The zygomatic bone is the primary bone of the lateral third of the midface. Zygomatic bone fractures are frequent lesions in maxillofacial trauma, representing approximately 32%to38% of facial fractures [2]. Their etiology is dominated by road traffic accidents, interpersonal violence, and sports accidents [3]. Zygomatic bone fractures present a polymorphic clinical symptomatology, sometimes involving associated lesions that can jeopardize vital, functional, and aesthetic prognoses [4]. The treatment of these fractures relies on anatomical reduction and fixation of displaced fractures. However, managing certain clinical forms remains a true therapeutic challenge [5][6]. While numerous studies have been conducted worldwide regarding zygomatic fractures, there is a lack of recent data specifically from the Stomatology and Maxillofacial Surgery Department of the Cocody University Hospital. The objective of this study is to identify the epidemiological profile and describe the clinical and therapeutic aspects of zygomatic bone fractures managed within this department.

This was a retrospective, cross-sectional descriptive study conducted over a 12-month period, from January 1st to December 31, 2025 carried out at the oral and maxillofacial surgery department of the Cocody teaching hospital. The study included patients presenting with an isolated zygomatic bone fracture confirmed by computed tomography (CT), who underwent an ophthalmological examination, received treatment for the fracture, and were reviewed one-month post-treatment. Patients without an ophthalmological assessment of their lesions and those who left against medical advice and were lost to follow-up were not included in the study. Data were collected from medical records (consultations, emergency room visits, hospitalizations). Data were collected using anonymous survey forms identified by clinical record numbers. The variables studied included epidemiological characteristics (prevalence, age, sex, and circumstances of occurrence), clinical data (functional and physical signs, fracture type according to the Zingg et al. classification), therapeutic modalities, and post-treatment evolution. Steel wire osteosynthesis was indicated for Zingg type A fractures or minimally displaced fractures. Plate fixation was indicated for Zingg type B and C fractures. Ophthalmological examinations were performed routinely. The outcome was considered satisfactory if the patient reported no functional (masticatory), visual, or aesthetic impairments. The limitations of the study were the short duration of the study period and patient follow-up.

The prevalence of zygomatic bone fractures in our study (31.7%) is similar to that reported by Traoré I. et al. [7] and higher than the prevalence found by Obimakinde OS [8]. This difference likely reflects the variability in the prevalence of zygomatic fractures depending on the study’s context and environment.

The mean age in our series was 32.7 years (Table 1). Traoré etal. [7] reported a mean age of 32.1 years. Shahzad et al. [9] found a mean age of 30.7 years in a series of 67 zygomatic complex fractures, and Soni et al. reported a mean age of 33 ± 14.5 years in 183 cases [10]. This similarity in mean ages reflects a predominance in young adults, likely related to increased exposure to risk factors such as intense occupational and sporting activities, road traffic accidents, falls, and interpersonal violence.

Table 1. Distribution of patients according to age group.

A clear male predominance was observed in our study (Figure 1), consistent with the literature [8][11]. This predominance may be explained by the higher frequency of male drivers of both motorized and non-motorized vehicles, as well as a more pronounced involvement of men in alcohol and psychotropic substance consumption, acts of violence, and high-risk behaviors.

Figure 1. Distribution of patients according to sex.

Road traffic accidents accounted for 82.3% of the etiology (Table 2). This predominance, also reported by several authors [4][9][11][12], can be explained by the rapid expansion of the vehicle fleet, the massive use of two-wheeled vehicles, lack of road safety etiquette, and insufficient coercive measures [13]. Driving under the influence of alcohol and psychoactive substances is an established risk factor, increasing the risk of severe facial trauma [9][14].

Table 2. Distribution of patients according to etiology.

Facial asymmetry was the most frequent clinical sign in our series (Table 3, Figure 2). Traoré I. et al. [7] noted a “step-off” deformity (sensation de marche en escalier) in 77% of cases, and Homer N. et al. [15] reported infraorbital hypoesthesia in 47.6% of cases. These differences are partly explained by the fact that some authors place greater emphasis on signs of absolute severity (sensory deficits, ocular involvement) rather than on swelling or the flattening of the malar relief, which are considered signs of relative severity.

Figure 2. Marked facial asymmetry due to right hemiface swelling.

Table 3. Distribution of patients according to functional and physical signs.

Ocular involvement, present in 9.2% of cases in our study (Table 4), has been previously described by Shahzad [9] and Brucoli [11]. This ophthalmological complication is common due to the anatomical proximity of the zygomatic bone to the eyeball and the violence of the traumatic impact on the orbito-zygomatic region.

Table 4. Distribution of patients according to the Zingg classification.

In our study, maxillofacial computed tomography (CT) was performed in 100% of cases (Table 4, Figure 3). The primary role of CT in our practice aligns with the approach of Shahzad [9]. CT scanning, through its axial, coronal, and sagittal planar sections as well as three-dimensional reconstruction, is currently the gold standard in medical imaging [16].

Figure 3. Disjunction fracture of the malar bone Zingg type B.

In our series, Type B fractures according to the Zingg classification were the most frequent (76.8%). This predominance of Type B, described in several studies [2][10][11][17], is explained by the prominent position of the cheekbone exposed to lateral shocks, making the zygomatic bone the “lateral bumper” of the face. Furthermore, the majority of facial traumas are of frontal or antero-lateral origin, favoring fractures of the three zygomatic articulations (Type B), whereas isolated fractures of the zygomatic arch (Type A) result from direct latero-facial impacts.

The average delay for the treatment of zygomatic bone fractures was 11 days, which is higher than the delays reported by Lebeau et al. (5 days) [18] and Bissa et al. (3 days) [19]. In our context, this delay in management may be linked to the slow administrative procedures of the Motor Guarantee Fund (FGA), which, despite providing free care for victims, extends the time required for treatment.

Osteosynthesis using screwed mini-plates was performed in 85.3% of cases (Table 5, Figure 4, Figure 5). Current recommendations favor open reduction and internal fixation (ORIF) to restore the stability and aesthetics of the facial skeleton [15]. The frequent use of osteosynthesis in our series could also be explained by the financial coverage provided by the Motor Guarantee Fund, a state social assistance service facilitating the management of road traffic accident victims.

Table 5. Distribution of patients according to treatment of zygomatic bone fracture.

Figure 4. Miniplate osteosynthesis of the infraorbital rim.

Figure 5. Miniplate osteosynthesis of the frontozygomatic suture.

The outcome one month after the treatment of the zygomatic bone fracture was satisfactory in 88.2% of cases (Table 6). Our result is similar to the rates reported in the literature, which generally range between 70% and 90% of cases [10][14][20].

Table 6. Distribution of patients according to outcome.

Zygomatic bone fracture is a common traumatic injury, occasionally associated with complications such as ocular involvement and limited mouth opening. The prognosis depends not only on the severity of the lesions but also on the promptness of specific treatment. In our context, it appears necessary to simplify the administrative procedures for therapeutic management established by the Motor Guarantee Fund (MGF).

Author Contributions

Conceptualization: Kouakou Konan René and Koffi Konan Marc, Boka Koffi Laurent;

Methodology: Gnepo Eve Josiane, N'Guessan Attowla Vianney;

Validation: Kouakou Konan René, Koffi Konan Marc;

Writing: Diarra Khader Morel, Chapo Ahi Morel;

Data Curation: Ebolo Ebolo Chardin, Fofana Harouna Jean, Fofana Yah Maïmouna;

Software: Aden Mohammed Abdoulrazack, Notoloum Steve;

Supervision: Ouattara Bakary.

All authors have read and approved the published version of the manuscript.