Abstract：
OBJECTIVE: Paediatric maxillozygomatic complex (MZC) fractures are uncommon, and there is a scarcity of data regarding their surgical treatment. The aim of this study was to analyse choices and outcomes of open reduction and internal fixation (ORIF) for MZC fractures among 14 maxillofacial centers around the world.
METHODS: This multicentric retrospective observational study included patients ≤16 years of age with quadripod MZC fractures treated with ORIF from January 2011 and December 2022. The following data were collected: age, gender, dentition stage (deciduous, mixed, and permanent), cause of injury, type of fracture, surgical approach, site of osteosynthesis (infraorbital rim, zygomaticomaxillary buttress, frontozygomatic, and zygomaticotemporal sutures), material (titanium or resorbable) and number of plates used, and outcome. The minimum follow-up was 6 months. Statistical analyses were performed with Fisher\'s exact test or chi-squared test, as appropriate.
RESULTS: Sixty-four patients (mean age, 12.3 years) with quadripod MZC fractures were included. Seventy-two percent of patients received a single-point fixation. The zygomaticomaxillary buttress was the most common site for fixation, both in single-point and two-point fixation schemes, especially in combination with the frontozygomatic suture. Increasing age was associated with a higher rate of plate removal (p < .001). Postoperative complications included 5 (7.8%) cases of wound infections, 2 (3.1%) infraorbital paraesthesia, 1 (1.6%) ectropion. Residual facial asymmetry was found in 5 (7.8%) patients and was not associated with the type of fixation (p > .05).
CONCLUSIONS: This study highlights the possibility of using ORIF, even with a single point of fixation, for the treatment of displaced quadripod MZC fractures in the paediatric population. The zygomaticomaxillary buttress was the preferred site of fixation and allowed for adequate stabilization with no external scars and a low risk of tooth damage. Future prospective studies with long-term follow-up are needed to establish definitive surgical protocols and clarify the surgical decision-making.
METHODS: This multicentric retrospective observational study included patients ≤16 years of age with quadripod MZC fractures treated with ORIF from January 2011 and December 2022. The following data were collected: age, gender, dentition stage (deciduous, mixed, and permanent), cause of injury, type of fracture, surgical approach, site of osteosynthesis (infraorbital rim, zygomaticomaxillary buttress, frontozygomatic, and zygomaticotemporal sutures), material (titanium or resorbable) and number of plates used, and outcome. The minimum follow-up was 6 months. Statistical analyses were performed with Fisher\'s exact test or chi-squared test, as appropriate.
RESULTS: Sixty-four patients (mean age, 12.3 years) with quadripod MZC fractures were included. Seventy-two percent of patients received a single-point fixation. The zygomaticomaxillary buttress was the most common site for fixation, both in single-point and two-point fixation schemes, especially in combination with the frontozygomatic suture. Increasing age was associated with a higher rate of plate removal (p < .001). Postoperative complications included 5 (7.8%) cases of wound infections, 2 (3.1%) infraorbital paraesthesia, 1 (1.6%) ectropion. Residual facial asymmetry was found in 5 (7.8%) patients and was not associated with the type of fixation (p > .05).
CONCLUSIONS: This study highlights the possibility of using ORIF, even with a single point of fixation, for the treatment of displaced quadripod MZC fractures in the paediatric population. The zygomaticomaxillary buttress was the preferred site of fixation and allowed for adequate stabilization with no external scars and a low risk of tooth damage. Future prospective studies with long-term follow-up are needed to establish definitive surgical protocols and clarify the surgical decision-making.
摘要：
目的：小儿颌骨复合体（MZC）骨折并不常见，关于他们的手术治疗的数据很少。这项研究的目的是分析世界各地14个颌面中心中MZC骨折的切开复位内固定（ORIF）的选择和结果。
方法：这项多中心回顾性观察研究包括2011年1月至2022年12月接受ORIF治疗的年龄≤16岁的四足MZC骨折患者。收集了以下数据：年龄，性别,牙列阶段(落叶，混合,和永久性的)，受伤原因,骨折类型,手术方法,骨合成部位(眶下边缘，合子腋窝支撑，额颧骨,和顺势缝合)，材料（钛或可吸收）和使用的板的数量，和结果。最短随访时间为6个月。统计分析采用Fisher精确检验或卡方检验，视情况而定。
结果：64名患者（平均年龄，12.3年），包括四足MZC骨折。72％的患者接受了单点固定。合子腋窝支撑是最常见的固定部位，在单点和两点固定方案中，尤其是与额颧骨缝合结合。年龄的增长与较高的平板去除率相关(p<.001)。术后并发症包括伤口感染5例(7.8%),2（3.1％）眶下感觉异常，1例（1.6%）外翻。在5例（7.8％）患者中发现了残余的面部不对称，并且与固定类型无关（p>.05）。
结论：这项研究强调了使用ORIF的可能性，即使是单点固定，用于治疗儿科人群中移位的四足MZC骨折。合子腋窝支撑是固定的首选部位，可以充分稳定，没有外部疤痕，牙齿损伤的风险较低。未来需要进行长期随访的前瞻性研究，以建立明确的手术方案并阐明手术决策。
方法：这项多中心回顾性观察研究包括2011年1月至2022年12月接受ORIF治疗的年龄≤16岁的四足MZC骨折患者。收集了以下数据：年龄，性别,牙列阶段(落叶，混合,和永久性的)，受伤原因,骨折类型,手术方法,骨合成部位(眶下边缘，合子腋窝支撑，额颧骨,和顺势缝合)，材料（钛或可吸收）和使用的板的数量，和结果。最短随访时间为6个月。统计分析采用Fisher精确检验或卡方检验，视情况而定。
结果：64名患者（平均年龄，12.3年），包括四足MZC骨折。72％的患者接受了单点固定。合子腋窝支撑是最常见的固定部位，在单点和两点固定方案中，尤其是与额颧骨缝合结合。年龄的增长与较高的平板去除率相关(p<.001)。术后并发症包括伤口感染5例(7.8%),2（3.1％）眶下感觉异常，1例（1.6%）外翻。在5例（7.8％）患者中发现了残余的面部不对称，并且与固定类型无关（p>.05）。
结论：这项研究强调了使用ORIF的可能性，即使是单点固定，用于治疗儿科人群中移位的四足MZC骨折。合子腋窝支撑是固定的首选部位，可以充分稳定，没有外部疤痕，牙齿损伤的风险较低。未来需要进行长期随访的前瞻性研究，以建立明确的手术方案并阐明手术决策。
