Zygomaticomaxillary Complex Fracture Repositioning Using Plates and Screws: Standard Techniques, Modifications, and Cost‑Effectiveness Considerations

Abstract

Iwan Setiawan Adji¹, Zerlina Norberta Ramadhani², Arum Widya Anantasya², Ardhini Tyas Megaranti², Gavin Editya Mukti², Mohammad Alifiya Devano²

¹Department of Otorhinolaryngology–Head and Neck Surgery, Kartini Regional General Hospital, Karanganyar, Indonesia; ²Medical Professional Education Program, Universitas Muhammadiyah Surakarta, Sukoharjo, Indonesia

Correspondence: Zerlina Norberta Ramadhani: Kampus IV UMS, Jl. Ahmad Yani, Tromol Pos 1, Pabelan, Kartasura, Sukoharjo; norbertazr@gmail.com

ABSTRACT

Zygomaticomaxillary complex (ZMC) fractures are among the most common midfacial injuries and may compromise both facial aesthetics and functional outcomes. Although traditional management recommends multipoint fixation to restore stability, emerging evidence suggests that minimal fixation may achieve comparable clinical results with greater procedural efficiency. This systematic review aims to evaluate the clinical outcomes and cost‑effectiveness of one‑point, two‑point, and three‑point fixation techniques in the management of ZMC fractures. This review was conducted following the PRISMA 2020 guidelines. A systematic search was performed in PubMed, ScienceDirect, Google Scholar, and ResearchGate. Eighteen studies evaluating plate‑and‑screw fixation techniques were included and analyzed qualitatively. Outcomes assessed included postoperative stability, facial symmetry, orbital function, complication rates, operative time, implant use, and overall treatment cost. One‑point and two‑point fixation demonstrated postoperative stability, facial symmetry, and orbital function comparable to three‑point fixation when adequate anatomical reduction was achieved. Complication rates were low and showed no meaningful differences among fixation techniques. Minimal fixation was associated with shorter operative time, reduced implant use, and lower overall treatment costs. Efficiency gains were primarily attributed to decreased surgical duration and fewer required implants. Clinical outcomes were more strongly influenced by the quality of reduction and the strategic selection of fixation points than by the number of fixation sites. In conclusion, one‑point and two‑point fixation represent safe and effective alternatives to traditional multipoint fixation for selected ZMC fractures, offering optimal clinical outcomes while improving procedural efficiency and cost‑effectiveness.

Keywords: zygomaticomaxillary complex fracture; internal fixation; one‑point fixation; two‑point fixation; cost‑effectiveness