Study on zygomaticomaxillary orbital floor complex fracture assisted by endoscopy combined with digital real-time navigation technology

Study on zygomaticomaxillary orbital floor complex fracture assisted by endoscopy combined with digital real-time navigation technology | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Study on zygomaticomaxillary orbital floor complex fracture assisted by endoscopy combined with digital real-time navigation technology Dong Wang, Zeyu Wang, Junhui Sun, Liang Liu, Kai Zhang, Tingyi Gao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5078036/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 Dec, 2025 Read the published version in BMC Oral Health → Version 1 posted 10 You are reading this latest preprint version Abstract Objective : To explore the effectiveness of endoscopy combined with digital navigation technology in the treatment of zygomaticomaxillary complex fractures. Methods : A retrospective controlled study was conducted. The endoscopy combined with digital navigation technology group was defined as the new technology group, and the conventional treatment group was defined as the conventional group. Eight patients were selected from each group. The chi-square test or t test was used to compare the basic conditions, postoperative recovery, and orbital volume between the two groups. Results : There were no significant differences in sex, age, injury mechanism, BMI, etc., between the new technology group and the conventional group. The fracture reduction fit of the new technology group was better than that of the control group, the postoperative orbital volume was closer to the preoperative orbital volume, and the difference was statistically significant. Conclusion : Based on the findings of this study, we believe that endoscopy combined with digital real-time navigation technology can improve the efficacy of surgical treatment for zygomaticomaxillary orbital floor complex fractures, thereby achieving better functional recovery. orbital zygomaticomaxillary complex fracture digital navigation endoscopy Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Facial injuries are common for various reasons, such as car accidents. Zygomaticomaxillary orbital floor compound fractures are the most common and serious type and directly affect facial appearance and functions such as eating and speech [ 1 ] . Zygomaticomaxillary orbital floor compound fractures are also very complex. In clinical practice, this type of fracture involves multiple anatomical parts of the orbital floor, maxilla, and zygomatic bone, with many cavities and small spaces, making anatomical reduction of the fracture difficult and risky [ 2 ] . Restoration of the orbital floor is the most difficult part of complex zygomaticomaxillary orbital floor fractures. Owing to the thin support structure and fracture fragments, anatomical reduction of the medial orbital floor is almost impossible [ 3 ] . However, if it is not restored, diplopia, visual impairment and enophthalmos can occur [ 4 ] . The advancement of digital technology has led to rapid progress in the field of fracture repair. Many scholars have reported that this method can effectively assist in fracture reduction [ 5 ] . However, there are still situations where the field of vision is insufficient and the operation is difficult [ 6 ] . The application of endoscopes in surgical operations is a major innovation. It can effectively reduce trauma and expand the surgical field of view, but its application in fractures is still rare. To address these difficulties, in this study, we used endoscopic technology combined with near-infrared navigation technology to assist in the reduction of orbitozygomatic–maxillary complex fractures, summarized the surgical experience, and explored the effects of surgical treatment. Materials and methods Patient selection principles Sixteen patients who were diagnosed with zygomaticomaxillary complex (ZMC) fractures and underwent oral and maxillofacial surgery at the First Affiliated Hospital of Bengbu Medical University between January 2021 and June 2024 were included in this retrospective study. The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Bengbu Medical University (Approval No. BYFYXJS2021074), and written informed consent was obtained from all participants prior to surgery. The inclusion criteria were as follows: age between 18 and 80 years, preoperative diplopia symptoms, and indications for orbital floor reconstruction. The exclusion criteria included patients whose physical condition precluded surgical intervention and those with monocular or binocular vision loss. The cohort that underwent the novel surgical technique was designated the New Technique Group (Group 1). The injury etiologies in this group included traffic accidents (7 cases) and accidental falls (1 case). For comparison, patients who underwent conventional surgery on the basis of the surgeon’s experience were classified into the Control Group (Group 2), comprising 8 patients, all of whom resulted from traffic accidents.All materials used in this study were non-absorbable pure titanium or titanium alloy internal fixation materials produced by DePuy Synthes. Preoperative plan for group 1 Before surgery, a helix scan (helix with 0.625 mm slice thickness; Bright Speed 16; GE Healthcare, Buckinghamshire, UK) was performed. The scanning range was from the top of the skull to the hyoid bone. The original data were stored in DICOM format and imported into Mimics software (Materialize, Belgium). The position of the fracture fragment was restored via mirroring and other methods, and then the images were exported as an STL file and imported into AccuNavi-A2.1 software to set the reference positioning point, which was generally set to a fixed tooth cusp. After the setting was completed, the files were converted into a UEG file for backup [ 7 ] . Surgical Procedure The operation was performed under general anesthesia with nasotracheal intubation by the same surgeon. The preoperative CT image (Fig. 1 ) revealed that the orbital floors on both sides were not at the same level. A Subciliary Approach incision was carried out to gain access to the fracture of the orbital floor (Fig. 2 ). Due to spatial constraints in the operative area, we utilized a navigation system with a reference frame fixed on the forehead to localize the fracture site(Fig. 3 ). This approach enables precise alignment with imaging data and minimizes soft tissue dissection. An additional incision through the intraoral maxillary vestibular approach is necessary to access the medial aspect of the zygomatic arch. This anatomical site is critical for mobilizing bone segments and restoring the overall facial framework. After completing the reduction of the bone fragments, the navigation probe is guided to verify whether the fracture alignment matches the preoperative planning objectives. After verifying that the fracture frame was satisfactory (Fig. 4 ), the orbital floor was bent to an appropriate curvature on the basis of the preoperative digital design and the position of the optic nerve. The orbital floor was slowly inserted with the assistance of an endoscope (video 1), the eyeball was moved, eyeball mobility was observed, and the wound was closed [ 8 ] . Conventional treatment (group 2) In Group 2, a subciliary incision combined with an intraoral vestibular incision was utilized. Reduction forceps were employed to reposition displaced bone fragments and restore the curvature of the zygomatic arch. Guided by the surgeon’s experience, the fracture ends were aligned to reconstruct the inferior orbital rim, and an orbital floor plate was placed to restore orbital volume. Postoperative treatment and follow-up Anti-inflammatory, analgesic, hemostatic and other drug treatments were given after the operation, and sodium hyaluronate eye drops were used. Three months after surgery, eye movement photos were taken for comparison with those before surgery, and thin-layer three-dimensional CT was taken. The preoperative design and postoperative data were fitted and compared (Fig. 5 ). The preoperatively designed orbital volume and the postoperative restored orbital volume were calculated and compared (Fig. 6 ). Statistical analysis SPSS software (version 20.0; IBM Corp., Armonk, NY, USA) was used for data analysis. The chi-square test was used for measurement data, and the t test was used for comparisons of means between two groups (α = 0.05). Results There was no significant difference in the basic data of the two groups of patients, such as age, sex, Time from trauma to operation, injured side, Fractures classification, or the presence of other systemic injuries. The specific data are shown in Table 1. The postoperative data of the two groups of patients are shown in Table 2 and include 3D deviation, diplopia, etc. The resetting effect of the new technology group was better than that of the conventional group, and the probability of diplopia was lower. The difference was statistically significant. There was no significant difference in the surgical operation time, average increase in mouth opening, or numbness between the two groups after statistical testing. No patients in either group experienced a sharp loss of vision. With respect to complications, one patient in Group 2 developed a postoperative wound infection, which was managed with irrigation and dressing changes without serious consequences. Neither group experienced cases of internal fixation device infection requiring immediate removal.Regarding enophthalmos, data from Tables 1 and 2 showed no significant differences in the incidence of enophthalmos between the two groups before surgery. Postoperatively, Group 1 demonstrated significantly better improvement in enophthalmos compared to Group 2, with statistically significant differences (t = 5.333, P = 0.021). Table 1 Basic conditions of the two groups of patients before surgery ZMC:zygomaticomaxillary complex OF:Orbital floor MOW:medial orbital wall Variable Group1 Group2 X 2 /t p Age(y) mean ± SD 26.00 ± 1.85 25.88 ± 1.73 0.140 0.891 Gender M F 7 1 7 1 0.000 0.767 Combined with craniocerebral injury Y N 2 6 3 5 0.291 0.590 Time from trauma to operation(h) 79.38 ± 13.22 81.38 ± 11.38 −0.324 0.750 Injured side L R 1 7 0 8 1.067 0.302 Enophthalmos Y N 7 1 6 2 0.410 0.522 Fractures classification ZMC + OF 1 2 0.410 0.522 ZMC + OF + MOW 7 6 ZMC:zygomaticomaxillary complex OF:Orbital floor MOW:medial orbital wall Table 2 Comparison of relevant indicators after surgery between the two groups Variable New Technology Group Conventional group t/X 2 P-value 3D deviation(mm) -5.433 0.00 operation time(min) 101.11 ± 9.99 107.88 -1.386 0.187 Mean Mouth opening(cm) 1.65 ± 0.80 1.80 ± 0.54 0.075 0.666 Incidence of diplopia Y 0 4 5.333 0.021 N 8 4 Incidence of Hypoesthesia Y 1 2 0.410 0.522 N 7 6 Enophthalmos Y 0 4 5.333 0.021 N 8 4 Comparison of orbital volume recovery after surgery The orbital volume of the new technology group was 26.13 ± 1.03 after surgery and 26.22 ± 1.29 after digital design reduction before surgery. There was no significant difference between the two sides ( t =-0.146, P = 0.886), and there was no significant difference between the two sides and the normal side orbital volume (26.47 ± 1.09) ( t =-0.644, P = 0.530). The orbital volume of the control group was 23.77 ± 0.83 after surgery, which was significantly different from the normal-side orbital volume (27.42 ± 0.87) ( t =-0.8.630, P = 0.000). Discussion Previous studies have revealed that zygomaticomaxillary complex (ZMC) fractures rank second only to nasal bone fractures in incidence among all facial fractures, with the prominent anatomical position of the zygomaticomaxillary buttress being the primary contributing factor to the occurrence of such fractures [ 9 ] . In this study, 90% of the injuries were caused by traffic accidents and a lack of head protection. In addition, zygomaticomaxillary complex fractures in this group of patients mainly occurred on the right side. The main reason for this finding is that the right upper limb of Chinese patients is the dominant side, which is more likely to cause injuries on this side [ 10 ] . The most complicated step in zygomaticomaxillary complex fractures is orbital floor injury, which is a common cause of orbital bone volume changes [ 11 ] . Orbital volume damage can cause facial aesthetic and functional damage, such as enophthalmos and diplopia. Preoperative CT scan assessment of orbital volume is helpful for planning orbital reconstruction [ 12 ] . At present, the mainstream surgical method involves the use of orbital floor and orbital fat filling to restore orbital volume, but there are poor recovery effects and a risk of damage to the optic nerve [ 13 – 15 ] . In this case, we used a digital design to locate the optic nerve position and orbital floor implantation position before surgery. Endoscopic assistance to expand the field of view and intraoperative navigation verification results were satisfactory, restoring the orbital volume and avoiding major complications. According to the literature, the emergence of new materials and technologies such as 3D printing and PEEK also provides a simpler and more convenient method for orbital volume restoration, but the clinical application time is still short, and the specific clinical effects need further verification and discussion [16–18] . Digital technology has been increasingly applied in medicine in recent years. It is widely used in orthopedic fields such as limb fractures and is now gradually being applied to oral and maxillofacial surgery [ 19 ] . In this case, digital technology has the following advantages: 1. Preoperative planning: Through digital technology, we can better understand the position of fracture reduction and accurately measure the three-dimensional structure of important facial organs. 2. Intraoperative assistance: Through digital technology, we can assist in the bending and shaping of fixation devices. 3. Postoperative comparison: After surgery, we used digital technology to analyze and fit the postoperative data with the preoperative data to understand the recovery effect. In summary, digital technology is widely used for the treatment of multiple maxillofacial fractures, with significant results. Notably, the use of digital technology and navigation has improved the accuracy of surgery, but the preoperative navigation design requires certain basic computer knowledge, and the installation of navigation brackets is somewhat complicated. This will extend the learning curve of this technology. Endoscopic technology was previously used in major surgeries, such as abdominal surgery, which magnifies the field of view and reduces trauma. Currently, some people are gradually using this technology to treat facial fractures and have achieved good clinical results. The concept of minimally invasive surgery originated from this approach[20]. In this study, the new technology group used endoscopy to assist in the implantation of the orbital floor. There was no significant difference in optic nerve damage or visual loss between the new technology group and the control group, but the incidence of postoperative diplopia symptoms was significantly lower. Therefore, we believe that in delicate areas such as the orbital floor, where the visual field is poor, endoscope-assisted surgery can effectively avoid damage to important structures such as the optic nerve and improve the quality of life of patients. In addition, in this study, we combined endoscopy and digital navigation technology to assist each other and better complete this type of surgery. Emerging technologies such as augmented reality are developing rapidly in the field of surgery and have many advantages over traditional surgery. We can foresee that they can be applied to areas such as zygomatico-maxillary fractures and overcome more difficulties [ 21 ] . Of course, the number of cases in this study was small. Considering the subjective requirements of the patients and ethical factors, the grouping was not randomized, which to some extent limited the conclusions. We will further optimize the process, increase the number of cases, and improve the reliability of the conclusions in the future. Conclusion This study revealed that the novel approach combining digital/navigation technology and endoscopic-assisted orbital floor implantation for zygomatico-orbital‒maxillary complex fracture reduction achieved outcomes comparable to those of conventional methods, with no increase in operative time or surgical trauma. Additionally, the new technique group exhibited fewer postoperative complications, and the fracture reduction results were closer to those of the preoperative simulations. Despite limitations in sample size, statistical comparisons highlighted the potential advantages of this novel technology. Declarations Funding This study was supported by the Anhui Province Medical Key Discipline (KJ2018A1005) and Bengbu Medical College (BYKY2019017ZD). Conflict of Interests The authors do not have any possible conflicts of interest. Ethics statement/confirmation of patient permission This study was approved by The First Affiliated Hospital of Bengbu Medical College, and all participants provided signed informed consent. Consent to publish The authors affirm that human research participants provided informed consent for the publication of the images in Figs. 1, 2, 3, 4 and 5. References Committeri U, Arena A, Carraturo E, et al. Incidence of orbital side effects in zygomaticomaxillary complex and isolated orbital walls fractures: a retrospective study in south Italy and a brief review of the literature[J]. Journal of clinical medicine, 2023, 12(3): 845. Schneider M, Besmens I S, Luo Y, et al. Surgical management of isolated orbital floor and zygomaticomaxillary complex fractures with focus on surgical approaches and complications[J]. Journal of plastic surgery and hand surgery, 2020, 54(4): 200-206. Hassan BA, Sylvester AD, Wescott DJ, Cunningham DL, Elegbede A, Manson PN, Grant MP. An Introduction to The Orbital Buttresses. Plast Reconstr Surg. 2024 Jun 28. Someda SK, Miyazaki H, Kakizaki H, Takahashi Y. Clinical Significance of the Inferomedial Orbital Strut in Orbital Blowout Fractures: Incidence of Symptomatic Diplopia in a Fractured vs. Intact Strut. J Clin Med. 2024 Jun 24;13(13):3682. Kim, JW., Kim, JC., Jeong, CG. et al. The accuracy and stability of the maxillary position after orthognathic surgery using a novel computer-aided surgical simulation system. BMC Oral Health 19, 18 (2019). McCulley TJ, Aakalu VK, Foster JA, Freitag SK, Dagi Glass LR, Grob SR, Tao JP, Vagefi MR, Yen MT, Yoon MK, Kim SJ, Wladis EJ. Intraoperative Image Guidance in Orbital and Lacrimal Surgery: A Report by the American Academy of Ophthalmology. Ophthalmology. 2024 Jun 24:S0161-6420(24)00307-5. Cai K, Yang R, Lin Q, et al. Near-Infrared Camera Calibration for Optical Surgical Navigation. J Med Syst . 2016;40(3):67. Mannapperuma N, Sayan A, Ilankovan V. Transconjunctival approach revisited and anatomical considerations. Br J Oral Maxillofac Surg . 2024;62(6):542-544. Khaqani MS, Tavosi F, Gholami M, Eftekharian HR, Khojastepour L. Analysis of Facial Symmetry After Zygomatic Bone Fracture Management. J Oral Maxillofac Surg. 2018 Mar;76(3):595-604. Gearing PF, Nathan EA, Devine M, et al. E-Scooter facial fractures: A comparative cohort study. J Craniomaxillofac Surg . Published online June 14, 2024. Parameswaran A, Panneerselvam E, Mukherjee B. Association of fracture type with enophthalmos and intraorbital volume correction in orbital fractures: A computed tomographic study. Indian J Ophthalmol . Published online July 11, 2024. Lentskevich MA, Nguyen A, Choudhary A, Obaid O, Purnell CA. What CT Findings are Predictive of Post-Traumatic Enophthalmos in Orbital Fractures?. Plast Reconstr Surg . Published online June 28, 2024. Winnand P, Ooms M, Ayoub N, et al. The impact of polydioxanone (PDS) foil thickness on reconstruction of the orbital geometry after isolated orbital floor fractures. Eur J Trauma Emerg Surg . Published online June 28, 2024. Sigron GR, Rüedi N, Chammartin F, et al. Three-Dimensional Analysis of Isolated Orbital Floor Fractures Pre- and Post-Reconstruction with Standard Titanium Meshes and "Hybrid" Patient-Specific Implants. J Clin Med . 2020;9(5):1579. Published 2020 May 22. Alharbi GM, Alotaibi KZ, Khalifa GA. Volumetric Analysis of Orbital Volume Discrepancy as a Marker of Change in Globe Position After Three-Point Fixation of Zygomatic Complex Fractures. J Oral Maxillofac Surg. 2025 Feb;83(2):188-198. Yu JH, Sang ZX, Zhang H, et al. Biomechanical analysis of an absorbable material for treating fractures of the inferior orbital wall. Int J Ophthalmol . 2024;17(7):1331-1336. Published 2024 Jul 18. Lee J, Choi YJ, Rha EY. Orbital Reconstruction Using a Polyetheretherketone Patient-Specific Implant After Removal of a Mucocele Developing After Orbital Fracture Repair. J Craniofac Surg . 2023;34(8):2321-2322. Sharma N, Welker D, Aghlmandi S, et al. A Multi-Criteria Assessment Strategy for 3D Printed Porous Polyetheretherketone (PEEK) Patient-Specific Implants for Orbital Wall Reconstruction. J Clin Med . 2021;10(16):3563. Published 2021 Aug 13. Solyom A, Moldovan F, Moldovan L, Strnad G, Fodor P. Clinical Workflow Algorithm for Preoperative Planning, Reduction and Stabilization of Complex Acetabular Fractures with the Support of Three-Dimensional Technologies. J Clin Med . 2024;13(13):3891. Published 2024 Jul 2. Zhang Q, Xu X, Ma J, Ling X, Wang Y, Zhang Y. Application of indocyanine green-labeled fluorescence technology in laparoscopic total extra-peritoneal inguinal hernia repair surgery:a preliminary study. BMC Surg . 2024;24(1):211. Published 2024 Jul 18. Liu S, Xie M, Gao F, et al. New augmented reality remote for virtual guidance and education of fracture surgery: a retrospective, non-inferiority, multicenter cohort study. Int J Surg . Published online June 4, 2024. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 15 Dec, 2025 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Revision requested 19 May, 2025 Reviews received at journal 08 May, 2025 Reviewers agreed at journal 29 Apr, 2025 Reviewers agreed at journal 28 Apr, 2025 Reviews received at journal 28 Apr, 2025 Reviewers agreed at journal 28 Apr, 2025 Reviewers agreed at journal 27 Apr, 2025 Reviewers invited by journal 17 Apr, 2025 Submission checks completed at journal 17 Apr, 2025 First submitted to journal 15 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5078036","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":444450687,"identity":"13104422-05a3-4419-aee9-354d25041bf5","order_by":0,"name":"Dong 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16:10:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2826605,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5078036/v1/ce2c910d-7b97-494b-85f2-73a37e8ffb57.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Study on zygomaticomaxillary orbital floor complex fracture assisted by endoscopy combined with digital real-time navigation technology","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFacial injuries are common for various reasons, such as car accidents. Zygomaticomaxillary orbital floor compound fractures are the most common and serious type and directly affect facial appearance and functions such as eating and speech \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Zygomaticomaxillary orbital floor compound fractures are also very complex. In clinical practice, this type of fracture involves multiple anatomical parts of the orbital floor, maxilla, and zygomatic bone, with many cavities and small spaces, making anatomical reduction of the fracture difficult and risky \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRestoration of the orbital floor is the most difficult part of complex zygomaticomaxillary orbital floor fractures. Owing to the thin support structure and fracture fragments, anatomical reduction of the medial orbital floor is almost impossible \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. However, if it is not restored, diplopia, visual impairment and enophthalmos can occur \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe advancement of digital technology has led to rapid progress in the field of fracture repair. Many scholars have reported that this method can effectively assist in fracture reduction \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. However, there are still situations where the field of vision is insufficient and the operation is difficult \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. The application of endoscopes in surgical operations is a major innovation. It can effectively reduce trauma and expand the surgical field of view, but its application in fractures is still rare.\u003c/p\u003e \u003cp\u003eTo address these difficulties, in this study, we used endoscopic technology combined with near-infrared navigation technology to assist in the reduction of orbitozygomatic\u0026ndash;maxillary complex fractures, summarized the surgical experience, and explored the effects of surgical treatment.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient selection principles\u003c/h2\u003e \u003cp\u003e Sixteen patients who were diagnosed with zygomaticomaxillary complex (ZMC) fractures and underwent oral and maxillofacial surgery at the First Affiliated Hospital of Bengbu Medical University between January 2021 and June 2024 were included in this retrospective study. The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Bengbu Medical University (Approval No. BYFYXJS2021074), and written informed consent was obtained from all participants prior to surgery. The inclusion criteria were as follows: age between 18 and 80 years, preoperative diplopia symptoms, and indications for orbital floor reconstruction. The exclusion criteria included patients whose physical condition precluded surgical intervention and those with monocular or binocular vision loss.\u003c/p\u003e \u003cp\u003eThe cohort that underwent the novel surgical technique was designated the New Technique Group (Group 1). The injury etiologies in this group included traffic accidents (7 cases) and accidental falls (1 case). For comparison, patients who underwent conventional surgery on the basis of the surgeon\u0026rsquo;s experience were classified into the Control Group (Group 2), comprising 8 patients, all of whom resulted from traffic accidents.All materials used in this study were non-absorbable pure titanium or titanium alloy internal fixation materials produced by DePuy Synthes.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePreoperative plan for group 1\u003c/h3\u003e\n\u003cp\u003eBefore surgery, a helix scan (helix with 0.625 mm slice thickness; Bright Speed 16; GE Healthcare, Buckinghamshire, UK) was performed. The scanning range was from the top of the skull to the hyoid bone. The original data were stored in DICOM format and imported into Mimics software (Materialize, Belgium). The position of the fracture fragment was restored via mirroring and other methods, and then the images were exported as an STL file and imported into AccuNavi-A2.1 software to set the reference positioning point, which was generally set to a fixed tooth cusp. After the setting was completed, the files were converted into a UEG file for backup \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eSurgical Procedure\u003c/h3\u003e\n\u003cp\u003eThe operation was performed under general anesthesia with nasotracheal intubation by the same surgeon. The preoperative CT image (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) revealed that the orbital floors on both sides were not at the same level. A Subciliary Approach incision was carried out to gain access to the fracture of the orbital floor (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Due to spatial constraints in the operative area, we utilized a navigation system with a reference frame fixed on the forehead to localize the fracture site(Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). This approach enables precise alignment with imaging data and minimizes soft tissue dissection. An additional incision through the intraoral maxillary vestibular approach is necessary to access the medial aspect of the zygomatic arch. This anatomical site is critical for mobilizing bone segments and restoring the overall facial framework. After completing the reduction of the bone fragments, the navigation probe is guided to verify whether the fracture alignment matches the preoperative planning objectives. After verifying that the fracture frame was satisfactory (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), the orbital floor was bent to an appropriate curvature on the basis of the preoperative digital design and the position of the optic nerve. The orbital floor was slowly inserted with the assistance of an endoscope (video 1), the eyeball was moved, eyeball mobility was observed, and the wound was closed \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \n\u003ch3\u003eConventional treatment (group 2)\u003c/h3\u003e\n\u003cp\u003eIn Group 2, a subciliary incision combined with an intraoral vestibular incision was utilized. Reduction forceps were employed to reposition displaced bone fragments and restore the curvature of the zygomatic arch. Guided by the surgeon\u0026rsquo;s experience, the fracture ends were aligned to reconstruct the inferior orbital rim, and an orbital floor plate was placed to restore orbital volume.\u003c/p\u003e\n\u003ch3\u003ePostoperative treatment and follow-up\u003c/h3\u003e\n\u003cp\u003eAnti-inflammatory, analgesic, hemostatic and other drug treatments were given after the operation, and sodium hyaluronate eye drops were used. Three months after surgery, eye movement photos were taken for comparison with those before surgery, and thin-layer three-dimensional CT was taken. The preoperative design and postoperative data were fitted and compared (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The preoperatively designed orbital volume and the postoperative restored orbital volume were calculated and compared (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eSPSS software (version 20.0; IBM Corp., Armonk, NY, USA) was used for data analysis. The chi-square test was used for measurement data, and the t test was used for comparisons of means between two groups (α\u0026thinsp;=\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThere was no significant difference in the basic data of the two groups of patients, such as age, sex, Time from trauma to operation, injured side, Fractures classification, or the presence of other systemic injuries. The specific data are shown in Table\u0026nbsp;1. The postoperative data of the two groups of patients are shown in Table\u0026nbsp;2 and include 3D deviation, diplopia, etc. The resetting effect of the new technology group was better than that of the conventional group, and the probability of diplopia was lower. The difference was statistically significant. There was no significant difference in the surgical operation time, average increase in mouth opening, or numbness between the two groups after statistical testing. No patients in either group experienced a sharp loss of vision. With respect to complications, one patient in Group 2 developed a postoperative wound infection, which was managed with irrigation and dressing changes without serious consequences. Neither group experienced cases of internal fixation device infection requiring immediate removal.Regarding enophthalmos, data from Tables\u0026nbsp;1 and 2 showed no significant differences in the incidence of enophthalmos between the two groups before surgery. Postoperatively, Group 1 demonstrated significantly better improvement in enophthalmos compared to Group 2, with statistically significant differences (t = 5.333, P = 0.021).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eBasic conditions of the two groups of patients before surgery ZMC:zygomaticomaxillary complex OF:Orbital floor MOW:medial orbital wall\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e/t\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge(y)\u003c/p\u003e\n \u003cp\u003emean ± SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.00 ± 1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.88 ± 1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.891\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.767\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCombined with craniocerebral injury\u003c/p\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.590\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTime from trauma to operation(h)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.38 ± 13.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.38 ± 11.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e−0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.750\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInjured side\u003c/p\u003e\n \u003cp\u003eL\u003c/p\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.302\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEnophthalmos\u003c/p\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.410\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.522\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFractures classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZMC + OF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.410\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.522\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZMC + OF + MOW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eZMC:zygomaticomaxillary complex \u0026nbsp;OF:Orbital floor \u0026nbsp; MOW:medial orbital wall\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eComparison of relevant indicators after surgery between the two groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNew Technology Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eConventional group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et/X\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3D deviation(mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-5.433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eoperation time(min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101.11 ± 9.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e107.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean Mouth opening(cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.65 ± 0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.80 ± 0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.666\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncidence of diplopia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncidence of\u003c/p\u003e\n \u003cp\u003eHypoesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.410\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.522\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEnophthalmos\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003eComparison of orbital volume recovery after surgery\u003c/h3\u003e\n\u003cp\u003eThe orbital volume of the new technology group was 26.13 ± 1.03 after surgery and 26.22 ± 1.29 after digital design reduction before surgery. There was no significant difference between the two sides (\u003cem\u003et\u003c/em\u003e =-0.146, \u003cem\u003eP\u003c/em\u003e = 0.886), and there was no significant difference between the two sides and the normal side orbital volume (26.47 ± 1.09) (\u003cem\u003et\u003c/em\u003e =-0.644, \u003cem\u003eP\u003c/em\u003e = 0.530). The orbital volume of the control group was 23.77 ± 0.83 after surgery, which was significantly different from the normal-side orbital volume (27.42 ± 0.87) (\u003cem\u003et\u003c/em\u003e =-0.8.630, P \u003cem\u003e=\u003c/em\u003e 0.000).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrevious studies have revealed that zygomaticomaxillary complex (ZMC) fractures rank second only to nasal bone fractures in incidence among all facial fractures, with the prominent anatomical position of the zygomaticomaxillary buttress being the primary contributing factor to the occurrence of such fractures\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. In this study, 90% of the injuries were caused by traffic accidents and a lack of head protection. In addition, zygomaticomaxillary complex fractures in this group of patients mainly occurred on the right side. The main reason for this finding is that the right upper limb of Chinese patients is the dominant side, which is more likely to cause injuries on this side \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe most complicated step in zygomaticomaxillary complex fractures is orbital floor injury, which is a common cause of orbital bone volume changes \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Orbital volume damage can cause facial aesthetic and functional damage, such as enophthalmos and diplopia. Preoperative CT scan assessment of orbital volume is helpful for planning orbital reconstruction \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAt present, the mainstream surgical method involves the use of orbital floor and orbital fat filling to restore orbital volume, but there are poor recovery effects and a risk of damage to the optic nerve \u003csup\u003e[\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. In this case, we used a digital design to locate the optic nerve position and orbital floor implantation position before surgery. Endoscopic assistance to expand the field of view and intraoperative navigation verification results were satisfactory, restoring the orbital volume and avoiding major complications. According to the literature, the emergence of new materials and technologies such as 3D printing and PEEK also provides a simpler and more convenient method for orbital volume restoration, but the clinical application time is still short, and the specific clinical effects need further verification and discussion \u003csup\u003e[16\u0026ndash;18]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDigital technology has been increasingly applied in medicine in recent years. It is widely used in orthopedic fields such as limb fractures and is now gradually being applied to oral and maxillofacial surgery \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. In this case, digital technology has the following advantages: 1. Preoperative planning: Through digital technology, we can better understand the position of fracture reduction and accurately measure the three-dimensional structure of important facial organs. 2. Intraoperative assistance: Through digital technology, we can assist in the bending and shaping of fixation devices. 3. Postoperative comparison: After surgery, we used digital technology to analyze and fit the postoperative data with the preoperative data to understand the recovery effect. In summary, digital technology is widely used for the treatment of multiple maxillofacial fractures, with significant results. Notably, the use of digital technology and navigation has improved the accuracy of surgery, but the preoperative navigation design requires certain basic computer knowledge, and the installation of navigation brackets is somewhat complicated. This will extend the learning curve of this technology.\u003c/p\u003e \u003cp\u003eEndoscopic technology was previously used in major surgeries, such as abdominal surgery, which magnifies the field of view and reduces trauma. Currently, some people are gradually using this technology to treat facial fractures and have achieved good clinical results. The concept of minimally invasive surgery originated from this approach[20]. In this study, the new technology group used endoscopy to assist in the implantation of the orbital floor. There was no significant difference in optic nerve damage or visual loss between the new technology group and the control group, but the incidence of postoperative diplopia symptoms was significantly lower. Therefore, we believe that in delicate areas such as the orbital floor, where the visual field is poor, endoscope-assisted surgery can effectively avoid damage to important structures such as the optic nerve and improve the quality of life of patients. In addition, in this study, we combined endoscopy and digital navigation technology to assist each other and better complete this type of surgery.\u003c/p\u003e \u003cp\u003eEmerging technologies such as augmented reality are developing rapidly in the field of surgery and have many advantages over traditional surgery. We can foresee that they can be applied to areas such as zygomatico-maxillary fractures and overcome more difficulties \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Of course, the number of cases in this study was small. Considering the subjective requirements of the patients and ethical factors, the grouping was not randomized, which to some extent limited the conclusions. We will further optimize the process, increase the number of cases, and improve the reliability of the conclusions in the future.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study revealed that the novel approach combining digital/navigation technology and endoscopic-assisted orbital floor implantation for zygomatico-orbital‒maxillary complex fracture reduction achieved outcomes comparable to those of conventional methods, with no increase in operative time or surgical trauma. Additionally, the new technique group exhibited fewer postoperative complications, and the fracture reduction results were closer to those of the preoperative simulations. Despite limitations in sample size, statistical comparisons highlighted the potential advantages of this novel technology.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Anhui Province Medical Key Discipline (KJ2018A1005) and Bengbu Medical College (BYKY2019017ZD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors do not have any possible conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthics statement/confirmation of patient permission\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by The First Affiliated Hospital of Bengbu Medical College, and all participants provided signed informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e The authors affirm that human research participants provided informed consent for the publication of the images in Figs. 1, 2, 3, 4 and 5.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCommitteri U, Arena A, Carraturo E, et al. Incidence of orbital side effects in zygomaticomaxillary complex and isolated orbital walls fractures: a retrospective study in south Italy and a brief review of the literature[J]. Journal of clinical medicine, 2023, 12(3): 845.\u003c/li\u003e\n\u003cli\u003eSchneider M, Besmens I S, Luo Y, et al. Surgical management of isolated orbital floor and zygomaticomaxillary complex fractures with focus on surgical approaches and complications[J]. Journal of plastic surgery and hand surgery, 2020, 54(4): 200-206.\u003c/li\u003e\n\u003cli\u003eHassan BA, Sylvester AD, Wescott DJ, Cunningham DL, Elegbede A, Manson PN, Grant MP. An Introduction to The Orbital Buttresses. Plast Reconstr Surg. 2024 Jun 28. \u003c/li\u003e\n\u003cli\u003eSomeda SK, Miyazaki H, Kakizaki H, Takahashi Y. Clinical Significance of the Inferomedial Orbital Strut in Orbital Blowout Fractures: Incidence of Symptomatic Diplopia in a Fractured vs. Intact Strut. J Clin Med. 2024 Jun 24;13(13):3682.\u003c/li\u003e\n\u003cli\u003eKim, JW., Kim, JC., Jeong, CG. et al. The accuracy and stability of the maxillary position after orthognathic surgery using a novel computer-aided surgical simulation system. BMC Oral Health 19, 18 (2019). \u003c/li\u003e\n\u003cli\u003eMcCulley TJ, Aakalu VK, Foster JA, Freitag SK, Dagi Glass LR, Grob SR, Tao JP, Vagefi MR, Yen MT, Yoon MK, Kim SJ, Wladis EJ. Intraoperative Image Guidance in Orbital and Lacrimal Surgery: A Report by the American Academy of Ophthalmology. Ophthalmology. 2024 Jun 24:S0161-6420(24)00307-5.\u003c/li\u003e\n\u003cli\u003eCai K, Yang R, Lin Q, et al. Near-Infrared Camera Calibration for Optical Surgical Navigation. \u003cem\u003eJ Med Syst\u003c/em\u003e. 2016;40(3):67.\u003c/li\u003e\n\u003cli\u003eMannapperuma N, Sayan A, Ilankovan V. Transconjunctival approach revisited and anatomical considerations. \u003cem\u003eBr J Oral Maxillofac Surg\u003c/em\u003e. 2024;62(6):542-544.\u003c/li\u003e\n\u003cli\u003eKhaqani MS, Tavosi F, Gholami M, Eftekharian HR, Khojastepour L. Analysis of Facial Symmetry After Zygomatic Bone Fracture Management. J Oral Maxillofac Surg. 2018 Mar;76(3):595-604. \u003c/li\u003e\n\u003cli\u003eGearing PF, Nathan EA, Devine M, et al. E-Scooter facial fractures: A comparative cohort study. \u003cem\u003eJ Craniomaxillofac Surg\u003c/em\u003e. Published online June 14, 2024.\u003c/li\u003e\n\u003cli\u003eParameswaran A, Panneerselvam E, Mukherjee B. Association of fracture type with enophthalmos and intraorbital volume correction in orbital fractures: A computed tomographic study. \u003cem\u003eIndian J Ophthalmol\u003c/em\u003e. Published online July 11, 2024.\u003c/li\u003e\n\u003cli\u003eLentskevich MA, Nguyen A, Choudhary A, Obaid O, Purnell CA. What CT Findings are Predictive of Post-Traumatic Enophthalmos in Orbital Fractures?. \u003cem\u003ePlast Reconstr Surg\u003c/em\u003e. Published online June 28, 2024.\u003c/li\u003e\n\u003cli\u003eWinnand P, Ooms M, Ayoub N, et al. The impact of polydioxanone (PDS) foil thickness on reconstruction of the orbital geometry after isolated orbital floor fractures. \u003cem\u003eEur J Trauma Emerg Surg\u003c/em\u003e. Published online June 28, 2024.\u003c/li\u003e\n\u003cli\u003eSigron GR, R\u0026uuml;edi N, Chammartin F, et al. Three-Dimensional Analysis of Isolated Orbital Floor Fractures Pre- and Post-Reconstruction with Standard Titanium Meshes and \u0026quot;Hybrid\u0026quot; Patient-Specific Implants. \u003cem\u003eJ Clin Med\u003c/em\u003e. 2020;9(5):1579. Published 2020 May 22.\u003c/li\u003e\n\u003cli\u003eAlharbi GM, Alotaibi KZ, Khalifa GA. Volumetric Analysis of Orbital Volume Discrepancy as a Marker of Change in Globe Position After Three-Point Fixation of Zygomatic Complex Fractures. J Oral Maxillofac Surg. 2025 Feb;83(2):188-198. \u003c/li\u003e\n\u003cli\u003eYu JH, Sang ZX, Zhang H, et al. Biomechanical analysis of an absorbable material for treating fractures of the inferior orbital wall. \u003cem\u003eInt J Ophthalmol\u003c/em\u003e. 2024;17(7):1331-1336. Published 2024 Jul 18.\u003c/li\u003e\n\u003cli\u003eLee J, Choi YJ, Rha EY. Orbital Reconstruction Using a Polyetheretherketone Patient-Specific Implant After Removal of a Mucocele Developing After Orbital Fracture Repair. \u003cem\u003eJ Craniofac Surg\u003c/em\u003e. 2023;34(8):2321-2322.\u003c/li\u003e\n\u003cli\u003eSharma N, Welker D, Aghlmandi S, et al. A Multi-Criteria Assessment Strategy for 3D Printed Porous Polyetheretherketone (PEEK) Patient-Specific Implants for Orbital Wall Reconstruction. \u003cem\u003eJ Clin Med\u003c/em\u003e. 2021;10(16):3563. Published 2021 Aug 13.\u003c/li\u003e\n\u003cli\u003eSolyom A, Moldovan F, Moldovan L, Strnad G, Fodor P. Clinical Workflow Algorithm for Preoperative Planning, Reduction and Stabilization of Complex Acetabular Fractures with the Support of Three-Dimensional Technologies. \u003cem\u003eJ Clin Med\u003c/em\u003e. 2024;13(13):3891. Published 2024 Jul 2.\u003c/li\u003e\n\u003cli\u003eZhang Q, Xu X, Ma J, Ling X, Wang Y, Zhang Y. Application of indocyanine green-labeled fluorescence technology in laparoscopic total extra-peritoneal inguinal hernia repair surgery:a preliminary study. \u003cem\u003eBMC Surg\u003c/em\u003e. 2024;24(1):211. Published 2024 Jul 18.\u003c/li\u003e\n\u003cli\u003eLiu S, Xie M, Gao F, et al. New augmented reality remote for virtual guidance and education of fracture surgery: a retrospective, non-inferiority, multicenter cohort study. \u003cem\u003eInt J Surg\u003c/em\u003e. Published online June 4, 2024.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"orbital, zygomaticomaxillary complex fracture, digital navigation, endoscopy","lastPublishedDoi":"10.21203/rs.3.rs-5078036/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5078036/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To explore the effectiveness of endoscopy combined with digital navigation technology in the treatment of zygomaticomaxillary complex fractures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A retrospective controlled study was conducted. The endoscopy combined with digital navigation technology group was defined as the new technology group, and the conventional treatment group was defined as the conventional group. Eight patients were selected from each group. The chi-square test or t test was used to compare the basic conditions, postoperative recovery, and orbital volume between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: There were no significant differences in sex, age, injury mechanism, BMI, etc., between the new technology group and the conventional group. The fracture reduction fit of the new technology group was better than that of the control group, the postoperative orbital volume was closer to the preoperative orbital volume, and the difference was statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Based on the findings of this study, we believe that endoscopy combined with digital real-time navigation technology can improve the efficacy of surgical treatment for zygomaticomaxillary orbital floor complex fractures, thereby achieving better functional recovery.\u003c/p\u003e","manuscriptTitle":"Study on zygomaticomaxillary orbital floor complex fracture assisted by endoscopy combined with digital real-time navigation technology","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-22 18:20:58","doi":"10.21203/rs.3.rs-5078036/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-19T08:52:36+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-09T03:39:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14766874132015306060919279960482088466","date":"2025-04-29T20:59:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"173408703893044699511016777307820330000","date":"2025-04-28T20:33:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-28T09:15:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87922295466167733701133606591244262667","date":"2025-04-28T07:08:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"154909068321023123317079581393658762737","date":"2025-04-27T14:44:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-17T14:18:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-17T14:13:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-04-15T07:38:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"baf19e43-6188-4d14-8ead-2fb0a1ef8214","owner":[],"postedDate":"April 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T16:04:12+00:00","versionOfRecord":{"articleIdentity":"rs-5078036","link":"https://doi.org/10.1186/s12903-025-07178-6","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2025-12-15 15:57:33","publishedOnDateReadable":"December 15th, 2025"},"versionCreatedAt":"2025-04-22 18:20:58","video":"","vorDoi":"10.1186/s12903-025-07178-6","vorDoiUrl":"https://doi.org/10.1186/s12903-025-07178-6","workflowStages":[]},"version":"v1","identity":"rs-5078036","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5078036","identity":"rs-5078036","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}