Evaluation of Sub Brow Approach Versus Lateral-Brow Approach to the Frontozygomatic Suture for Open Reduction and Internal Fixation (ORIF) of Zygomatico-Maxillary Complex (ZMC) Fractures.- A Comparative Study

Background:The frontozygomatic (FZ) region is an important site for reduction and fixation of zygomaticomaxillary complex (ZMC) fractures. The choice of surgical approach may influence operative efficiency, postoperative morbidity, and aesthetic outcomes. This study compared the sub-brow and lateral brow approaches for FZ fracture exposure and fixation. Methods:A comparative study was conducted on 20 patients with ZMC fractures involving the FZ suture. Patients were divided into two groups of 10 each. Group 1 underwent fixation through a sub-brow approach, whereas Group 2 underwent fixation through a lateral brow approach. Surgical exposure, operative time, postoperative pain, and scar formation were evaluated. Pain was assessed using the Visual Analogue Scale on postoperative Days 1, 5, and 10, while scar quality was assessed using the Modified Vancouver Scar Scale on Days 7, 30, and 90. Inter- and intra-group comparisons were performed using appropriate statistical tests. Results:Adequate surgical exposure was achieved in all patients in both groups. Mean operative time was significantly lower in Group 1 (88.50 ± 33.952 seconds) than in Group 2 (170.20 ± 61.150 seconds; p < 0.01). Pain scores showed a significant reduction over time in both groups (p < 0.01), with significantly higher pain in Group 2 on Days 1 and 5 (p < 0.01). Scar scores also decreased significantly over time in both groups (p < 0.01). Group 2 demonstrated significantly higher scar scores on Day 30 (p < 0.05). Conclusion:Both approaches provided adequate FZ region exposure and fixation. The sub-brow approach demonstrated shorter operative time, lower early postoperative pain, and favorable intermediate scar outcomes, suggesting its utility as an alternative approach for selected ZMC fractures.