S, Nam SH. Proposal for a modified classification of isolated zygomatic arch fractures. Arch Craniofac Surg. 2022;23(3):111–8.
Tiwari M, Gupta M, Roy S. Analysis of Gillies temporal approach vs Towel Clip method for reduction of zygoma fractures. Oral Maxillofac Surg. 2024 Dec;28(4):1643–51.
de Moura AM, Marinho DR, de Matos BM. Reduction of zygomatic arc fracture by intraoral access. Multidiscip Sci J. 2022;4(2).
Gentile MA, McKinlay AA, Stires SA. Pediatric maxillary and zygomatic fractures. In: Pediatric Maxillofacial Trauma. Cham: Springer International Publishing; 2020. p. 115–43.
Karşıcı S, Balaban E. The effect of preoperative low-level laser therapy on pain, swelling, and trismus associated with mandibular third molar extraction. BMC Oral Health. 2025;25(1):306.
Ling XF, Yew CC, Mohd Nazri SB, Tew MM. Unilateral zygomatic complex fracture - a comparison between nonsurgical treatment and surgical treatment. J Craniofac Surg. 2021 Oct 1;32(7):e627-30. doi:10.1097/SCS.0000000000007606.
Wang HD, Dillon J. Contemporary management of zygomaticomaxillary complex fractures. Semin Plast Surg. 2021 Nov;35(4):256–62.
JonesCM,SchmalbachCE.Zygomaticomaxillary fractures. Facial Plast Surg Clin North Am. 2022 Feb;30(1):47–61. doi: 10.1016/j.fsc.2021.08.004.
Abbas Z, Imran MB, Khalil F, Khan MA. Zygomatic complex fractures in patients with oral and maxillofacial trauma: prevalence and causes at a tertiary care center. Med Forum Mon. 2024;35(10).
Wang MR, Chin MG, McIntire DR, Chang K, Zhao L, Kwan DK. The association of fracture displacement and surgical intervention in isolated zygomatic arch fractures. J Oral Maxillofac Surg. 2025;83(5):565–75.
doi: 10.1016/j.joms.2025.01.006.
Devakumari S, Dominic N, Vijhayapriya T, Dinesh DS, Devameena S. Modified temporal incision for the management of zygomatic arch fractures: a retrospective study for 7 years. Craniomaxillofac Trauma Reconstr. 2021;15(1):12–20. doi: 10.1177/1943387521989550.
Saponaro G, Moro A, Todaro M, Gasparini G, Perquoti F, Ascani G, et al. Aesthetic approaches to zygomatic fracture management: achieving optimal outcomes with minimal scarring. J Craniofac Surg. 2025;36(1):279.
Rahman S, Roy ID, Kumari P. Recovery of neurosensory deficit in zygomatic complex fracture: a prospective study. J Dent Def Sect. 2022;16(2):119.
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