The Relationship Between

Morphometric Measurements,
Severity, and Success of Zygomatic
Arch Fracture Reduction
Saleh Nseir, DMD,* Hanna Frid, DMD,y Dekel Shilo, DMD, PhD,z
Tal Capucha, DMD, PhD,x Omri Emodi, DMD, MD,k and Adi Rachmiel, PhD DMD{
Purpose: Identify associations between preoperative radiographic measurements and clinical findings
of zygomatic arch fractures and postoperative radiographic measurements. Based on those findings,
propose a comprehensive treatment algorithm for the solitary zygomatic arch fracture and combined zygo-
matic arch-zygomatic complex fracture.
Methods: Retrospective cohort study with patients referred to our department for zygomatic arch frac-
tures between 2013 and 2018. Data analyzed included patient demographics, clinical evaluation, and
radiographic information. Predictor variables were preoperative morphometric measurements: the initial
latero-lateral (LL) defect was determined by the difference between the preoperative LL distances of the
fractured and the healthy arches, LL distance was measured from the midsagittal plane in the cranium
to the inner cortex of the most displaced arch segment, initial arch coronoid distances were measured
from the medial part of the most dislocated arch fragment to the lateral aspect of the coronoid, and the
anterior-posterior telescoping was measured as the distance between the 2 points in the arch that lost con-
tinuity and overlapped as a result of the fracture. The outcome was defined as the residual defect. It was
calculated as the ratio between the postoperative remaining LL distance and the initial LL defect.
Results: A total of 179 cases were enrolled, all involving head residual defects. Statistical analysis was
performed only on 149 medially displaced fractures. Results show that an initial LL defect larger than
3.5 mm has an 86.3% chance of remaining with a better residual defect (<84.1%), P = .001. Cases with an-
tero-posterior (AP) telescoping > 1.45 mm showed a 72.4% chance of remaining with a poor residual
defect >84% (P = .003). Arch-coronoid initial distance showed little effect on the chance of remaining
with a large remining defect (P = .417, CI = 95%)

*Senior Surgeon, Department of Oral and Maxillofacial Surgery,
Rambam Medical Care Center, Haifa, Israel.
yResident, Department of Oral and Maxillofacial Surgery,
Rambam Medical Care Center, Haifa, Israel.
zSenior Surgeon, Department of Oral and Maxillofacial Surgery,
Rambam Medical Care Center, Haifa; Israel and the Bruce
Rappaport Faculty of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel.
xResident, Department of Oral and Maxillofacial Surgery,
Rambam Medical Care Center, Haifa, Israel and the Bruce
Rappaport Faculty of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel.
kDeputy Head, Department of Oral and Maxillofacial Surgery,
Rambam Medical Center, Haifa, Israel and the Bruce Rappaport
Faculty of Medicine, Technion-Israel Institute of Technology, Haifa,
Israel.
{Department Head, Department of Oral and Maxillofacial
Surgery, Rambam Medical Care Center, Haifa, Israel, and Ruth &
Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel.
Saleh Nseir and Hanna Frid contributed equally to this manu-
script.
Conflict of Interest Disclosures: None of the authors have any
relevant financial relationship(s) with a commercial interest.
Address correspondence and reprint requests to Dr Frid: Depart-
ment of Oral and Maxillofacial Surgery, Rambam Medical Care Cen-
ter, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa
3109601, Israel.; e-mail: hanna.frid2@gmail.com
Received February 5 2022
Accepted April 2 2022
Ó 2022 American Association of Oral and Maxillofacial Surgeons
0278-2391/22/00272-5
https://doi.org/10.1016/j.joms.2022.04.001

1371
1372
Conclusion: Based on our results, we found that morphometric measurements can be used to predict
the reduction results and can assist the clinician in choosing the optimal reduction method and thus
increasing the success rate.
Ó 2022 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 80:1371-1381, 2022
Zygomatic complex fractures (ZMC) are among the
most common facial fractures.1-3 They include any
injury that disrupts 1 or more of the 5 articulations
with the adjacent craniofacial skeleton: the
zygomaticofrontal, infraorbital rim,
zygomaticomaxillary buttress, zygomatic arch, and
zygomaticosphenoid sutures.4
Isolated zygomatic arch fractures can be found in
5%-14% of all ZMC fractures, but most frequently,
they occur as a component of ZMC fractures.2,5-7
The inferior margin of the zygomatic arch is the
origin of the masseter muscle, fascial layers of the
face superficial muscular aponeurotic system
(SMAS), and temporoparietal fascia.
The strength applied by the masseter muscle can
impede the proper reduction and fixation of the arch
fracture and can even be responsible for a relapse.8
Collapse of the zygomatic arch following trauma can
result in inadequate anteroposterior projection of the
zygomatic body, increase in facial width, and limitation
of mouth opening.2,6
Treatment of zygomatic arch fractures can be
achieved by closed reduction, open reduction, or
conservatively by observation alone.
Throughout history, facial fractures used to be clas-
sified and treated mainly based on anatomic location.
Currently, the classification of and indications for spe-
cific surgical treatments are based on clinical and 3-
dimensional radiological imaging.4,9
Numerous classifications of isolated arch fractures
and ZMCs have been published to assist surgeons in
determining treatment choices.10-13
The isolated arch fracture is typically caused by a
low-energy trauma and is mostly not associated with
multisystem trauma,14 whereas an arch fracture that
is a part of a ZMC fracture is most likely a result of
higher energy mechanisms that transmit a sufficient
portion of the force posteriorly, which causes the
arch disruption.15
The zygomatic arch fracture pattern depends mainly
on the force magnitude and direction of the trauma.
The fractures can be encountered in 3 forms; a medi-
ally displaced arch due to direct lateral force applica-
tion, a telescoping pattern of injury which is usually
the result of an anterior force applied on the malar
prominence, and a third form of a laterally displaced
arch which usually occurs due to a large energy burst
mostly as a consequence of a posteriorly
directed force.15
MORPHOMETRICS OF ZYGOMATIC ARCH FRACTURE
In spite of the abundance of classifications, we
found that a uniform and objective classification for
reduction outcomes and a treatment algorithm based
on uniform morphometric measurements are lacking.
The purpose of this study was to identify associa-
tions between preoperative radiographic measure-
ments and clinical findings of zygomatic arch
fractures and postoperative radiographic measure-
ments. Based on those findings, we propose a compre-
hensive treatment algorithm for the solitary zygomatic
arch fracture and combined zygomatic arch-ZMC frac-
ture that can assist the clinician in tailoring a specific
and suitable treatment for each case, avoiding pitfalls
to achieve the best results possible.
Materials
The research was designed as a retrospective
cohort study.
The study sample included patients who were
referred to our department of maxillofacial surgery
in the Rambam Health Care Campus in Haifa, Israel,
for treatment of solitary zygomatic arch fracture or as
part of a ZMC fracture between the years
2013 and 2018.
Patients included in the study sample had to suffer
from zygomatic arch fracture and had to have preoper-
ative computed tomography (CT) scan. Patients were
excluded from the study if they suffered from bilateral
ZMC fractures, had incomplete information in their
medical chart, and lacked postoperative imaging.
We defined the predictor variables as the preopera-
tive morphometric measurements.
The initial LL defect was determined by the differ-
ence between the preoperative LL distances of the
fractured and the healthy arches (Fig 1A, B).
Latero-lateral (LL) distance was measured from the
midsagittal plane in the cranium to the inner cortex
of the most displaced arch segment (Fig 1A).
Initial arch coronoid distances were measured from
the medial part of the most dislocated arch fragment to
the lateral aspect of the coronoid (Fig 1C).
The anterior-posterior (AP) telescoping was
measured as the distance between the 2 points in
the arch that lost continuity and overlapped as a result
of the fracture (Fig 1D).
The metric measurements were made on preopera-
tive axial CT scans that were then compared to postop-
erative submentovertex x-rays.
NSEIR ET AL 1373

All radiographic images were calibrated to avoid er-
rors caused by different image ratios. All measure-
ments were made bilaterally, thus using the intact
contralateral side as a point of reference.
The outcome was defined as the residual defect. It
was calculated as the ratio between the postoperative
remaining LL distance and the initial LL defect
(Fig 1A, B).
The postoperative remaining LL distance was calcu-
lated by comparing the LL distances of the healthy side
and the postoperative LL distance of the frac-
tured arch.
The results were arranged by the remaining defect
and divided in to quarters, with the fourth quarter
(remaining LL defect >84.1%) having the worst results
(ie, the largest percentage of remaining defects).

FIGURE 1. A, Preoperative CT and postoperative submentovertex measurement of latero-lateral (LL) distance from the midsagittal plane in the
cranium to the inner cortex of the most displaced arch segment. B, Calculation of the residual defect. C, Operative arch coronoid distance mea-
surements from the medial part of the most dislocated arch fragment to the lateral aspect of the coronoid. D, Anterior-posterior telescoping mea-
surements between the 2 points in the arch that lost continuity and overlapped as a result of the fracture.
Nseir et al. Morphometrics of Zygomatic Arch Fracture. J Oral Maxillofac Surg 2022.
1374 MORPHOMETRICS OF ZYGOMATIC ARCH FRACTURE

DATA COLLECTION, MANAGEMENT, AND DEMOGRAPHICS AND PREVALENCE OF

ANALYSES
Other covariants included the fracture type
(isolated or combined), the direction of the fracture
(medial or lateral), preoperative functional defect (lim-
itation in mouth opening <35 mm16-18 was considered
a functional defect), and preoperative esthetic defect
(a clinically observed arch depression, step, or
visible lateral asymmetry between the cheeks was
considered an esthetic defect).
Demographic information included age, gender,
etiology, and treatment.
Although this retrospective study relied on data
from patient files alone with no interaction between
investigators and patients, approval was obtained
from our institutes’ Helsinki Committee for Ethics.
Information was collected from the clinical and sur-
gical notes of each patient in a standardized and sys-
tematic pattern.
Descriptive statistics on terms of means, standard
deviation, median, percentiles, and ranges were pre-
formed to all parameters in the study. Normal distri-
bution of the continuous parameters was tested by
the Kolmogorov-Smirnov test. As a result of this
test, nonparametric (median and 25%-75%) or para-
metric test (t-test) was used for differences be-
tween groups.
A multivariate logistic regression model (with odds
ratio and 95% confidence interval [95% CI]) was
used to identify and measure the association between
preoperative radiographic measurements and large re-
maining defects with adjustment for several indepen-
dent parameters.
Receiver-operating characteristic (ROC) curve
analysis with area under the curve and Youden index
were used to find the best cutoff according to sensi-
tivity and specificity of AP telescoping. P < .05 was
considered statistically significant. SPSS version 27
(IBM, Armonk, New York) was used for all statisti-
cal analysis.
ZYGOMATIC ARCH FRACTURES
The age range of patients was 11 - 88 years. Less than
10% of patients were younger than 20 years, while
almost half were 21-40 years old (Fig 2A). The mean
age of patients at the time of surgery was 41 years.
The overall age distribution of the 179 patients
showed a decreased trend of these types of injuries
per decade of life, except in the first 2 decades. The
highest prevalence (29.1%) of accidents was in the
21 to 30 years age group, while the lowest prevalence
(7.3%) was in the 61-70 years age group. Included
were 141 (78.8%) men and 38 (21.2%) women, with
a male to female ratio of 3.7:1 (Fig 2A). The etiology
of fractures is shown in Figure 2B. Among these pa-
tients, 70 (39.1%) were due to falls, 39 (21.8%) from
road traffic accidents, 33 (18.4%) from interpersonal
violence, 17 (9.5%) from sports injuries, 15 (8.4%)
had been hit by hard objects, and 5 (2.8%) from firearm
injury. Overall, falls were the most frequent cause of
zygomatic fractures (39.1% of cases), while interper-
sonal violence prevalence rate was 18.4%. However,
it must be noted that the high percentage of patients
who reported falling may in fact have been involved
in a violent act they chose to conceal, especially
among men aged 20-40 years.

Results
ZYGOMATIC ARCH FRACTURE PATTERN
DISTRIBUTION
We assessed 179 patients with zygomatic arch frac-
tures, of whom 148 had combined zygomatic maxil-
lary complex and arch fractures (83%), and 31 had
solitary zygomatic arch fractures (17%). The most com-
mon pattern of dislocation of the arch was medial
displacement (149 patients, 83.2%), while lateral FIGURE 2. A, Demographic information. By age and gender. B,
displacement of the zygomatic arch was observed in Fracture etiologies reported by patients.
only 30 (16.8%) patients. In 108 (60.4%) cases, the Nseir et al. Morphometrics of Zygomatic Arch Fracture. J Oral Max-
fracture was on the left side. illofac Surg 2022.
NSEIR ET AL 1375

THE LINK OF THE INITIAL MORPHOMETRIC
MEASUREMENTS AND CLINICAL STATUS TO THE
POSTOPERATIVE RESULTS
Analyzing the medially displaced zygomatic arch
group alone, only 14.5% of the medially displaced
arch fractures were not treated surgically, either due
to the surgeon’s decision or owing to patient refusal.
When we assessed the initial LL defect in these pa-
tients’ group, we found an average defect of
3.06 mm compared to 5.76 mm in the operated group
(Fig 3, A). At this point, we hypothesized this variable
might represent the cutoff point at which an esthetic
defect is not profound and therefore surgeons and pa-
tients decided no operation was necessary. To further
prove this correlation, we performed an analysis in
which we assessed the relationship between the size
of the initial LL defect and findings of clinically
aesthetic defect in a blinded manner. ROC analysis
showed that the initial LL defects’ best diagnostic
value for having an esthetic defect is 3.45 mm
(Fig 3B). Initial LL defects >3.45 mm had an 83.6%
chance to manifest as an esthetic defect (P = .003)
(Fig 3C). Consequently, based on this result, we chose
a cutoff point of 3.5 mm as the value that could help
predict a patient’s clinical status.
INITIAL LL DEFECT
The correlation model in Figure 4 presents the nega-
tive correlation between the initial LL defect and the

FIGURE 3. A, The initial LL defect in the medially displaced arch fractures that were not treated surgically were almost twice as small from the
initial LL defect in patient that were surgically treated. B, Analysis of receiver-operating characteristic (ROC) curve of initial LL defect and the
presence of an esthetic defect. C, An initial LL defect >3.4 mm had an 83.6% chance to manifest as an esthetic defect.
Nseir et al. Morphometrics of Zygomatic Arch Fracture. J Oral Maxillofac Surg 2022.
1376
FIGURE 4. Pearson correlation between predictor variables and
the chance of remaining with a poor residual defect. **P < .001.
Nseir et al. Morphometrics of Zygomatic Arch Fracture. J Oral Max-
illofac Surg 2022.
large residual defect, and a logistic regression model
(Fig 5) shows that reduction in the initial LL defect rai-
ses the chance to remain with a large remaining defect
(>84.1%), odds ratio = 0.798, P = .026, and 95%
CI = 0.654-0.974.
An initial LL defect larger than 3.5 mm has an 86.3%
chance of remaining with a better residual defect
(<84.1%), P = .001.
Patients with initial LL defects < 3.5 mm presented
postoperative residual defect 3-times greater than pa-
tients with initial LL defects > 3.5 mm (Fig 6).
Basically, treatment of cases with a small initial LL
defect, in most cases, resulted in only a slight improve-
ment in the defect condition. On one hand, the post-
operative defect was indeed small, leading to a
conclusion that the surgery was successful; however,
on the other hand, the residual LL defect was higher,
which meant that the change or gain from the surgery
was meager.
AP TELESCOPING
The correlation model in Figure 4 presents the pos-
itive correlation between the AP telescoping and the
residual defect, and a logistic regression model
(Fig 5) shows that enlargement in the AP telescoping
FIGURE 5. Logistic regression analysis of the association between initial morphometric measurements and the chance of remaining with a
poor remaining defect.
Nseir et al. Morphometrics of Zygomatic Arch Fracture. J Oral Maxillofac Surg 2022.
MORPHOMETRICS OF ZYGOMATIC ARCH FRACTURE
FIGURE 6. Patients with a large initial defect had a better chance
achieving smaller residual defect.
Nseir et al. Morphometrics of Zygomatic Arch Fracture. J Oral Max-
illofac Surg 2022.
raises the chance of remaining with a large remining
defect (>84.1%) odds ratio = 1.221, P = .007, and
95% CI = 1.057-1.411.
ROC analysis showed that the AP telescoping best
diagnostic value for residual defect is 1.45 mm
(Fig 7A).
Cases with AP telescoping > 1.45 mm showed a
72.4% chance of remaining with a poor residual defect
> 84% (P = .003).
The group that had the poorest results had a higher
average of anteroposterior telescoping than the group
that had smaller residual defects (Figs 7B, C).
ARCH CORONOID DISTANCE
Arch coronoid initial distance and residual defect
showed a positive correlation (Fig 4). A logistic regres-
sion model (Fig 5) shows little effect of arch coronoid
initial distance on the chance of remaining with a large
defect (P = .417, CI = 95%)
NSEIR ET AL 1377

FIGURE 7. A, Analysis of receiver-operating characteristic (ROC) curve of AP telescoping and the presence of an esthetic defect. B, Primary
morphometric measurements (in mm) in regard to the remaining defect. C, Worst results of residual defect had a larger initial AP telescoping.
Nseir et al. Morphometrics of Zygomatic Arch Fracture. J Oral Maxillofac Surg 2022.

MOUTH OPENING an 83.1% (0.002) chance of having free

ROC analysis showed that the best value of arch mouth opening.
coronoid distance for predicting limitation in mouth ROC analysis showed that the best value of initial LL
opening is 3.35 mm (Fig 8A), and patients with an defect for predicting limitation in mouth opening is
arch coronoid distance larger than 3.35 mm have 6.75 mm (Fig 8B), and patients with an initial LL defect
1378
< 6.75 mm had a 91.5% probability of normal mouth
opening (P < .001).
Patients with a restriction in mouth opening had a
larger mean initial LL defect (6.22 mm) than those
with free mouth opening (3.8 mm) (P < .0005).
Preoperative limitation in mouth opening was
found in 60.4% of the medially displaced arches.
Follow-up showed no limitation in mouth opening
in 94% of the treated cases.
Discussion
The purpose of this study was to identify associations
between preoperative radiographic measurements and
clinical findings of zygomatic arch fractures and postop-
erative radiographic measurements.
We recognized that a large LL initial defect in arch
fracture and the ones without a significant component
of AP telescoping can achieve a more prominent
reduction result. Based on these findings, we propose
a comprehensive treatment algorithm for the zygo-
matic arch fracture.
A deformity resulting from changes in zygomatic
arch location or shape could manifest in flattening of
the cheek (cheek concavity) or a palpable step defor-
mity that disturbs the arches continuity.19,20
In some cases, an esthetic evaluation is futile
because the deformity is concealed clinically by edema
and ecchymosis that accompany the fracture,19
making the radiographic evidence a major consider-
ation in evaluating facial contour.
Reduction of a zygomatic arch fracture can be chal-
lenging. We argue that management of arch fractures
in their solitary and combined forms should not only
depend on the degree of displacement, resultant
aesthetic, and functional deficits as described by Mi-
loro and Peterson (2012) but also be further analyzed
with morphometric measurements that can assist in
predicting reduction difficulty and the capacity to
achieve a meaningful change in the arch’s position.21
Treatment options include observation, closed
reduction, or open reduction with internal fixation.22
We agree that nondisplaced or minimally displaced
zygomatic arch fractures may not necessitate a surgical
treatment,21,22 as these injuries usually do not result in
significant functional and esthetic deficits; hence, it
may be sufficient to observe the patient.21
SUGGESTED TREATMENT ALGORITHM FOR
ZYGOMATIC ARCH FRACTURE BASED ON
OBJECTIVE AND MEASURABLE PARAMETERS
Our algorithm is based on horizontal and sagittal
changes. Deciding whether to treat a fracture is based
on horizontal changes, while the treatment modality is
based on sagittal changes. Figure 9 summarizes our al-
gorithm. LL defects smaller than 3.5 mm should be
MORPHOMETRICS OF ZYGOMATIC ARCH FRACTURE
observed without surgical intervention. As shown
earlier in the results, a small initial LL defect <
3.5 mm has a lower probability of possessing evident
esthetic and functional defects. In addition, small
initial LL defects show limited potential for achieving
meaningful measurable changes (Fig 6). It has been
shown that 4.0 mm changes in a patient’s profile is
barely noticeable, even by experienced
physicians.23,24
In cases where esthetic evaluation is difficult to
attain, we suggest considering initial LL defect
< 3.5 mm as having a meager chance of causing an
esthetic defect.
Therefore, patients suffering from solitary arch frac-
tures with initial LL defect < 3.5 mm may be treated
conservatively by observation. In cases of combined
fractures, we recommend avoiding additional
approaches for the reduction of the arch due to the
small clinical influence (Fig 9).
When choosing to surgically reduce the fracture in
cases of initial LL defect > 3.5 mm, we recommend
measuring the anterior-posterior telescoping of
the arch.
Cases with AP telescoping < 1.45 mm can be easier
to reduce presumably because a greater periosteal
continuity is maintained and may be treated by direct
approaches. One possibility is making a stab incision
in the malar prominence and inserting a T bar (Car-
roll-Girard screw) into the zygomatic bone, and after
interlocking in the bone, a firm tug is employed until
the bone snaps back to its place.25 Another option is
making a stab incision at a point where the perpendic-
ular lines from the lateral canthus and the alar margin
join, a bone hook is inserted and anchored under the
zygomatic arch root, and manipulation is made in ante-
rior and lateral directions until the bone clicks back
into place.26 The advantages of using a closed reduc-
tion include a minimal or an insignificant scar, a short
operating time, which enables the usage of sedation
instead of general anesthesia, and faster healing of
the patient.
However, cases with AP telescoping > 1.45 mm may
add to the complexity of the reduction due to the addi-
tional vector needed in the treatment process. For
these cases, an open reduction may be warranted
and performed by indirect approaches. One possibil-
ity, described by Gillies et al, is making an incision of
approximately 1.5 cm length in the temporal skin
and temporoparietal fascia, placing an elevator under-
neath the temporalis fascia, and then advancing it un-
der the zygomatic bone and arch to allow for
reduction.27 Another option, described by Keen and
Chalmers, is a maxillary vestibular approach, creating
an incision in the gingivobuccal sulcus and elevating
the periosteum to make room for an elevator to be in-
serted underneath and reposition the arch.28 A similar
NSEIR ET AL 1379

FIGURE 8. A, Analysis of receiver-operating characteristic (ROC) curve of arch coronoid distance and limitation in mouth opening. B, Analysis
of receiver-operating characteristic (ROC) curve of an initial LL defect and the presence of a functional defect.
Nseir et al. Morphometrics of Zygomatic Arch Fracture. J Oral Maxillofac Surg 2022.

approach, described by Quinn, is based on inserting an
instrument through an intraoral incision and placing it
between the coronoid process and the zygomatic
arch, allowing for lateral pressure to be applied on
the medially displaced arch for reduction.29
Due to the possibility of partial or improper reduc-
tion in cases of AP telescoping > 1.45 mm, we recom-
mend the procedure be performed by an experienced
surgeon and to consider using intraoperative imaging
to confirm a stable and desired reduction.
1380
FIGURE 9. Suggested treatment algorithm for zygomatic arch fracture based on objective and measurable parameters.
Nseir et al. Morphometrics of Zygomatic Arch Fracture. J Oral Maxillofac Surg 2022.
In case a stable reduction cannot be attained for a
comminuted arch fracture or laterally displaced
fracture, we recommend considering an open reduc-
tion via the coronal approach.30 This allows for direct
access, accurate antero-posterior and LL anatomic
restoration of the arch, and stable fixation using
miniplates.6,31
Regarding functional complications, typically limita-
tion in mouth opening could be a result of coronoid
impingement and direct or indirect muscle trauma
leading to tearing, spasm, or hematoma disturbing
normal mouth opening.14,20,32,33
Reduction of the horizontal defect increases the
distance between the coronoid and the arch, thus
postoperative functional disturbances can be largely
attributed to lack of a proper postoperative physio-
therapy regime.3,32,33
As with the majority of studies, the design of the cur-
rent study is subjected to limitations.
The first is the insufficient sample size of a laterally
displaced arch fracture. The sample was inadequate
for statistical measurements and excluded from the
final conclusion. Hence, our findings are relevant to
medially displaced fractures only. Future studies can
fill this information gap by reaching out to neighboring
departments and expanding the sample size.
The second limitation concerns the comparison of
preoperative CT scan to a postoperative submentover-
tex image. The calibration made to standardize the
measurements may serve this empirical study, but
further research should eliminate the human factor
and aspire to compare the same type of image for
more compelling results.
To conclude, it is important to take into account the
morphological changes when deciding on a treatment
option in zygomatic arch fractures due to injury-
related soft-tissue disturbances. Our algorithm intends
to help the surgeon decide in which cases surgical
MORPHOMETRICS OF ZYGOMATIC ARCH FRACTURE
intervention is indicated and what approach should
be considered based on the morphological assessment
of the fracture in order to receive the best results with
minimal complications.
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