Zygomatic Complex Fracture Patterns and Reduction Outcomes in a Conflict-Affected Region: Evidence from Northeast Nigeria

Zygomatic complex fractures are among the most common midface injuries seen in maxillofacial trauma practice, arising from direct blows to the cheekbone from interpersonal violence, blast injuries, or road traffic accidents. In Nigeria's North East geopolitical zone, a protracted insurgency has significantly altered the trauma epidemiology at regional tertiary centers. This retrospective multi-centre study describes zygomatic complex fracture patterns, treatment approaches, and outcomes in a conflict-affected population presenting to two teaching hospitals in Borno and Gombe States, over a five-year period from 2019 to 2023. One hundred and twelve zygomatic complex fractures were identified from clinical records. Fractures were classified using the Zingg classification system. Clinical variables include injury mechanism, time to surgical intervention, surgical approach, and reduction quality assessed by postoperative CT imaging where available. Blast-related fractures accounted for 24.1% of cases in the Borno center, a significantly higher proportion than the Gombe center. Gillies temporal approach was the most commonly employed reduction technique at both centers. Open reduction with miniplate fixation was used in significantly comminuted or displaced fractures. Reduction adequacy was deemed satisfactory in 78.6% of surgically managed cases. Delayed presentation beyond two weeks was associated with poorer reduction outcomes and higher rates of residual deformity. The study presents unique conflict-zone trauma epidemiology data and recommends capacity building in advanced zygomatic reconstruction techniques at North East facilities. Keywords: zygomatic complex fracture, conflict trauma, North East Nigeria, open reduction, Zingg classification.