Anatomically oriented approach to osteotomy of the bones of the zygomatico-orbito-maxillary complex

Background. Post-traumatic deformities (PTD) of the zygomatico-orbito-maxillary complex (ZOMC) constitute a substantial proportion of midfacial skeletal injuries and often lead to persistent aesthetic and functional impairments. The primary surgical treatment method for this pathology is osteotomy of the ZOMC bones followed by reposition and fixation in an anatomically correct position. Conventional reconstruction approaches are insufficient in long-standing PTD due to bone remodeling and the loss of clear anatomical landmarks. Objective. This study aimed to establish reproducible anatomical landmarks and to evaluate the technical aspects of ZOMC osteotomy in patients with midfacial PTD. Material and methods. A laboratory anatomical-methodological study was performed on 15 fresh-frozen cadaveric heads (30 sides, paired observations before and after intervention). Stepwise dissection was followed by ZOMC osteotomy along natural sutures, fragment fixation, and analysis of morphometric parameters before and after surgery. Statistical analysis included methods recommended for small samples: Shapiro—Wilk test for normality, paired t-test or Wilcoxon signed-rank test with calculation of exact p-values, confidence intervals, and standardized effect sizes. Data processing was carried out in StatTech v.4.0.5 (StatTech LLC, Russia). Results. Statistically significant changes in key anthropometric parameters (p<0.05) confirmed the accuracy of reposition using the anatomically oriented approach. Restoration of the spatial architecture of the ZOMC, orbital, and maxillary sinus parameters was noted. A unified surgical protocol was proposed, including methods of soft tissue fixation with mini-screws and retaining sutures, as well as strategies for preventing secondary soft tissue deformities. Detailed morphometric results are presented in the main text. Conclusion. The findings substantiate an anatomically oriented approach to ZOMC reconstruction. For the first time, reproducible quantitative landmarks for osteotomy of the ZOMC are proposed. These results may serve to standardize osteotomy techniques and support the development of clinical algorithms for reconstructive surgery of midfacial PTD.