Introduction
zygomaticomaxillary fractures, fracture, fractures, ZMC
SCAR, COMPLICATION, COMPLICATIONS
The zygomaticomaxillary complex (ZMC) is a tetrapod structure that involves articulation with the maxilla, frontal, temporal, and sphenoid bones [Being a major buttress of the face, the ZMC integrity is crucial to function and aesthetics of the facial skeleton. To restore the fractured ZMC to the proper anatomical position, adequate exposure of the fracture site is of high importance [More than 70% of ZMC fractures are managed surgically using open reduction and internal fixation, where access to the inferior orbital rim is obtained through either transcutaneous or transconjunctival approach. Transcutaneous approaches include the infraorbital, subtarsal and subciliary incisions which provide good accessibility to the fracture site but on the expense of the associated scar formation [The transconjunctival approach has been advocated for avoidance of the undesirable scar in an exposed region of the face. Another important advantage of the transconjunctival approach is that it provides visualization of the orbital floor and inferior orbital rim without interference of the lacrimal drainage system [However, some limitations were reported in terms of accessibility to reduce the fracture and apply plates for fixation. In addition, technical skills, proper eye protection and gentle retraction of tissues are required to prevent complications [Several modifications for the original transconjunctival approach have been suggested to overcome the limitations, provide wider access, and still benefit from the hidden incision advantage. One of the modifications was the Y-modification of the cutaneous portion of the transconjunctival approach with lateral canthotomy proposed by Martinez and Bradrick [Over the previous decades, several approaches were used for management of the orbital region of zygomaticomaxillary fractures. However, no single approach has yet been proved to be the best option concerning maximum accessibility and least complication rate.The present study was performed to compare three surgical approaches to ZMC fractures: the subtarsal approach, the conventional transconjunctival approach (with or without lateral canthotomy) and the transconjunctival approach with Y- modification.