Efficacy of a Y-modified Transconjunctival Approach for Open Reduction and Internal Fixation of Zygomaticomaxillary Complex Fractures: Functional Recovery and Cosmetic Outcomes

Abstract

INTRODUCTION: Fractures of the zygomaticomaxillary complex (ZMC), a crucial component of the midface, frequently lead to functional impairments, such as diplopia, enophthalmos, and restricted ocular motility. Although surgical intervention is often required, conventional techniques can be limited by suboptimal access and potential aesthetic drawbacks. This study prospectively assessed the efficacy, functional recovery, and cosmetic results of the Y-modified transconjunctival technique for managing ZMC fractures with concomitant orbital floor injury. MATERIALS AND METHODS: A prospective cohort study was conducted at a single oral and maxillofacial surgery department. Fifteen eligible patients (aged 18-65 years) presenting with displaced ZMC fractures and orbital floor defects were treated with open reduction and internal fixation using the Y-modified transconjunctival approach. Outcome measures included pain (Visual Analog Scale (VAS) score), enophthalmos (Hertel exophthalmometer), scar quality (Patient and Observer Scar Assessment Scale (POSAS) 3.0), and paresthesia. Fracture reduction and implant position were verified using high-resolution computed tomography. Patients were systematically evaluated postoperatively on days 1, 10, 28, and 42, and the data were subjected to statistical analysis. RESULTS: The results demonstrated a statistically significant reduction in pain levels over time, with mean VAS scores declining from 5.82 on postoperative day 1 to 1.00 by day 42 (p < 0.01). Residual enophthalmos was observed in a single case (6.67%). Objective scar evaluation using POSAS 3.0 indicated marked improvements in vascularity, pigmentation, and pliability between the 10- and 28-day assessments (p < 0.01). Furthermore, patient-reported feedback corroborated these findings, indicating a diminished perception of discomfort and a positive view of scar healing. CONCLUSIONS: The Y-modified transconjunctival approach proved to be an effective strategy for ZMC fractures with orbital floor involvement, providing ample surgical exposure for stable fixation while yielding excellent functional and aesthetic outcomes. However, the promising results should be interpreted in the context of the study's limitations, including a modest sample size and single-institution design. Future research involving larger multicenter cohorts with long-term follow-up is necessary to confirm these preliminary findings and establish broader clinical applicability.