Treatment of zygomatic-orbital complex fractures: surgical approaches and clinical outcomes

Abstract

Introduction: Fractures of the zygomatic-orbital complex are frequent injuries in oral and maxillofacial trauma and can compromise malar projection, facial symmetry, orbital function, and mastication. The choice of surgical approach and fixation points depends on the displacement pattern, the extent of the fracture, and associated functional impairments. However, controversies persist regarding the selection of the most appropriate techniques for each clinical presentation. Objective: To critically analyze the available evidence on surgical approaches used in the treatment of zygomatic-orbital complex fractures, considering their indications, fixation techniques, functional and aesthetic outcomes, and primary complications. Methodology: This is a narrative literature review conducted through searches in databases—PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library, and Google Scholar—as well as on scientific journal websites, using terms related to zygomatic-orbital fractures, surgical approaches, bone fixation, and clinical outcomes. Sixteen publications, dating from 1992 to 2026 and relevant to the study's objective, were selected; their findings were synthesized qualitatively. Results: The analyzed literature consists predominantly of retrospective studies, case series, and clinical reports, in addition to one systematic review focused specifically on the orbital floor. The findings indicate that an intraoral approach, combined with fixation at the zygomaticomaxillary buttress, may be sufficient for select fractures. In cases involving greater displacement, instability, or orbital impairment, additional approaches and multiple fixation points may be required. Reported complications include infraorbital hypoesthesia, residual diplopia, ectropion, and infection. Digital technologies and minimally invasive techniques show promising results, although there are still limitations regarding the robustness of the available evidence. Conclusion: The treatment of zygomatic-orbital complex fractures must be individualized based on the fracture pattern, the degree of displacement, and any functional or aesthetic impairments. Despite the variety of available approaches, the scarcity of high-quality comparative studies hinders the establishment of universally applicable surgical protocols, underscoring the need for prospective research using standardized evaluation criteria.