The face occupies the most prominent position in the human body rendering it vulnerable to injuries quite commonly. The prominence of the zygomatic region predisposes it to bearing the brunt of the facial injuries . Because of its position, it is the second most common mid-facial bone fractured after the nasal bones and overall represents 13% of all craniofacial fractures [1, 2].
However, the incidence and etiology varies from area to area as another study shows that zygomatic bone fractures were commonly found among young males and the most common cause was found to be road traffic accidents .
The sex distribution is markedly higher for males than for females (4:1). In developed countries, the ratio is on average 3-5:1, whereas in underdeveloped countries, the ratio is on average 10-40:1 .
The causes of the fractures were mainly attributed to assault and road traffic accidents (RTA), which is iconsistent with worldwide experience. However, in many places, either RTA or assault was consistently the main contributing cause with one of these two consistently dominating the other by a large degree .
The architectural pattern of zygomatic bone allows it to withstand blows of great forces without fracturing. Because of such heavy forces zygomatic bone gets separated from adjacent bone at or near the suture lines. It may be separated from its four articulations, resulting in a zygomatico-maxillary complex, zygomatic-complex or orbito-zygomatic fracture. Fractures of this complex are one of the more common types of maxillofacial injuries to treat. They are seen as isolated or in association with other facial fractures due to the complex midface anatomy [4–6].
The fracture of the zygomatic bone can result in restricted mouth opening due to impingement on the coronoid process. Disruption of the zygomatic position also carries psychological, aesthetic and functional significance, causing impairment of ocular and mandibular function. Therefore, for both cosmetic and functional reasons, it is mandatory that zygomatic bone injury is properly diagnosed and adequately managed .
Skeletal healing of displaced zygomatic bone fragments after insufficient fracture reduction and fixation results in an inadequate projection of the zygomatic body and thus facial asymmetry. Accurate assessment of the position of the zygomatic bone in relation to the cranial base posteriorly and the midface anteriorly, is the key to the acute repair of mid facial fractures. Secondary reconstruction of posttraumatic deformities of the orbitozygomatico- maxillary complex remains a major surgical challenge.
Three principle buttresses need to be considered in midface fractures. The medial or nasomaxillary buttress reaches from the anterior maxillary alveolus to the frontal cranial attachment. The second is the pterygomaxillary or posterior buttress, which connects the maxilla posteriorly to the sphenoid bone. The third is the lateral or zygomaticomaxillary buttress. This important buttress connects the lateral maxillary alveolus to the zygomatic process of the temporal bone. These buttresses help to give the zygoma an intrinsic strength such that blows to the cheek usually result in fractures of the zygomatic complex at the suture lines, rarely of the zygomatic bone itself .
Another important landmark with respect to zygomatic fractures is the sphenozygomatic junction (especially laterally displaced fractures). The alignment of the zygoma with the greater wing of the sphenoid in the lateral orbit is critical for determining adequate reduction of zygomatic fractures. Reducing the three points that make up the buttresses also helps to ensure proper alignment of the zygoma and proper reduction of other facial fractures present. This graduated approach helps to preserve facial height and width .
Various surgical techniques have been described for the reduction of zygomatic complex fracture. Open reduction with surgical incisions has been accomplished through Keen's approach, Gillies' approach, bicoronal scalp flap approach or the more popular Dingman's approach. Gillies' approach is the temporal approach. This procedure has advantages in that it leaves no facial scars and is simple to perform. The Gillies temporal approach method is used widely in U.K for zygomatic bone fracture [9, 10].
Open reduction & internal fixation of simple displaced fractures of the zygoma in an attempt to define the simplest method of achieving post reduction stability. In a report, the three-point fixation (FZ suture, inferior orbital rim, and zygomaticomaxillary buttress) using either miniplates alone or interfragmentary wiring conferred the greatest stability .
Comparison of various surgical approaches and their complications can only be done objectively using outcome measurements which in turn require protocol management and long-term follow up. The preference for open reduction and internal fixation of zygomatic fractures using three point fixation has continued to grow in response to observations of inadequate results from two pint fixation technique, with the exception of management of isolated fractures of the zygomatic arch .
Miniplate removal following trauma surgery is indicated in approximately 10% of cases and is mainly caused by infection and/or dehiscence, pain, interference with denture position, screw or plate failure, and palpability .
This study was designed to compare 2 point internal fixation with 3 point internal fixation, for the better clinical results and fewer complications, consequently contributing towards the greater goals of a better treatment option and in due process benefit the concerned patients.