Orbitozygomatic Complex Research Articles

Major clinical and surgical approaches to treating orbitozygomatic and zygomatic maxillary complex fractures: a systematic review

Introduction: In the scenario of orbitozygomatic fractures, facial and head injuries account for half of deaths due to trauma, and thousands are left with long-term or permanent injuries. Fractures of the zygomatic-maxillary complex (ZMC) and zygomatic arch are common athletic injuries. Operative treatment is indicated in cases of significant displacement or functional disturbance. Technology such as virtual surgical planning, intraoperative navigation, and intraoperative imaging has the potential to improve the accuracy of treatment of challenging fractures. Objective: It was to develop a systematic review of the main clinical and surgical approaches to the treatment of orbitozygomatic and zygomatic maxillary complex fractures. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from October 2023 to January 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 102 articles were found, 26 articles were evaluated in full and 25 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 14 studies with a high risk of bias and 12 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=57.9%>50%. A single-piece fracture of the fronto-orbito-zygomatic-maxillary bone connected to a temporoparietal bone may require additional osteotomy to achieve successful results in an acute setting. Orbital volume analysis offers a valid modality for objectively evaluating the efficiency of the management of orbitozygomatic complex fractures. The success rate of the fixation procedure at 1 point of the zygomaticomaxillary complex is high, with minimal complications. Intraoperative CT/three-dimensional imaging should be used in the treatment of ZMC fractures requiring orbital floor reconstruction, where adjacent fractures require fixation and/or when ≥ 2 axes are displaced ≥ 5 mm.

One-piece Craniofacial Bone Fracture Reduction With an Additional Single Osteotomy at the Zygomaticomaxillary Buttress: A Successful Reduction of Frontoorbitozygomaticomaxillary Fracture Associated With a Temporoparietal Bone Fracture.

A frontoorbitozygomaticomaxillary fracture, also known as a complex midface fracture or "quadripod fracture," is a type of facial fracture involving multiple midface region bones. This includes the frontal bone (forehead), orbitozygomatic complex (which includes the zygomatic bone or cheekbone and the orbital bones around the eye), and the maxillary bone (upper jaw). These complex midface fractures associated with temporoparietal bone fractures can occur in clinical practice. However, a single-piece fracture of these has not been reported before. This study reports a 44-year-old male patient with a significant frontoorbitozygomaticomaxillary fracture associated with a temporoparietal bone fracture combined with epidural hematoma at the superior aspect of unilateral frontoparietotemporal convexity. Surgical treatment was performed 3 weeks after the traumatic event. Despite craniotomy of the parietal bone fragment, the reduction was not possible. The facial bone reduction was finally achieved following an additional single osteotomy at the unilateral zygomaticomaxillary buttress. The follow-up CT scan taken immediately and 3 weeks postoperatively showed successful realignment of craniofacial bone fracture. In conclusion, a single-piece fracture of frontoorbitozygomaticomaxillary bone connected to a temporoparietal bone can require additional osteotomy to achieve successful outcomes in an acute setting.

Correction of Post-Traumatic Enophthalmos by Orbital Floor Reconstruction with Titanium Mesh

Aim: To see the efficacy of titanium mesh in orbital floor reconstruction to correct the post-traumatic enophthalmos in orbito-zygomatic complex fractures. Methods: This retrospective study was carried out in the department of Oral and Maxillofacial Surgery, University College of Medicine & Dentistry, University of Lahore, Pakistan from January 2017 to January 2020. All patients who had enophthalmos after orbito-zygomatic fractures and were treated for orbital floor reconstruction with titanium mesh were included in the study. Computer tomography (CT scan) was done to diagnose and measure the orbital floor defect. Pre-operative and post-operative hertalex ophthalmometry was done to measure and compare the enophthalmos. Results: Among the 30 patients, 23 were male and 7 were female. The mean age of the patients was 30±5.80 years. Fourteen patients had right and 16 patients had left side orbitozygomatic complex fracture. The mean orbital floor defect size was 1.72±0.78 cm preoperatively measured by CT scan. There was a correction of enophthalmos in 23 patients out of 30(76.66%). Conclusion: Titanium mesh is a commonly used and easily available material for the correction of orbital floor defects. It is efficacious in terms of the correction of post-traumatic enophthalmos resulting from orbito-zygomatic complex fracture. Keywords: Enophthalmos, titanium mesh, orbitozygomatic fractures

Outcomes of transconjunctival approach and its modifications for the treatment of orbito-zygomatic complex fractures: A pilot study

Background and Objectives: Transconjunctival incision is used to access the floor of orbit and infraorbital rim; however, when continued with lateral canthotomy, it becomes a versatile approach to treat various types of zygomaticomaxillary fractures. The aim of this study was to evaluate the outcomes of transconjunctival approach and its modifications in terms of accessibility, esthetic outcome, and postoperative complications for the treatment of patients of orbito-zygomaticomaxillary complex fractures. Methods: In the hospital, a total of five cases of zygomatic complex fractures were operated from October 2019 to December 2019. The transconjunctival approach was assessed on the following criteria: adequacy and ease of exposure, time required for exposure of fracture site, accuracy of reduction of fracture, esthetic outcome, and postoperative complications (e.g., ectropion, entropion, chemosis, infection, and scarring). The patients were kept on follow-up for 6 weeks. Results: The average age of the patients was 26 years. The average time required for exposure of fracture site was 25.2 min. Exposure obtained in all the cases was adequate according to the operating surgeon. During postoperative follow-up, all the patients were evaluated for ectropion, entropion, chemosis, and infection. None of the patients reported with any complications, and the postoperative esthetic results were satisfactory (according to the patient). Conclusion: The transconjunctival approach is an efficient approach to gain surgical access to infraorbital rim and zygomatic complex fractures. With good exposure and nonvisible scar, transconjunctival approach is superior to other techniques. The numerous advantages of this approach nullify the longer time taken for the procedure.

Transconjunctival Approach Using Lateral Skin Extension for Reconstruction of Orbit Zygomatic Complex Fractures: Technique Description and a Case Series Analysis

A descriptive-observational study of a series case report of patients diagnosed with orbito-zygomatic complex (OZMC) fracture with lateral wall involvement, was conducted. All patients were assessed in the Oral and Maxillofacial Surgery Service at Hospital El Carmen, Maipu, Santiago, Chile. The purpose of this study was to evaluate a single-institution experience with the transconjunctival approach to the orbit, utilizing a lateral skin extension as unique approach to access to fronto-zygomatic suture, infraorbital rim and/or orbital floor. The authors identified 41 patients with OZMC fractures who underwent to surgical treatment over a 45 months period. Among this group, 21 patients needed fixation with osteosynthesis of the frontozygomatic suture, and 16 of whom were treated with the approach being studied. The authors assessed scleral exposure, eyelid position changes, ectropion, and entropion as outcome measures, and reported satisfactory outcomes at a minimum of 9 months follow-up. This study concludes that in our experience, the transconjunctival approach utilizing a lateral skin extension allows a direct, easy, and quick access to the entire infra orbital rim, orbital floor, fronto-zygomatic suture and lateral wall of the orbit, up to spheno-zygomatic suture, with low associated morbidity and complications.

Craniofacial Trauma Due to Stone-pelting - Patterns of Injury and Management.

The aims of the study were to elucidate the pattern of stone-pelting induced cranio-facial injuries and to document soft and hard tissue injuries, their management, and complications. A retrospective descriptive study was conducted using a sample of patients reporting to our department in the years 2015 to 2020. Cranio-facial injuries were assessed for soft and hard tissue injuries, including tissue loss, and corresponding management. Follow up ranged from 18 ± 6 months. & A standardized surgical regime was followed for patient management, which included primary survey, debridement of wounds, and routine primary repair of soft tissue. Bony defect reconstruction was performed by open reduction and internal fixation. Cranial bone was used as split calvarial graft in postcraniectomy cranioplasty procedures, which were performed after 6 months. Local flaps were used for the reconstruction of soft tissue defects. Being a military hospital, majority of cases fell in the 20 to 30 age group with a male preponderance. The etiology in all cases was stone-pelting. Among cranio-facial injuries, cranial vault injuries and mid-face injuries (71%) were most prevalent, mandibular fractures (24%) and remaining were soft tissue injuries (5%). & Frontal & parietal bone injuries were seen in 23.6% cases (n = 9) and orbito-zygomatic complex injuries were seen in (36.8%) cases (n = 14). Isolated blow-out fractures were seen in 4 patients of our series. 52.6% of patients of our series suffered associated soft tissue injuries to the head, face, and neck region. The most common cause of injury was due to the direct impact of stone hitting the mid-face/cranial vault and the most common pattern of injury was gross comminution of the skeleton. & 2 patients suffered ocular injuries that required management and 6 patients of our series who suffered head injuries to the cranium required a secondary cranioplasty procedure (n = 4) &The most commonly used technique for treatment was open reduction internal fixation, which was used in 89% of patients. Soft-tissue injuries overall occurred most frequently on the forehead, nose, lips, and chin which was managed by primary suturing. Cranial vault injuries & orbito-zygomatic complex fractures are most commonly seen in patients with stone-pelting injuries. Early management of such injuries improves outcomes in terms of function and restitution of preinjury skeleton structure. The most common patterns seen is gross comminution to the cranio-facial skeleton that can be treated with immediate primary wound repair after meticulous wound debridement and open reduction and internal fixation. Importance of stone-pelting as a cause of craniofacial injuries is highlighted as it leads to significant disruption of craniofacial skeleton.

Efficacy of modified two point fixation versus three point fixation in management of moderate energy orbitozygomatic complex fractures (Clinical and radiographic study)

Background: Orbitozygomatic complex (OZC) fractures are second most common fracture among facial skeletal injuries. Ithas been reported that three point fixation is the most acceptable technique for management of moderate energy OZC fractures.However, it has several drawbacks such as skin scare and palpable hardware over lateral orbital rim.Aim: The purpose of current study was to compare modified two point (the ZM buttress and infraorbital rim) and three pointmethod of internal fixation in moderate energy OZC fractures.Patients and Methods: This randomized controlled trial was conducted on of 32 patients with unilateral moderate energy OZCfractures of both genders. They were divided into equal two groups (group I, three point fixation and group II, modified twopoint fixation). Patient demographics and both clinical and CT radiographical assessments were done postoperatively after 6months to evaluate postoperative complications, patient satisfaction score ,and quality of bone reduction.Results: Clinically There was highly statistical significant difference between groups in aspects of mean operation time,numbers of postoperative complications and values of patient satisfaction score (p value = 0.015, 0.003, 0.0016 respectively).Postoperative radiographic measurements and means of difference between affected and unaffected sides revealed nonsignificantdifference between groups (p > 0.05).Conclusio: Modified two point fixation technique is effective alternative to three point fixation technique in management ofmoderate energy OZC fractures with advantages of reduced operation time, fewer complications, higher patient satisfactionscore

Surgical-Orthodontic Considerations in Subcranial and Frontofacial Distraction.

Subcranial and frontofacial distraction osteogenesis have emerged as powerful tools for management of hypoplasia involving the upper two-thirds of the face. The primary goal of subcranial or frontofacial distraction is to improve the orientation of the upper face and midface structures (frontal bone, orbitozygomatic complex, maxilla, nasal complex) relative to the cranial base, globes, and mandible. The various techniques used are tailored for management of specific phenotypic differences in facial position and may include segmental osteotomies, differential vectors, or synchronous maxillomandibular rotation.

Evaluation of orbital volume after orbitozygomatic complex fractures fixation: A radiographical study

BackgroundOrbitozygomatic complex fractures are one of the most commonly encountered injuries of the craniofacial skeleton. The aim of this study was to implement the orbital volume as an objective evaluation modality for the assessment of the accuracy of unilateral Orbitozygomatic complex fracture fixation, by comparing the postoperative values with the contralateral normal side and the pretreated values. Materials and methodsA retrospective radiographic, chart review was performed in order to investigate the primary outcome of the objective quantification of the accuracy of Orbitozygomatic complex fracture reduction utilizing orbital volume analysis. Comparing the postoperative orbital volume values with the preoperative, and the contralateral normal ones was set as the study secondary outcome, along with the percentage of changes in the orbital volume of unilateral Orbitozygomatic complex fracture treated patients. Data reliability was performed using Interclass correlation coefficient and Statistical significance was set at 5% level. ResultsSeventeen records met the inclusion criteria. While a statistically significant difference was found between the preoperative orbital volume values of the affected side and that in the normal unaffected side (P < 0.001), a statistically insignificant difference was encountered between the postoperative values and the control side (P = 0.333). An average percentage of decrease of 6.1%. was reported in the postoperative records when compared to the preoperative ones, with a statistically significant difference (P < 0.001). the study reported high inter (ICC = 0.97) and Intra (ICC = 0.97) observer reliability. ConclusionOrbital volume analysis offers a valid modality for the objective evaluation of the efficiency of Orbitozygomatic complex fracture management.

Clinical Signs and Intraocular Pressure Changes in Patients with Orbitozygomatic Complex Fractures.

The study investigated the association between intraocular pressure changes and clinical ocular signs in 51 patients with orbitozygomatic complex fractures. Diplopia, chemosis, enophthalmos, subconjunctival haemorrhage, periorbital ecchymosis and extraocular muscles entrapment were assessed. Intraocular pressure was measured in mmHg at different time intervals with Perkins and Goldman tonometers; within first 3days of injury (T1), 24h post-elevationwithin 3-14 days of injury (T2), 1month after initial treatment assessment (T3), 2months after initial treatment assessment (T4), and 3months after initial treatment assessment (T5). Intraocular pressure changes between T2/T1 and T3/T1 were analysed as change 1 and change 2, respectively, with paired t test. Significance was set at p < 0.05. Minimum intraocular pressure recorded in the affected eye was 5mmHg at T1 and T2, while maximum intraocular pressure was 28mmHg at T1. Mean intraocular pressure at T1 and T2 was 15.90 ± 4.73mmHg and 16.80 ± 4.43mmHg, respectively. All eye signs had completely resolved at T3 except enophthalmos, which persisted till T5. Statistical significant relationship exist between orbitozygomatic complex fracture and enophthalmos (T1: p = 0.04). subconjunctival haemorrhage (T2: p = 0.003), periorbital ecchymosis (T2: p = 0.005),and T3: p = 0.001). Chemosis, diplopia, enophthalmos, periorbital ecchymosis and subconjunctival haemorrhage showed positive contributory effect to intraocular pressure elevation in orbitozygomatic complex fracture.

A New Orbito-Zygomatic Complex Reconstruction Technique Using Computer-Aided Design and Manufacturing–Assisted Harvest of Autologous Calvarial Bone in Cases of Orbito-Zygomatic Benign Tumor

The orbito-zygomatic complex (OZC) includes several key structures, and its destruction leads to the impairment of functional activities such as nutrition, communication, nasal support, and vision.Management of benign tumors of the OZC is therefore a surgical challenge because of the necessity for reconstruction of these elements. Autogenous bone is considered the gold standard for reconstruction. Nevertheless, there is difficulty related to the complex anatomy and distorted skeletal anatomic landmarks, which require precise work in the case of bone grafts. The aim of this report is to propose a new reconstruction technique consisting of OZC reconstruction with computer-aided design and manufacturing of autologous calvarial bone. Three cases are presented. After performing tumor resection using computer-aided design and manufacturing cutting guides, we used a piezotome to perform osteotomies and preserve the periosteum and sinus mucosa.The SinpliciTi system (Materialise, Châtillon, France) allowed us to make cutting guides and a 3-dimensional surgical plan of the shapes and ideal positions of the calvarial bony plates for the OZC reconstruction. Calvarial osteotomies were performed using a piezotome through the polyamide calvarial cutting guide to obtain the shapes designed beforehand. Once the samples were collected, the shapes could be assembled exvivo and then put in place through a minimally invasive approach. We discuss the advantages and limitations of our reconstruction method and its place in the management of OZC reconstruction.

Decannulation and Airway Outcomes With Maxillomandibular Distraction in Treacher Collins and Nager Syndrome.

Treacher Collins syndrome is a rare disorder (1/50,000 live births) with features that include hypoplastic orbitozygomatic complex with downward slanting eyes, and maxillary/mandibular retrusion. Obstructive sleep apnea and tracheostomy-dependence are common. This study presents the outcomes of skeletal distraction on avoidance of tracheostomy and decannulation in this patient population. The authors reviewed charts of all patients with Treacher Collins syndrome who underwent craniofacial reconstruction from 2003 to 2016. Primary outcome measures included decannulation of tracheostomy dependent patients and avoidance of tracheostomy. Secondary outcome measures included cephalometric parameters, polysomnography scores, and airway exposure scores on direct laryngoscopy. Twenty-five patients underwent mandibular and maxillary advancement to resolve upper airway obstruction. Mandibular distraction was performed in 24 of 25 patients, and maxillary distraction in 14 of 25 patients. Maxillary distraction was combined with mandibular distraction in 13 of 17 to accomplish greater advancement and counter-clockwise rotation of the entire maxillary-mandibular complex. Six of 7 patients, 85.7%, avoided a tracheostomy and 39% (7 of 18) were decannulated. Cephalometric changes in sella-nasion-A point, sella-nasion-B , occlusal plane angle, and posterior airway space were equivalent between the groups who were able to clear their obstruction and those who were not. Treacher Collins is a very challenging disease in which to resolve airway obstruction. Thus, thorough evaluation of the entire airway for all levels of obstruction is critical to successful outcomes. Future collaborative efforts between multiple institutions can help to increase our understanding and effective management of this rare disease.

The orbit first! A novel surgical treatment protocol for secondary orbitozygomatic reconstruction

A novel surgical treatment sequence for secondary orbitozygomatic complex (OZC) reconstruction is described. Orbital reconstruction is performed before OZC repositioning. A surgical plan is made: the affected OZC is virtually osteotomized and aligned with a mirrored model of the unaffected OZC. A patient-specific implant (PSI) is designed for orbital reconstruction. Screw holes from the primary reconstruction are used for fixation. Primary screw hole positions at the repositioned OZC are embedded in the design, to guide OZC repositioning. A second patient-specific design is made for guidance at the zygomaticomaxillary buttress.The workflow was utilized in two patients. The PSI was positioned using navigation feedback. After repositioning of the zygomatic complex, the screw hole positions at the infraorbital rim and zygomaticomaxillary buttress seemed to align perfectly: no screw hole adjustments were necessary. Minor deviations were seen between planned and acquired PSI position; the mean errors between planned and acquired OZC position were 1.5 and 1.2 mm.Orbital reconstruction with a PSI before OZC repositioning ensures true-to-original orbital reconstruction. The use of old screw hole positions enables the PSI to be used as a static guide for OZC repositioning. The combination of static and dynamic guidance increases predictability in secondary OZC reconstruction.

Meta-analysis of orbitozygomatic complex trauma. The cost–benefit relationship for the usefulness of eye care and orthoptic screening

Meta-analysis of orbitozygomatic complex trauma. The cost–benefit relationship for the usefulness of eye care and orthoptic screening

A Unique Case of Gossypiboma following Treatment of the Orbitozygomatic Complex Fracture

Transmaxillary approach to the orbital floor has been used successfully to treat the blowout fracture by antral packing to support the orbital floor. However, antral packs are associated with a high incidence of infection and persistent oroantral fistula. A 30-year-old man with a history of the orbitozygomatic complex fracture 8 years ago presented with a persistent facial wound on the right side of the cheek. The patient underwent an exploratory surgery under general anesthesia, and the maxillary sinus was approached through the Caldwell-Luc operation and a long 2-m nasal tampon was found in the sinus. Foreign bodies including gossypibomas are rare, hard to diagnose, and mostly asymptomatic and in chronic cases do not reveal specific radiological and clinical signs for differential diagnosis. Therefore, in the evaluation of the soft-tissue lesions in patients with a history of a prior operation, it is wise to consider foreign bodies in the differential diagnosis.

Long-term sensory disturbances after orbitozygomatic fractures

Orbitozygomatic fractures often lead to infraorbital nerve (ION) injury, and affected sensibility is a common long-term complaint within this patientgroup. We presenta long-term follow-up study where the validated von Frey filament system was usedfor testing ION sensibility. Furthermore, we examined the incidence of persistent nerveinjury and whether more complex fractures led to more pronounced ION sensibility disturbances. Patients treated for facial fractures involving the orbitozygomatic complex were included and the follow-up time was 3 years or more. Depending on the location and severity of the fractures, the patients were divided into 4 groups. The patients answered a questionnaire before ION sensibility testing with von Frey filaments. Eighty-one patients were examined: 65 males (80%) and 16 females (20%). Examinations were conducted between 3.0 and 7.6 years (mean 4.9 years) after injury. Sixteen patients (20%) had affected and 6 patients (7.4%) had severely affected ION sensibility according to von Frey testing. No statistically significant differences were found in terms of questionnaire score between the groups. There was also no statistically significant correlation between questionnaire results and log von Frey values. Although the effect of groups could not be statistically verified using the log von Frey values, a larger proportion of patients with complex fractures had higher log von Frey values than the other groups. Patients with complex fractures report more permanent sensory disturbance of the ION after surgery than those with isolated orbitozygomatic fractures, although this could not be verified statistically with von Frey filament testing at several locations. Hence, a validated method for testing facial sensibility such as von Frey filaments, although sensitive, is inadequate to determine all aspects of sensory malfunction after orbitozygomatic fractures. This suggests that the patient's experience of long-term sensation after trauma may not be correlated with objective measures.

Importância epidemiológica de acidentes com motocicletas e bicicletas no contexto atual do trauma bucomaxilofacial no sul do Brasil

Purpose: Epidemiological studies exhibit regional variation patterns as the result of local demographic and socioeconomic factors. This study assessed the epidemiology of maxillofacial fractures treated at a trauma center in Southern Brazil to identify the importance of motorcycle and bicycle crashes. Methods: The records of 2261 patients admitted between April 2003 and March 2013 were reviewed. Results: The male-to-female ratio was 5.6:1. The peak incidence occurred in the third decade of life. Bicycle and motorcycle crashes accounted for 20% of all reported etiologies. Mandibular and orbitozygomatic complex fractures were most prevalent. The most common treatments were open reduction with rigid internal fixation and conservative therapy. Overall, 1248 patients (55.9% of recorded admissions) had a length of stay of 7 days or less. Conclusion: Countrywide prevention projects and the use of alternative transportation should be encouraged.

Reasons for plate removal after treatment of orbitozygomatic complex fractures

PurposeThe purpose of this study was to assess numbers of patients that required removal of miniplates after open reduction and internal fixation of the orbitozygomatic complex over a six-year period, and review the reasons for removal. Patients and methodsThis was a retrospective study from February 2007 to December 2013. All patients who had open reduction and internal fixation for traumatic orbitozygomatic complex fractures were included and those who returned to theatre for plate removal were identified. Results307 plates were placed in 216 patients. Eight plates were removed from six patients giving a 2.6% incidence of plate removal (2.78% of patients). Infection or exposure occurred within the first year in five out of six patients, accounting for the seven buttress plates, which were in situ for an average of 180 days. The infraorbital plate was in situ for 972 days. The majority of plates used were buttress plates as single point fixation. ConclusionsIn our experience placement of buttress plates for one-point fixation of traumatic orbitozygomatic complex fractures seems to be a safe and effective method with a low rate of complication. Complications seem to occur within a year, which is similar to previous studies.

Maxillofacial firearm injuries: a protocol for management in Asyut University Hospital

none of the published studies reported objective means to evaluate accuracy of reconstruction. Methods: Twelve patients with unilateral massively displaced or comminuted orbitozygomatic complex fractures received computer-assisted reconstruction guided by stereolithographic models and zygomatic templates. Titanium meshes and fixation plates were bent onto the models preoperatively, while the templates were used intraoperatively for guidance of zygomatic reduction into the pre-planned position. Linear and angular measurements were used to assess accuracy of reconstruction on the postoperative 3D-CT images. Results: Results are currently being generated and will be presented and disussed during the conference.

Digital guide plates for correction of unilateral delayed orbitozygomatic complex fractures

Objective To investigate the clinical outcome of correction of unilateral delayed orbitozygomatic complex fractures with digital guide plates.Methods The study involved 14 cases of unilateral delayed orbitozygomatic complex fractures treated between September 2007 and March 2012.Craniofacial structures were measured by thin-section CT before operation,followed by data input to the image processing software.Before and after the processing of images,three dimensional skull models were produced using rapid prototyping technique and applied to have surgical simulation.Digital guild plates were produced for guiding the reduction of fractures and orbital walls were reconstructed as well.Results All cases were followed up for a period of 6-11 months,which showed basic restoration of facial structure and significant correction of diplopia and enophthalmos,with no infection or dislocation of implants buried in orbit floor.Mild ectropion of the lower eyelid occurred in one case and temporary decrease of frontal wrinkle in two cases,but all recovered in 3-6 months postoperatively.Conclusion Digital guide plate is easy in operation and reliable for treatment of unilateral delayed orbitozygomatic complex fractures. Key words: Zygomatic fractures; Surgery, computer-assisted; Rapid prototyping