Orbital floor repair and three-point fixation of zygomaticomaxillary complex fractures to restore orbital morphological features and ocular functions - a retrospective observational cohort study

Q: What clinical problem does the study address in ZMCF patients?

The study targets the uncertainty in optimal management of zygomaticomaxillary complex fractures and focuses on restoring orbital morphology while managing post-traumatic ocular complications.

Q: How was orbital volume measured and categorized?

Orbital volume was measured on CT using manual segmentation and categorized as OVIntact, OVFractured, and OVRepaired.

Q: What were the main outcomes after three-point fixation with orbital floor reconstruction?

The approach significantly reduced the enlarged orbital volume (OVFractured) and achieved high correction rates, with substantial resolution of diplopia and improvement in restricted extraocular muscle movements.

Sep 29, 2026

Uploaded by Danger Angel

A retrospective observational cohort study investigated whether three-point fixation with orbital floor reconstruction effectively restores orbital morphology and improves post-traumatic ocular outcomes in patients with unilateral zygomaticomaxillary complex fractures (ZMCFs). Orbital volume was measured on CT via manual segmentation and outcomes included changes in enophthalmos-related volume, resolution of diplopia, recovery of restricted extraocular muscle movements, and correction of post-traumatic enophthalmos. The protocol significantly reduced enlarged orbital volume and resolved ocular complications.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Keywords

Khalifa et al. BMC Surgery (2026) 26:5 [https://doi.org/10.1186/s12893-025-03343-4](https://doi.org/10.1186/s12893-025-03343-4) BMC Surgery RESEARCH Open Access Orbital floor repair and three-point fixation of zygomaticomaxillary complex fractures to restore orbital morphological features and ocular functions: a retrospective observational cohort study Ghada Amin Khalifa 1,2*, Gharam Mefleh Alharbi3 and Khalid Zabin Alotaibi 1,2 Abstract Background Despite numerous investigations on how to manage zygomaticomaxillary complex fractures (ZMCFs), the best treatment option remains uncertain. The purpose of this study was to investigate the efficacy of threepoint fixation with orbital floor reconstruction in restoring orbital morphology and managing post-traumatic ocular complications associated with ZMCFs, as well as to measure the postoperative reduction in orbital volume (OV) . Methods A retrospective observational cohort study was conducted on patients with unilateral ZMCFs and orbital floor fractures with a completely intact contralateral orbit. The primary variable was the efficacy of three-point fixation of ZMCFs with orbital floor reconstruction in reducing enlarged OV and restoring ocular functions. The manual segmentation method was used to measure the OV of both orbits on CT scans. The measurements were categorized into OVIntact, OVFractured, and OVRepaired. The outcome variables were the percentages of OV difference and OV change between both orbits, the resolution rate of diplopia, the improvement in restricted extraocular muscle movements (EOMs), and the correction of post-traumatic enophthal mos. Results The study included 63 patients (mean age: 28.1 ± 2.6 years), with a male predominance of 60 . 3% . Posttraumatic enophthal mos and diplopia were observed in 49 (77 . 8%) patients, while restricted EOMs in upward gaze was noted in 33 (52.4%). The treatment protocol significantly reduced the OVFractured from 26.8 ± 1.6 cc to 21.9 ± 1.3 cc, achieving a correction rate of 97.3%(p < 0.021). Comparison between OVRepaired and OVFractured showed a 20.12% difference and 18.28% change, whereas comparison with the OVIntact revealed a minimal asymmetry, with a 2.78% difference, 2. 82% change, and a mean volume difference of 0.6 ± 2.3 cc. Ocular complications were significantly resolved, with a p-value < 0.001. Postoperatively, 54 patients had normal globe position, while three showed enophthal mos and six showed exophthal mos. At the end of the postoperative first month, the resolution rate of *Correspondence: Ghada Amin Khalifa [G.Khalifa@qu.edu.sa](G.Khalifa@qu.edu.sa) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Khalifa et al. BMC Surgery (2026) 26:5 Page 2 of 10 diplopia and restricted EOMs were 52.4% and 98.4%, respectively. Diplopia was completely resolved at the end of the postoperative third month. Conclusion

FAQs

What clinical problem does the study address in ZMCF patients?

The study targets the uncertainty in optimal management of zygomaticomaxillary complex fractures and focuses on restoring orbital morphology while managing post-traumatic ocular complications.

How was orbital volume measured and categorized?

Orbital volume was measured on CT using manual segmentation and categorized as OVIntact, OVFractured, and OVRepaired.

What were the main outcomes after three-point fixation with orbital floor reconstruction?

The approach significantly reduced the enlarged orbital volume (OVFractured) and achieved high correction rates, with substantial resolution of diplopia and improvement in restricted extraocular muscle movements.

Sep 29, 2026

Uploaded by Danger Angel