Introduction
In the scenario of facial trauma, fractures of the Zygomatic-maxillary complex (ZMC) are common facial fractures. Annually 5.8 million people die from trauma worldwide [1]. Trauma mortality accounts for 10% of all causes of death. Thus, trauma is a worldwide public health problem. Still, trauma is the main cause of death among patients aged 1 to 44 years and the fourth major cause considering all age groups. According to WHO data, head and face injuries can represent half of traumatic deaths [1].
In this context, the ZMC is an important structure, serving as an important buttress of the middle third of the face. The ZMC also aesthetically projects anterolaterally to form the malar eminence and establish the width and medial-facial contour of the orbital border [2]. Attempts to treat ZMC fractures are to achieve stability and restore aesthetic appearance through three-dimensional reduction and rigid fixation. After adequate fracture reduction, it is important to maintain stability and rigid fixation to avoid functional impairment and aesthetic sequelae. Thus, open reduction and internal fixation have been used as a standard method for the treatment of these fractures [3].
Therefore, several surgical and technical procedures, including fixation of one, two and three points are used according to the severity and extent of ZMC fractures [4]. Among these techniques, some authors argue that fixation of just one point provides sufficient stability of the ZMC fracture when the ZMC fracture is not crushed [5,6]. At the moment, it is not yet clear which treatment, fixation of one point, fixation of two points or fixation of three points, is better [7]. In addition, there is a growing interest in minimally invasive procedures and concerns about scarring, further highlighting the use of fixing a point. Thus, fixing a point of the zygomatic- maxillary (ZM) buttress through a gingivobuccal incision has the advantage of not leaving an external scar [8,9].
In this sense, the main indications for the use of fixation at 1 point of the tripod fracture are minimal or moderate displacement of the infra-orbital border in the zygoma tripod fracture, no ocular sign of diplopia or enophthalmia and comminuted infraorbital edge fractures in which internal fixation is difficult [10]. Successful repair requires not only an accurate diagnosis, but also a careful consideration of the complex three-dimensional anatomy, because even minimally displaced fractures in the ZMC can result in functional and aesthetic deformities [10].
Therefore, the present study aimed to analyze, through a meta-analysis, the success rates of fracture stability of the Zygomatic-maxillary complex, incidences of complications and aesthetic satisfaction after 1-point fixation.