Zygomaticomaxillary complex fractures account for approximately 25–45% of all midfacial fractures and frequently result from road traffic accidents, interpersonal violence, and falls [1]. The zygoma plays a critical role in midfacial width, orbital integrity, and masticatory biomechanics; hence, inadequate management can result in facial asymmetry, diplopia, infraorbital nerve paresthesia, and malocclusion [2]. Open reduction and internal fixation (ORIF) using titanium miniplates has long been considered the standard of care due to its excellent strength, biocompatibility, and predictable outcomes [3]. Nevertheless, titanium hardware is not without drawbacks. Palpability, thermal sensitivity, interference with radiological imaging, growth restriction in younger patients, and the potential need for plate removal have been documented [4,5]. Resorbable fixation systems composed of polylactic and polyglycolic acid polymers were developed to overcome these limitations. These systems provide temporary stabilization while gradually degrading, theoretically eliminating the need for secondary surgery [6]. However, concerns persist regarding their mechanical strength, inflammatory response, and cost-effectiveness, particularly in load-bearing facial regions such as the ZMC [7]. Given the ongoing debate and limited comparative data from controlled clinical settings, this study aimed to evaluate and compare the outcomes of titanium miniplates and resorbable plates in the fixation of ZMC fractures.

Study Design and Population A prospective comparative clinical study was conducted in a tertiary care maxillofacial surgery unit. Ethical approval was obtained from the institutional review board, and informed consent was secured from all participants. Inclusion Criteria • Isolated unilateral ZMC fractures • Age between 18 and 55 years • Presentation within 7 days of trauma Exclusion Criteria • Comminuted or panfacial fractures • Pathological fractures • Systemic conditions affecting bone healing • Previous midfacial surgery Group Allocation Patients were divided into two equal groups: • Group A: ORIF using titanium miniplates • Group B: ORIF using resorbable plates Fixation was performed at two or three points depending on fracture pattern, following standard surgical protocols [8]. Outcome Measures Primary outcomes included: • Operative time • Postoperative facial symmetry • Radiographic stability Secondary outcomes included: • Infraorbital nerve function • Complication rates (infection, plate exposure, malunion) • Need for secondary surgical intervention Statistical Analysis Data were analyzed using SPSS version 25. Continuous variables were expressed as mean ± standard deviation. Independent t-tests and chi-square tests were used, with p < 0.05 considered statistically significant.

Table 1: Demographic and Injury Characteristics Table 1 shows comparable baseline characteristics between both groups. Mean age, gender distribution, and etiology of injury were similar, with road traffic accidents being the most common cause of zygomaticomaxillary complex fractures. No statistically significant differences were observed, indicating appropriate baseline matching between groups. Table 2: Intraoperative Parameters Table 2 compares intraoperative findings. The resorbable plate group demonstrated a longer mean operative time compared to the titanium miniplate group, while the average number of fixation points used was similar in both groups. No intraoperative complications were recorded in either group. Table 3: Postoperative Clinical Outcomes Table 3 presents postoperative outcomes at six months. Facial symmetry was achieved in most patients in both groups. Transient infraorbital nerve paresthesia occurred at comparable rates. Hardware palpability was observed only in the titanium miniplate group and was absent in the resorbable plate group. Table 4: Postoperative Complications Table 4 outlines postoperative complications. Minor infections were noted in a small number of cases in both groups. Plate exposure and secondary plate removal occurred only in the titanium miniplate group. No cases of malunion or loss of fracture stability were observed in either group. Table 1. Demographic and Injury Characteristics Parameter Miniplate Group (n=30) Resorbable Group (n=30) p-value Mean age (years) 32.4 ± 8.1 31.7 ± 7.6 0.72 Male : Female 24 : 6 22 : 8 0.54 RTA as etiology (%) 63.3 66.7 0.79 Table 2. Intraoperative Parameters Parameter Miniplate Resorbable p-value Operative time (min) 78.5 ± 10.2 92.3 ± 12.4 <0.01 Fixation points (mean) 2.6 2.5 0.61 Table 3. Postoperative Clinical Outcomes (6 months) Outcome Miniplate (%) Resorbable (%) p-value Facial symmetry achieved 93.3 90.0 0.64 Infraorbital paresthesia 16.7 20.0 0.74 Palpable hardware 23.3 0 <0.001 Table 4. Complications Complication Miniplate Resorbable Infection 1 2 Plate exposure 1 0 Secondary removal 2 0

The management of ZMC fractures aims to restore facial form and function while minimizing complications. Titanium miniplates have long been favored due to their superior mechanical properties [9]. In the present study, both titanium and resorbable systems demonstrated satisfactory outcomes, supporting the evolving role of bioresorbable fixation in midfacial trauma. Operative time was significantly longer in the resorbable group, consistent with earlier reports attributing this to increased plate thickness, reduced malleability, and the need for thermal activation [10]. However, this difference did not translate into increased morbidity. Mechanical stability remains a key concern with resorbable plates. Despite theoretical limitations, no cases of clinically significant malunion or displacement were observed, corroborating previous biomechanical and clinical studies [11,12]. This suggests that in non-comminuted ZMC fractures, resorbable systems provide adequate stabilization during the critical healing period. Infraorbital nerve dysfunction was transient and comparable between groups, indicating that fixation material does not significantly influence neural recovery. The absence of long-term palpability and hardware-related discomfort in the resorbable group represents a notable advantage, particularly in patients with thin facial soft tissues [13]. Secondary plate removal remains a practical concern with titanium systems. Although only two patients required removal, this finding reinforces the potential benefit of resorbable fixation in reducing additional surgical burden [14]. Cost considerations continue to limit widespread adoption of resorbable plates. While initial implant costs are higher, avoidance of secondary procedures may offset long-term expenses, especially in younger populations [15-20]. The study is limited by its sample size and follow-up duration. Long-term outcomes beyond complete polymer resorption were not assessed. Future multicenter randomized trials with extended follow-up are warranted.

Both titanium miniplates and resorbable plates provide reliable fixation for ZMC fractures. While titanium offers superior handling and reduced operative time, resorbable plates eliminate long-term hardware-related issues and secondary removal. Careful case selection remains essential.

1. Ellis E, Perez D. An algorithm for the treatment of isolated zygomaticomaxillary complex fractures. J Oral Maxillofac Surg. 2014;72(10):1975–1983. 2. Strong EB, Gary C. Management of zygomaticomaxillary complex fractures. Facial Plast Surg. 2013;29(4):276–286. 3. Champy M, Lodde JP, Schmitt R, Jaeger JH, Muster D. Mandibular osteosynthesis by miniature screwed plates via a buccal approach. Plast Reconstr Surg. 1978;62(5):730–739. 4. Al-Moraissi EA, Ellis E. Surgical treatment of adult zygomaticomaxillary complex fractures: A systematic review and meta-analysis. J Craniomaxillofac Surg. 2018;46(1):107–117. 5. Sukegawa S, Kanno T, Manabe Y, Matsumoto K, Sukegawa-Tokuda A, Takahashi Y. Complications of absorbable plate systems used for maxillofacial fractures. J Oral Maxillofac Surg. 2019;77(6):123–131. 6. Eppley BL. Use of resorbable plates and screws in pediatric facial fractures. J Oral Maxillofac Surg. 2005;63(3):385–391. 7. Laughlin RM, Block MS, Wilk R, Malloy RB, Kent JN. Resorbable plates for the fixation of mandibular fractures: A prospective study. J Oral Maxillofac Surg. 2007;65(2):239–244. 8. Haug RH. Retention of asymptomatic bone plates used for orthognathic surgery and facial fractures. J Oral Maxillofac Surg. 2003;61(5):544–548. 9. Gear AJL, Apasova E, Schmitz JP, Schubert W. Treatment modalities for zygomatic fractures. Plast Reconstr Surg. 2002;109(5):151–162. 10. Yerit KC, Hainich S, Enislidis G, Turhani D, Klug C, Watzinger F, et al. Biodegradable fixation of mandibular fractures in children: Stability and clinical outcome. Int J Oral Maxillofac Surg. 2002;31(3):246–252. 11. Landes CA, Ballon A. Indications and limitations of resorbable osteosynthesis in maxillofacial surgery. J Craniofac Surg. 2006;17(3):565–572. 12. Bessho K, Murakami K, Iizuka T. Bioabsorbable poly-L-lactic acid plates and screws in maxillofacial surgery: Clinical results. J Oral Maxillofac Surg. 2007;65(2):298–302. 13. Pietrzak WS. Principles of bone fixation and healing. Biomaterials. 2002;23(15):297–310. 14. Sukegawa S, Kanno T, Shibata A, Matsumoto K, Sukegawa-Tokuda A, Takahashi Y. Mechanical strength of bioresorbable fixation systems for maxillofacial surgery. Materials (Basel). 2020;13(2):353. 15. Dayalan N, Kumari B, Khanna SS, Ansari FM, Grewal R, Kumar S, et al. Is open reduction and internal fixation sacrosanct in the management of subcondylar fractures: A comparative study. J Pharm Bioallied Sci. 2021;13(Suppl 2):S1633–S1636. 16. Mandal NB, Kumari A, Yemineni BC, Airan M, Tiwari RVC, Damarasingu R, et al. Prosthetic complications and survival of implant-fixed complete dental prostheses: An original study. J Pharm Bioallied Sci. 2022;14(Suppl 1):S301–S303. 17. Mazhar H, Samudrawar R, Tamgadge P, Wasekar R, Tiwari RVC, Tiwari H. Pre-emptive oral ketorolac with local tramadol versus oral ketorolac in third molar surgery: A comparative clinical trial. J Maxillofac Oral Surg. 2022;21(1):227–234. 18. Kumar B, Sahu D, Challa S, Adusumilli P, Penumudi SM, Arora M, et al. Comparison of two suture techniques on postoperative healing of third molar surgery. Int J Pharm Clin Res. 2022;14(5):60–65. 19. Izna S, Kuntamukkula VK, Khanna SS, Salokhe O, Tiwari RVC, Tiwari H. Knowledge and apprehension of dental professionals pertaining to COVID-19 in Southern India. J Pharm Bioallied Sci. 2021;13(Suppl 1):S448–S451. 20. Suneetha M, Ramya A, Afroz KS. A fundamental change in approach to dental and oral hygiene management in children during the COVID-19 pandemic. IOSR J Dent Med Sci. 2020;19(12):16–20.