Kim Min Ji, Lee Jun Suk, Lim Hyoseob
Department of Plastic and Reconstructive Surgery, School of Medicine, Ajou University, 164 World Cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, Republic of Korea.
J Craniofac Surg. 2025 Jan 9;36(5):1520-4. doi: 10.1097/SCS.0000000000011081.
Managing facial trauma in patients with severe polytrauma presents significant challenges due to competing priorities, poor systemic conditions, and delayed surgical timing. At a national level I trauma center, the authors evaluated the feasibility and outcomes of proactive surgical intervention for unilateral zygomaticomaxillary complex (ZMC) fractures in severe trauma patients.
This retrospective study included 81 patients with unilateral ZMC fractures treated at a regional level I trauma center between October 2019 and August 2021. Patients were categorized into high and low trauma severity groups based on the injury severity score (ISS). Three-dimensional (3D) computed tomography analyses were performed to evaluate surgical outcomes, including dimensional distances (Dx, Dy, and Dz) and the Asymmetry Index.
Of the 81 patients, 52 underwent surgical intervention. No significant differences were observed in 3D distances (Dx, Dy, and Dz) between the high and low ISS groups, both preoperatively and postoperatively. However, postoperative symmetry was superior in the high ISS group ( P < 0.010). The average delay from injury to surgery was slightly longer in the high ISS group (8.69 versus 7.35 d, P = 0.248). Complications such as diplopia and paresthesia were more common in the high ISS group, but no significant differences in overall complication rates were observed between the groups.
Proactive surgical management of unilateral ZMC fractures in major trauma patients is effective. Despite the systemic challenges in this population, timely intervention resulted in superior postoperative symmetry in the high ISS group and comparable 3D outcomes across trauma severities.
由于存在相互冲突的优先事项、全身状况不佳以及手术时机延迟，在严重多发伤患者中处理面部创伤面临重大挑战。在一家国家级 I 级创伤中心，作者评估了对严重创伤患者的单侧颧上颌复合体（ZMC）骨折进行积极手术干预的可行性和结果。
这项回顾性研究纳入了2019年10月至2021年8月期间在一家地区级 I 级创伤中心接受治疗的81例单侧ZMC骨折患者。根据损伤严重程度评分（ISS）将患者分为高创伤严重程度组和低创伤严重程度组。进行三维（3D）计算机断层扫描分析以评估手术结果，包括尺寸距离（Dx、Dy和Dz）以及不对称指数。
81例患者中，52例接受了手术干预。高ISS组和低ISS组术前和术后的3D距离（Dx、Dy和Dz）均未观察到显著差异。然而，高ISS组术后对称性更好（P < 0.010）。高ISS组从受伤到手术的平均延迟时间略长（8.69天对7.35天，P = 0.248）。复视和感觉异常等并发症在高ISS组中更常见，但两组之间的总体并发症发生率未观察到显著差异。
对主要创伤患者的单侧ZMC骨折进行积极手术治疗是有效的。尽管该人群存在全身方面的挑战，但及时干预使高ISS组术后对称性更好，且不同创伤严重程度的3D结果相当。
