Introduction: The treatment of zygomatic fractures is challenging for maxillofacial surgeons; although there is research related to this issue still exist doubts in some elements of treatment.

Aim: To establish conditions for surgical and non-surgical treatment of zygomatic complex (ZC) fractures.

Materials and methods: In a 10-year period, 532 patients were examined for ZC fractures. The medical records of patients were analyzed to obtain information related to sociodemographic characteristics, trauma etiology, sign and symptoms of patients, and surgical or nonsurgical treatment. Statistical analysis was performed using χ ² test with statistical significance of P < 0.05.

Results: The mean age of the sample was 31 years. Surgical treatment of ZC fractures was statistically associated to the presence of other facial fractures ( P = 0.004), alteration of occlusion ( P = 0.0001; probably due to jaw fractures), presence of the comminuted fractures ( P = 0.0002), and infra orbital nerve sensory disturbances ( P = 0.003). One hundred fifty-three patients were treated with surgical techniques; in 60.1% of the patients, one surgical approach was used to treat the ZC fractures, and the zygomaticomaxillary buttress was fixed in 86.9% of the patients. There was a statistical significance between fracture displacement and surgical approach for the infraorbital rim ( P = 0.0001) and zygomaticofrontal suture ( P = 0.0001).

Conclusion: A mixture of complex variables can be associated to surgical treatment; however, variables as comminuted fracture and alteration of occlusion were associated to surgical treatment indications; In cases of displacement bigger than 5 mm, approaches to 3 of 4 points of the ZC are mandatory to reduce the fractures. The infraorbital rim and zygomaticofrontal suture approaches are indicated to treat displaced fractures.

Conflict of interest : None declared.