Kasrija Rishabh, Gupta Himanshi, Mittal Tarun, Dang Mansi, Behl Riya, Kumar Munish, Gupta Seema
Department of Oral and Maxillofacial Surgery, Jagadguru Sri Shivarathreeshwara Dental College, Mysuru, IND.
Department of Oral and Maxillofacial Surgery, Guru Nanak Dev Dental College and Research Institute, Sunam, IND.
Cureus. 2025 Jun 9;17(6):e85659. doi: 10.7759/cureus.85659. eCollection 2025 Jun.
Zygomaticomaxillary complex (ZMC) fractures are among the most prevalent facial injuries encountered during maxillofacial surgery because of the anatomical prominence and structural significance of the zygoma. These fractures often result from high-energy impacts, such as road traffic accidents, assaults, falls, and sports injuries, predominantly affecting males in their third to fourth decades of life. The management of ZMC fractures requires restoring facial aesthetics, orbital integrity, and masticatory function while minimizing surgical morbidity. Open reduction and internal fixation (ORIF) remains the primary approach, with two- and three-point fixation being the most commonly employed techniques. This narrative review evaluates and compares the clinical outcomes, stability, aesthetic results, and complications associated with two- and three-point fixation methods. Three-point fixation, involving stabilization at the frontozygomatic suture, infraorbital rim, and zygomaticomaxillary buttress, offers superior mechanical stability, particularly in displaced or comminuted fractures. It provides better control over rotational displacement and ensures improved malar projection and facial symmetry. However, this approach is invasive and may lead to increased surgical time and tissue trauma. Two-point fixation, typically involving the frontozygomatic suture combined with either the infraorbital rim or zygomaticomaxillary buttress, is less invasive and is suitable for minimally displaced or non-comminuted fractures. It is associated with a reduced operative time and morbidity, although it may offer less control over rotational forces and result in a higher incidence of malar asymmetry in complex fractures. Although both techniques showed comparable complication rates in select cases, three-point fixation demonstrated better outcomes in terms of malar height restoration and stability under functional loads. Alternative fixation strategies, such as single- or four-point fixation, are reserved for specific clinical scenarios but carry their own limitations and risks. The decision-making process must consider the fracture classification, displacement severity, and patient-specific factors. Ultimately, individualized treatment planning, guided by clinical assessment and evidence-based practice, is essential. Three-point fixation remains the standard for complex fractures, whereas two-point fixation is a reliable option for simpler injuries, offering a balance between functional recovery and minimal invasiveness. This review aims to evaluate and compare the clinical outcomes, stability, aesthetic results, and complications of two-point versus three-point fixation techniques in the management of zygomaticomaxillary complex fractures, guiding evidence-based treatment decisions.
颧上颌复合体（ZMC）骨折是颌面外科手术中最常见的面部损伤之一，因为颧骨在解剖学上较为突出且具有重要的结构意义。这些骨折通常由高能撞击引起，如道路交通事故、袭击、跌倒和运动损伤，主要影响30至40岁的男性。ZMC骨折的治疗需要恢复面部美观、眼眶完整性和咀嚼功能，同时尽量减少手术并发症。切开复位内固定（ORIF）仍然是主要方法，两点和三点固定是最常用的技术。这篇叙述性综述评估并比较了两点和三点固定方法的临床结果、稳定性、美学效果及并发症。三点固定涉及额颧缝、眶下缘和颧上颌支柱的稳定，提供了更好的机械稳定性，特别是在移位或粉碎性骨折中。它能更好地控制旋转移位，确保改善颧骨突出度和面部对称性。然而，这种方法具有侵入性，可能导致手术时间延长和组织创伤增加。两点固定通常涉及额颧缝与眶下缘或颧上颌支柱的联合，侵入性较小，适用于轻度移位或非粉碎性骨折。它与手术时间缩短和并发症减少相关，尽管它对旋转力的控制可能较差，并且在复杂骨折中导致颧骨不对称的发生率较高。虽然在某些情况下两种技术的并发症发生率相当，但在颧骨高度恢复和功能负荷下的稳定性方面，三点固定显示出更好的效果。替代固定策略，如单点或四点固定，适用于特定临床情况，但也有其自身的局限性和风险。决策过程必须考虑骨折分类、移位严重程度和患者特定因素。最终，以临床评估和循证实践为指导的个体化治疗计划至关重要。三点固定仍然是复杂骨折的标准，而两点固定是较简单损伤的可靠选择，在功能恢复和微创之间取得平衡。这篇综述旨在评估和比较两点与三点固定技术在颧上颌复合体骨折治疗中的临床结果、稳定性、美学效果及并发症，指导循证治疗决策。
