Zygomatic Bone Fractures Research Articles

Rapid prototyping use for the treatment of cominute zygomatic bone fracture: a case report

Rapid prototyping use for the treatment of cominute zygomatic bone fracture: a case report

Three-Dimensional Computed Tomography Analysis of Stability Following Two- and Three-Point Fixation With Biodegradable Plates Among Patients With Zygomatic Fracture.

Open reduction followed by internal fixation has been regarded as the most effective technique for the surgical repair of zygomatic fractures. However, the ideal number and locations of internal fixation points to maintain stable reduction remain controversial. Using 3-dimensional computed tomography, we aimed to compare the stability of 2-point and 3-point fixation among patients who had undergone surgical repair of zygomatic bone fractures. The study included 22 patients (17 men, 5 women) with unilateral zygomatic bone fractures who had undergone open reduction with 2-point or three-point fixation using biodegradable materials (11 patients in each group). The authors measured the lateral projection and height of the zygoma at 2 landmark points (zygomaticofacial foramen and frontozygomatic suture). In each group, bony displacement was analyzed between the preoperative and immediate postoperative phases, and between the preoperative and follow-up phases. Differences in stability between the 2 groups were analyzed by comparing values between the immediate postoperative and follow-up phases. The 2-point group exhibited a lower rate of complex fractures at the frontozygomatic suture than the 3-point group (18.2%, 63.6%, respectively). In both groups, the authors observed significant differences in the lateral projection of the zygomaticofacial foramen between the preoperative and immediate postoperative phases, and between the preoperative and follow-up phases. No significant differences in stability were observed between the groups. Our findings demonstrated that 2-point fixation of the zygoma with biodegradable materials is as stable as 3-point fixation. It could be initially considered when open reduction of frontozygomatic suture was not essential.

Outcome of treatment of Zygomatic bone fracture by two point fixation versus three point fixation in Mayo Hospital Lahore.

To compare the outcome of two-point internal fixation versus three-point internal fixation for the treatment of zygoma fractures.The quassi-experimental study was conducted at the King Edward Medical University, Mayo Hospital, Lahore, Pakistan, from April to September 2016, and comprised patients with zygomatic bone fracture who were randomly divided into two groups. In Group A, patients were treated with two-point fixation and in Group B, patients were treated with three-point fixation. All patients were treated by the same consultant. Patients were followed up on first, third and sixth week postoperatively and malar height and mouth opening were recorded at the sixth week follow-up. Data was analysed using SPSS 17.Of the 60 patients, there were 30(50%) in each of the two groups. There were 39(65%) males and 21(35%) females. The mean age in Group A was 29.56±9.89 years (range: 17-50 years), while in Group-B it was 29.45±8.68 years (range: 17-49 years). Mean malar height at 6th week post-operative follow up showed a significant reduction in Group B compared to Group A (p= 0.001). Significant improvement in mouth opening was seen in Group B compared to Group A (p= 0.034).Three-point fixation was found to give more stable reduction compared to 2-point fixation for treating zygomatic bone fractures in terms of malar height and mouth opening.

Four Cases of Medial Transposition of a Zygomatic Bone Fracture Associated with Fracture of the Greater Wing of the Sphenoid

Four Cases of Medial Transposition of a Zygomatic Bone Fracture Associated with Fracture of the Greater Wing of the Sphenoid

Ophthalmic Injuries Related to Maxillofacial Trauma Due to Urban Warfare.

Is to evaluate the associated ophthalmic injuries in maxillofacial trauma due to war and to emphasize the need for proper ophthalmic examination to exclude and manage any associated ophthalmic injuries. A total of 66 patients with maxillofacial trauma due to war were considered in this study and underwent classification of the fractures to know patterns of fractures and to specify the ophthalmic injuries which might be associated with each fracture. Referral to ophthalmologist was considered to determine the exact nature of ophthalmic injuries. Results by a maxillofacial surgeon and ophthalmologist were evaluated. Midfacial trauma particularly those associated with zygomatic bone fracture was highly significant due to blast and bullets can lead to serious ophthalmic injuries. This was related to 57% of ophthalmic injuries. The related ocular injuries which were subconjunctival hemorrhage and the rupture or lacerated eye globe found to be highly significant war injuries while the preretinal hemorrhage and diplopia were significant. A thorough proper ophthalmic examination should be carried out for every patient with these fractures and suspected cases should be placed under close observation so that immediate and active treatment can be taken if necessary.

Treatment and Complications of Patients with Zygomatic Fractures Referring to Imam Reza Hospital in a 2-Year Period

Background: In recent years, there has been a significant increase in the incidence of injuries and the relevant morbidity and mortality in Iran. The present study was undertaken to determine the etiology, type, and treatment modalities applied to zygomatic fractures and investigate the correlation of postoperative complications with the treatment modality used in patients referring to Imam Reza hospital. Methods: The target population consisted of all the patients with zygomatic bone fractures referring to the oral and maxillofacial surgery service of Imam Reza hospital (2011 - 2012). Demographic data, the reason for trauma, the trauma date, the location and the type of fracture, and the clinical symptoms of fracture were recorded in checklists. The surgery was undertaken and the surgical procedure, the type of the therapeutic intervention and its complications, the type of the plate used, and the place it was used for fixation also were recorded in the checklists. Data were analyzed with descriptive statistics and chi-squared test using SPSS 21. Results: Of 165 patients with zygomatic fractures, 80% were male and 20% were female with a mean age of 32.81 years. Motor vehicle accidents were the most important cause of zygomatic fractures (64.8%), and the infraorbital nerve paresthesia was the most frequent symptom (62.4%). Paresthesia was the most frequent complication remaining after surgery in three follow-up visits (38%). The most commonly used open surgical procedures were eyebrow (53.9%), subciliary (46, 27.8%), and vestibular (46, 27.8%) surgeries, respectively. Conclusions: Male patients, with amean age of 32 years, exhibited the highest rate of zygomatic fractures. Themost commonly used open surgical procedure was eyebrow surgery. Paresthesia of the infraorbital nerve was the most prevalent postoperative complication but these complications had no relationship with the surgical techniques used.

Patterns of Facial Bone Fractures in Western Region of Nepal

Objective: The aim of this study was to determine pattern of facial bones fracture in western region of Nepal.Material and Methods: A descriptive cross sectional study was carried out in department of ENT, Nepalgunj medical college, Nepalgunj. Records from emergency department, inpatient ward and OPD of ENT and dental department of last 3 years (Jan 2012 to Dec 2014) were enrolled in the study and entered into proforma. Comparison was done between mode of injury, demography and types of injuries. Data was analyzed using SPSS 17 software.Results: Out of included 626 cases, there were 410 male patients and 216 female patients. Age ranged from 3 to 68 years with average age being 32.4 years. Most of the male patients sustained trauma due to road traffic accidents (51.7%) followed by physical assault (23.9%). In female also same mode of injuries were common with higher proportion due to physical assault. Majority of cases were from Midwestern Terai region (35.4%). There were 288(46.0%) cases with isolated facial bone fracture. The maximum was that of mandibular fracture (29.1%) followed by nasal bone fracture (27.7%) and maxilla (24.3%). Rest of 338 patients had multiple facial bone fractures with zygomatic bone fracture (79.2%) being commonest. It was followed by maxilla (64.4%) and mandible fracture (36.6%). The overall frequency of fracture is mainly involving zygomatic bone (49.5%) followed by maxilla (46.0%) and mandible (33.2%).Conclusion: Middle aged male patients are usually involved in facial bone fractures with road traffic accident and physical assault being common modes of injury. Zygomatic bone is the commonest bone to get fractured in isolated cases while mandible is commonest bone to get fractured in multiple fracture cases.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Correction of a Posttraumatic Orbital Deformity Using Three-Dimensional Modeling, Virtual Surgical Planning with Computer-Assisted Design, and Three-Dimensional Printing of Custom Implants.

We describe a case of complex, posttraumatic skull and orbital deformities that were evaluated and treated with advanced computer technology, including virtual surgical planning, three-dimensional (3D) modeling, and printed patient custom implants (PCI) fabricated by 3D printing. A 50-year-old man presented to our craniofacial referral center 1 year after failed reduction of complex left orbital, zygomatic, and frontal bone fractures due to a motorcycle collision. The patient's chief complaint was debilitating diplopia in all fields of gaze. On examination, he had left enophthalmos, left canthal displacement, lower eyelid ectropion, vertical orbital dystopia, and a laterally and inferiorly displaced, comminuted zygoma with orbital rim and frontal bone defects. The normal orbit was mirrored to precisely guide repositioning of the globe, orbital reconstruction, and cranioplasty. Preinjury appearance with normal globe position was restored with complete resolution of diplopia. Modern 3D technology allows the surgeon to better analyze complex orbital deformities and precisely plan surgical correction with the option of printing a PCI. These techniques were successfully applied to resolve a case of debilitating diplopia and aesthetic deficits after facial trauma. Further application of advanced 3D computer technology can potentially improve the results of severe orbital and craniofacial trauma reconstruction.

Treatment of Zygomatic Complex Fractures in an Urban Saudi Arabian Population: A 10-Year Retrospective Survey

Background: Zygomatic complex fractures (ZMCF) are treated by various closed and open reduction procedures. The common goal, however, is to achieve three-dimensional stability of the fractured zygoma. Patients and Methods: All cases diagnosed with ZMCF were included in this study over a 10-year-period starting from December 2002 to December 2012 at Riyadh Dental Centre, King Saud Medical City-Riyadh, Saudi Arabia. Patient's gender, age, etiology, and type of treatment modality of the zygomatic bone fracture were retrieved and recorded. Data were stored and statistically analyzed using SPSS (ver. 16.0; SPSS Inc., Chicago, IL, USA). Results were presented as simple frequencies and percentages. Results: A total of 306 patients were diagnosed with ZMCF during the study period. There were 271 (88.6%) males and 35 (11.4%) females with a male-to-female ratio of 7.7:1. Age range of 21–30 years had the highest number of maxillofacial fracture. A total of 62 (20.3%) cases were treated by closed reduction while 235 (76.8%) cases were treated by open reduction and internal fixation using titanium miniplate (2.0 mm) and screws. Combination of treatment modalities was utilized in only 9 (2.9%) cases. Complications observed during the review period were palpable plate and screws in 26 (8.4%) patients. These palpable plates and screws, however, did not necessitate plate and screw removal from any of these patients. Conclusion: Most of the ZMCF were treated by open reduction and rigid internal fixation. Advances in imaging, surgical technique, and materials for fixation have allowed for improved functional and esthetic outcomes.

Patterns of Zygomatic Complex Bone Fracture in Saudi Arabia.

Introduction:Zygomatic bone (ZB), also known as the cheekbone, articulates with the maxilla, temporal sphenoid, and the frontal bones. It forms the prominence of the cheek and part of the orbit, and because of its prominence, it is susceptible to trauma. The aim of this study was to present the pattern of ZB fracture in a country in the Middle East.Patients and Methods:The medical records of all trauma cases admitted to the Department of Oral and Maxillofacial Surgery Ward, Riyadh Dental Centre, King Saud Medical City, Riyadh, Saudi Arabia, were reviewed and all cases with ZB fractures were included in this study from December 2002 to December 2012. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, IL, USA). The results were presented as simple frequencies and percentages.Results:A total of 1487 patients had maxillofacial trauma and 306 cases were diagnosed with ZB fractures during the study. There were 271 (88.6%) males and 35 (11.4%) females with male: female ratio of 7.7:1. Age group of 21–30 years has the highest number of fracture cases (133 [43.5%]). Road traffic accident (RTA) remained the leading etiology of zygomatic complex fracture (ZMCF; 221 [72.2%]). August has been observed to be associated with the highest cases of ZMCF (40 [13.1%]). The years 2005 and 2006 recorded the highest frequency of ZMCF cases (46 [15.0%] and 44 [14.4%], respectively).Conclusion:The results of this study showed that RTA is the leading cause of ZB fractures followed by assaults. The most commonly fractured site was the zygomaticomaxillary. Proper road traffic regulation is paramount to help reduce maxillofacial trauma.

Analysis of Facial Symmetry After Zygomatic Bone Fracture Management

The location of the zygomatic bone plays an important role in facial symmetry and esthetics. The aim of this study was to determine and compare the frequency of facial asymmetry in a sample of patients who had undergone treatment of unilateral zygomaticomaxillary complex (ZMC) fractures (study group) and a sample of patients without ZMC fracture (control group). This was a retrospective controlled cross-sectional study. The primary predictor variable was the type of ZMC fracture (linear or comminuted). The primary outcome variable was facial asymmetry characterized by the bilateral difference in the position of the malar eminence (ME) in 3 dimensions based on computed tomographic images. The other variables for this study were classified as demographic (age and gender) and anatomic (side of ZMC fracture). Descriptive and bivariate statistics were computed. Statistical significance was set at a P value less than .05 with 95% reliability. The entire sample consisted of 134 patients (n=67 per group). The mean bilateral difference of the ME position in the study group was markedly greater than in the control group. More than half the study patients had facial symmetry and almost 10% of them had marked asymmetry, whereas none of the control patients had marked asymmetry. All patients with marked asymmetry and approximately 70% of them with greater than maximum normal asymmetry had a comminuted fracture. The results of this study show that although the frequency of facial asymmetry in patients with ZMC fracture was higher than in the control patients, it was found in all patients to a certain extent. Patients' awareness of this fact can decrease their dissatisfaction.

Management of Zygomatico-Maxillary Complex Fracture in Military Dental Centre, Dhaka: A Study of 40 Cases

Introduction: Zygomatic bone is closely associated with the maxilla, frontal, temporal bones which are usually involved when a zygomatic bone fracture occurs. The most common causes of these fractures are from the assaults, road traffic accidents and falls. Aesthetic beauties and functions are greatly hampered with the displacement of the fractured fragments.
 Objective: To analyze the aetiology, clinical presentations, surgical intervention and complications associated with zygomatic complex (ZC) fractures in a tertiary level healthcare facility.
 Materials and Methods: This descriptive observational study was carried out in the Oral and Maxillofacial Department, Military Dental Centre, Dhaka during the period of January 2016 to December 2016. Data were obtained from clinical notes and surgical records of the patients using standardized data collection form specifically designed to examine the variables and features of zygomatic complex fractures.
 Results: Road traffic accidents were the leading cause (75%) of zygomatic fractures. The mean operation time was found 99.5±31.2 minutes with a range from 60 to 125 minutes. Open reduction and two-point internal fixation were employed in more than two-third (67.5%) of the cases. Four (10.0%) patients developed postoperative complications; among them 2(5.0%) cases suffered paresis of temporal branch of facial nerve and trismus. Other complications included paraesthesia, ectropion, scar and palpability of plate. Twenty-five (62.5%) patients were found having limited mouth opening preoperatively and postoperative improvement occurred in 21(52.5%). Thirty three (82.5%) patients had facial asymmetry preoperatively and postoperative improvement occurred in 29(72.5%).
 Conclusion: More than two-third of the patients received two point fixations. Only four patients out of forty in this study were found having post operative complications. The functional and Aesthetic outcome was found to be fair in terms of improvement in limitation of mouth opening and correction of facial asymmetry.
 Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 71-74

Keen's Approach: A Dynamic Approach for Zygomatic Arch Fracture Management

AbstractMaxillofacial fractures are often associated with blunt head injuries of which the outward projection of the Zygomatic Arch exposes it to frequent injury. Isolated Zygomatic arch fractures account for 10% of all Zygomatic bone fractures. Depressed Zygomatic arch fractures causes restricted mouth opening due to the partial or total obstruction of the movement of mandibular coronoid and condylar processes. Numerous techniques have been used to approach the site and reduce the fractured fragments, such as the Gillie's temporal approach, Keen's intraoral approach, anterior cheek skin incision and direct open approach.Below is a case report of an isolated Zygomatic arch fracture following a road accident in a middle aged woman that was surgically treated by open reduction through the Keen's intraoral approach. Successful reduction of the fractured segments and restoration of function was achieved with no scarring, minimal post-operative pain and satisfactory aesthetics.

Closed reduction of zygomatic tripod fractures using a towel clip

Background: The zygomatic bone constitutes the prominence of the cheek. Fractures of the zygomatic bone are the second most treatment of zygomatic bone fractures and can be examined under two headings, open and closed reductions. This paper describes a new technique in the closed reduction of tripod fractures using a towel clip.Methods: Seventeen consecutive patients (three females, 14 males) with a mean age of 35.5 years (range = 18–66 years) with zygomatic tripod fracture were treated using the towel clip technique between December 2011 and February 2014.Results: Patients were assessed in the first and 6 months postoperatively, by physical examination and computed tomography. Preoperatively, nine patients had paresthesia in the infraorbital nerve region. Three of these cases regressed postoperatively. Persistent collapse of the zygomatic projection was present in one patient.Conclusion: Non-comminuted zygomatic tripod fractures can be easily treated percutaneously with the towel clip method in the absence of preoperative ocular problems such as diplopia, enophthalmos, or restricted eye movements. The technique is economical, fast, and safe. The possibility of persistent zygoma collapse after reduction should be kept in mind, and preoperatively the team should be warned of the possibility of progression to open reduction during surgery.

Can Submandibular Tracheal Intubation Be an Alternative to Tracheotomy During Surgery for Major Maxillofacial Fractures?

During surgery for major maxillofacial fractures, orotracheal intubation can interfere with some surgical procedures and nasal intubation can be contraindicated or impossible. That is why tracheotomy is presented as a solution, although it carries a relatively high incidence of complications. In this study, the use of submandibular tracheal intubation is basically evaluated as an alternative to tracheotomy in such circumstances. This prospective study was performed in patients undergoing surgery formajor maxillofacial fractures in which oral intubation and/or nasal intubation have been unsuitable, impossible, or contraindicated. The technique of submandibular intubation was assessed intraoperatively and in the postoperative period. The outcomes and complications are presented. The study included 26 patients aged between 14 and 57years. All patients had mandibular fractures, with 19 midface fractures (73.1%), 11 nasal bone fractures (42.3%), 10 zygomatic bone fractures (38.5%), 9 naso-orbito-ethmoidal fractures (34.6%), and 9 frontobasilar fractures (34.6%). The procedure time ranged from 5 to 12minutes (mean, 7minutes 4.6seconds). Delayed extubation was performed in 15cases (57.7%) in which the tube was left in place for a period ranging from 8 to 50hours (mean, 30hours 24minutes). The technique has proved to be straightforward and satisfactory. A postoperative superficial infection occurred in 2 patients, whereas hypertrophic scars occurred in another 2 patients. Submandibular endotracheal intubation is straightforward, safe, and quick to carry out. It can be an alternative to tracheotomy as it allows operative techniques and postoperative airway protection without the risks and side effects of tracheotomy.

Defining current facial fracture patterns in a quaternary institution following high-velocity blunt trauma

Background: In the early 20th century, René Le Fort studied facial fractures resulting from blunt trauma and devised a classification system still in common use today. This classification, however, was based on low-velocity trauma. In modern practice, in a quaternary-level referral hospital, patients are often admitted following high-velocity injuries that mostly result from motor vehicle collisions.Objectives: A retrospective study to define facial bone fractures occurring subsequent to highvelocity trauma.Method: A retrospective study comprising the review of CT scans of 52 patients with highvelocity facial fractures was performed between April 2007 and March 2013. Injuries were classified using the Le Fort classification system. Deviations from the true Le Fort types, which are often depicted in the literature as occurring bilaterally and symmetrically, were documented; these included unilaterality, occurrence of several Le Fort fractures on one side of the face, occurrence of several Le Fort fractures on different levels and on different sides of the face, and occurrence of other fractures in addition to Le Fort fractures.Results: Of the 52 cases, 12 (23%) had Le Fort injuries, with true Le Fort fractures occurring in only 1, and 11 deviating from the classic description. Nine patients had Le Fort fractures and additional fractures. Mandibular and zygomatic bone fractures were found to be common associations with Le Fort injuries, occurring in 58% and 33% of the cases respectively.Conclusion: Fractures occurring in modern practice often deviate from the traditional Le Fort classification. Precise recognition of these deviations and recognition of additional associated fractures is pivotal in their management, assisting the surgeon in determining the treatment plan, such as the surgical approach and the order in which to fix the various fractured components.

A prospective analysis of physical examination findings in the diagnosis of facial fractures: Determining predictive value

Background There are >150,000 patient visits per year to emergency rooms for facial trauma. The reliability of a computed tomography (CT) scan has made it the primary modality for diagnosing facial skeletal injury, with the physical examination playing more a cursory role. Knowing the predictive value of physical findings in facial skeletal injuries may enable more appropriate use of imaging and health care resources. Objective A blinded prospective study was undertaken to assess the predictive value of physical examination findings in detecting maxillofacial fracture in trauma patients, and in determining whether a patient will require surgical intervention. Methods Over a four-month period, the authors' team examined patients admitted with facial trauma to the emergency department of their hospital. The evaluating physician completed a standardized physical examination evaluation form indicating the physical findings. Corresponding CT scans and surgical records were then reviewed, and the results recorded by a plastic surgeon who was blinded to the results of the physical examination. Results A total of 57 patients met the inclusion criteria; there were 44 male and 13 female patients. The sensitivity, specificity, positive predictive value and negative predictive value of grouped physical examination findings were determined in major areas. In further analysis, specific examination findings with n≥9 (15%) were also reported. Conclusions The data demonstrated a high negative predictive value of at least 90% for orbital floor, zygomatic, mandibular and nasal bone fractures compared with CT scan. Furthermore, none of the patients who did not have a physical examination finding for a particular facial fracture required surgery for that fracture. Thus, the instrument performed well at ruling out fractures in these areas when there were none. Ultimately, these results may help reduce unnecessary radiation and costly imaging in patients with facial trauma without facial fractures.

Life-threatening hemorrhage after zygomatic bone surgery. About 2 posttraumatic cases

Management of zygomatic bone fractures is still debated. Method and delay for intervention has to be chosen considering respective issues of operative or conservative treatments, especially hemorrhagic complications. The maxillofacial surgeon must be able to determine life-threatening situations and to react appropriately. We report 2cases of external carotid branches pseudoaneurysm leading to massive hemorrhage after early or delayed zygomatic fracture surgery. The first patient underwent open reduction of fracture by intraoral approach. An active bleeding occurred in the immediate postoperative time. In the second case, a zygomatic osteotomy was performed 1year after fracture. Bleeding occurred 2weeks after surgery. In both cases, angiography demonstrated a pseudoaneurysm developed from the external carotid branches. Embolisation led to rapid bleeding control. Severe hemorrhage resulting from maxillofacial trauma may be life-threatening. Once the "damage control" principles applied, selective embolisation of external carotid branches is an efficient alternative to surgery for the control of bleeding resulting from ruptured pseudoaneurysm.

ISOLATED ZYGOMATIC BONE FRACTURE

Introduction: Facial bones injuries results in functional disturbances. Patientsmay presents with flattening of normal malar prominence, lid drop, eye movement limited orwith double vision, numbness of cheek area and unilateral epitasis. Emphasizing upon incisiontype, fixation method and occasionally reconstruction, surgeons suggest different methods forrepairing complex fractures of Zygoma. Study Design: Descriptive study. Setting: Departmentof Oral & Maxillofacial Surgery, Liaquat University of Medical & Health Sciences, Jamshoro.Period: Mar 2013 to Feb 2014. Materials and methods: Total 20 patients were included.Patients with fracture more than 28 days old were excluded. Zygomatic bone can be approachedby lateral brow or subcilicary incisions and by subgingival buccal sulcus approach. When 3fracture sites were reduced and aligned satisfactorily, application of miniplates was performedat 3 points frontozygomatic suture, Zygomatico maxillary buttress and infraorbital rim, woundwere closed in 2 layers. At 2nd week follow-up patients were assessed for outcome. Results:There were 14 male and 6 female patients. Most were of age <25 years. 45% fractures weredue to RTA. Duration of fracture of 2 patients was 2 days, 7 days of 11 patients, 4 patients had14 days and 3 patients had 28 days. 5 fractures were reduced using Gilies temporal approach,6 with Keen approach, 4 with Hook approach and 5 with Dingman approach. Preoperatively,17 patients had facial asymmetry, 19 had limited mouth opening and postoperatively this wasreduced to 6 cases each for facial asymmetry and limited mouth opening. Conclusion: Itis concluded from this study that three point fixation is most effective and safe method forreduction of fracture of Zygomatic bone.

English

Introduction: Facial bones injuries results in functional disturbances. Patientsmay presents with flattening of normal malar prominence, lid drop, eye movement limited orwith double vision, numbness of cheek area and unilateral epitasis. Emphasizing upon incisiontype, fixation method and occasionally reconstruction, surgeons suggest different methods forrepairing complex fractures of Zygoma. Study Design: Descriptive study. Setting: Departmentof Oral & Maxillofacial Surgery, Liaquat University of Medical & Health Sciences, Jamshoro.Period: Mar 2013 to Feb 2014. Materials and methods: Total 20 patients were included.Patients with fracture more than 28 days old were excluded. Zygomatic bone can be approachedby lateral brow or subcilicary incisions and by subgingival buccal sulcus approach. When 3fracture sites were reduced and aligned satisfactorily, application of miniplates was performedat 3 points frontozygomatic suture, Zygomatico maxillary buttress and infraorbital rim, woundwere closed in 2 layers. At 2nd week follow-up patients were assessed for outcome. Results:There were 14 male and 6 female patients. Most were of age <25 years. 45% fractures weredue to RTA. Duration of fracture of 2 patients was 2 days, 7 days of 11 patients, 4 patients had14 days and 3 patients had 28 days. 5 fractures were reduced using Gilies temporal approach,6 with Keen approach, 4 with Hook approach and 5 with Dingman approach. Preoperatively,17 patients had facial asymmetry, 19 had limited mouth opening and postoperatively this wasreduced to 6 cases each for facial asymmetry and limited mouth opening. Conclusion: Itis concluded from this study that three point fixation is most effective and safe method forreduction of fracture of Zygomatic bone.