Clinical Impact of Treatment Modalities for Zygomatic Fractures on Infraorbital Nerve Sensory Recovery: A Cross-sectional Observational Study

Abstract

Background: Lesions of the infraorbital nerve are common sequelae of zygomatic complex fractures, significantly compromising patients' quality of life. This study aimed to identify the most effective treatment method for zygomatic fractures, minimizing sequelae such as persistent numbness, which can significantly affect patients' quality of life. To this end, conservative and surgical approaches and one- and two-point fixation techniques were compared, considering the influence of fracture location on neurosensory and functional prognosis. Materials and Methods: This retrospective, cross-sectional study evaluated the medical records of patients with zygomatic complex fractures. The sample consisted of all medical records of patients from the Federal University of the Jequitinhonha and Mucuri Valleys treated for zygomatic complex fractures between January 2016 and December 2018, evaluating sensory recovery over a 12 months follow-up. Results: 126 medical records were evaluated, with 147 facial fractures, of which zygomatic complex fractures had the highest incidence (31.29%). Most patients were male, with a mean age of 42.5 years. The primary etiology was traffic accidents. In zygomatic complex fractures, the most common signs and symptoms were altered neurosensory function of the infraorbital   nerve (78.26%) and infraorbital rim step-off (54.34%). The conservative or non-surgical method was the most used (34.78%), followed by open reduction and internal fixation of the frontozygomatic process and infraorbital rim (32.6%), open reduction and internal fixation of the frontozygomatic process (19.56%), and open reduction and internal fixation of the infraorbital rim (13.04%). Complete resolution of infraorbital nerve sensory disturbances was observed in only 33.33% of patients, of whom 66.7% were treated by open reduction with internal fixation. Conclusions: Thus, open reduction with internal fixation of the infraorbital rim and frontozygomatic process has proven to be a practical approach, promoting better fracture reduction, re-establishment of the orbital contour, and superior aesthetic and functional results, in addition to increasing the chances of neurosensory recovery of the infraorbital nerve.