Rotational Mapping-Designed Approach for Minimally Invasive Fixation of Zygomaticomaxillary Fractures: A Retrospective Study

OBJECTIVE: This study aimed to evaluate the early clinical efficacy of a standardized incision approach based on the rotational mapping method. The approach was applied in significantly displaced Zingg Type B and mildly comminuted Zingg Type C zygomaticomaxillary complex (ZMC) fractures requiring direct exposure of the zygomatic arch. METHODS: A total of 43 patients with selected Zingg Type B/C ZMC fractures requiring open reduction of the zygomatic arch were retrospectively assessed. The "rotational mapping method" was used intraoperatively to plan a preauricular incision for direct zygomatic arch exposure and fixation, combined with other standard incisions for ZMC reduction. Surgical parameters, postoperative complications, and facial symmetry restoration were evaluated using three-dimensional digital analysis of the mean absolute differences (MAD). RESULTS: At 3 months postoperatively, maximum interincisal opening improved to 3.51±0.44 cm. Only 1 patient (2.3%) developed transient postoperative facial nerve dysfunction, which resolved completely within 3 months. The MAD between the bilateral zygomaticomaxillary complexes decreased from 1.18±0.11 mm preoperatively to 0.59±0.47 mm postoperatively. The mean incision length was 2.12±0.42 cm, and Vancouver Scar Scale scores improved during follow-up. CONCLUSION: The "rotational mapping method" provides a structured quantitative framework for designing preauricular incisions. The Rotational Mapping-Designed (RMD) approach serves as an effective adjunctive option for selected Zingg Type B/C ZMC fractures requiring direct visualization of the zygomatic arch, with favorable early safety and clinical outcomes.