Accuracy of Positioning Guide and Customized Plate in Zygomaticomaxillary Complex Fractures

Accuracy of Positioning Guide and Customized Titanium Plate for Reduction and Fixation of Zygomaticomaxillary Complex Fracture: A Case Series

The goal of this clinical trial is to evaluate the accuracy and stability of positioning guides and customized titanium plates in the treatment of Zygomaticomaxillary Complex (ZMC) fractures. The main questions it aims to answer are:

• Is the anatomical reduction achieved using a virtual planning-based positioning guide accurate when compared to preoperative plans?
• Does the customized titanium plate provide stable fixation during the follow-up period?

Researchers will compare the actual postoperative outcome to the preoperative virtual surgical plan to see if the customized workflow improves anatomical alignment.

Participants will:

• Undergo a preoperative Computed Tomography (CT) scan for virtual surgical planning.
• Receive surgical treatment using a patient-specific positioning guide and customized titanium plate.
• Complete follow-up assessments including postoperative CT scans and clinical evaluations for 6 months.

Study Overview

• Status: Enrolling by invitation
• Conditions: Zygomatic Fractures; Zygomaticomaxillary Complex Fracture; Zygoma Fracture
• Intervention / Treatment: Device: Patient-specific positioning guide; Device: Customized titanium plate

Detailed Description

The clinical workflow for managing unilateral Zygomaticomaxillary Complex (ZMC) fractures begins with a standardized diagnostic phase. Patients undergo a thorough medical and dental history followed by a comprehensive clinical examination. A high-resolution preoperative Computed Tomography (CT) scan (T0) is acquired within one week prior to the intervention to visualize fracture patterns and the extent of displacement. The Digital Imaging and Communications in Medicine (DICOM) data is imported into specialized medical imaging software, such as Materialise Mimics or 3-matic, for three-dimensional (3D) reconstruction and Virtual Surgical Planning (VSP).

During the digital planning phase, the fractured zygomaticomaxillary complex is virtually reduced by mirroring the unaffected contralateral side to achieve optimal anatomical symmetry. Based on this virtual model, a patient-specific positioning guide is designed to fit the bone surface and indicate exact locations for plate and screw placement. Simultaneously, a customized titanium plate is designed to conform perfectly to the reduced bone contours, incorporating optimal screw hole positions to maximize stability and avoid vital structures. These plates are fabricated using additive manufacturing techniques, specifically selective laser melting, to ensure high precision and biocompatibility.

The surgical procedure is performed under general anesthesia. Appropriate surgical approaches, including lateral eyebrow and intraoral vestibular incisions, are used to expose the fracture site. The positioning guide is utilized to facilitate the accurate relocation of ZMC fragments according to the preoperative virtual plan. Once the fracture is accurately reduced, the custom-made titanium plate is adapted to the bone surface and secured with screws to achieve rigid internal fixation, minimizing the need for intraoperative plate bending.

Postoperative care includes an immediate follow-up Computed Tomography (CT) scan (T1) within 1 to 3 days to assess the accuracy of fracture reduction and plate placement by superimposing the postoperative actual model onto the preoperative virtual plan. Clinical follow-up occurs at regular intervals (1 week, 1 month, 3 months, 6 months, and 1 year) to assess wound healing, facial symmetry, ocular function, and mouth opening. A long-term follow-up CT scan (T2) is obtained at 6 months to evaluate bone healing and the long-term stability of the fixation.

• Study Type: Interventional
• Enrollment (Estimated): 8
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Cairo, Egypt
    • department of oral and maxillofacial surgery, faculty of dentistry, Cairo university

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients diagnosed with Zygomatico-maxillary complex fractures requiring surgical intervention.
• Patients aged 18 years or older.
• Patients willing to provide informed consent and comply with follow-up protocols.
• Patients with adequate bone quality and quantity for stable fixation.

Exclusion Criteria:

• Patients with comminuted ZMC fractures that preclude the use of custom-made guides based on mirroring the contra lateral side.
• Patients with pre-existing facial deformities or asymmetries that would interfere with accurate assessment of fracture reduction.
• Patients with systemic diseases or conditions that contraindicate elective surgery or impair bone healing (e.g., uncontrolled diabetes, severe osteoporosis, active malignancy, and immunosuppression).
• Patients on medications affecting bone metabolism (e.g., long-term corticosteroids, bisphosphonates). Patients with active infections in the maxillofacial region.
• Pregnant or lactating women.
• Patients with psychiatric disorders or unrealistic expectations.
• Patients who are unable to undergo CT scans or follow post-operative instructions.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Virtual Planning and Customized Plates; Patients with ZMC fractures undergoing surgical treatment using 3D virtual planning and patient-specific titanium plates.	Device: Patient-specific positioning guide; A 3D-printed positioning guide designed through virtual surgical planning to assist in the accurate reduction of ZMC fractures.; Device: Customized titanium plate; A custom-fabricated titanium plate designed to fit the patient's specific anatomy for rigid fixation of ZMC fractures.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Accuracy of Fracture Reduction	Evaluation of the accuracy of fracture reduction achieved using the positioning guide and customized titanium plate. This will be assessed by superimposing the post-operative computed tomography (CT) scans onto the pre-operative virtual surgical plan. The difference will be reported as linear deviation, measured in millimeters (mm).	one week postoperative
Assessment of Facial Symmetry (Malar Projection)	Evaluation of aesthetic outcome and facial symmetry by assessing the malar projection. This will be measured clinically or via imaging (e.g., comparing the fractured side to the intact side). The outcome will be reported as the linear discrepancy or difference between the two sides, measured in millimeters (mm).	6 months postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assessment of Ocular Motility and Diplopia	Clinical assessment of functional recovery regarding ocular motility. Patients will be clinically examined for the presence or absence of diplopia (double vision) in different fields of gaze. The outcome will be reported as a categorical variable (e.g., Presence / Absence of diplopia).	6 months postoperatively
Total Operative Time	The total duration of the surgical procedure measured in minutes, from the initial incision to the final closure.	Day of surgery (Intraoperative)
Patient Satisfaction	Evaluation of the patient's overall satisfaction with the functional and aesthetic outcomes of the procedure. This will be assessed using a Visual Analog Scale (VAS) ranging from 0 to 10, where 0 indicates "completely dissatisfied" and 10 indicates "completely satisfied". The reported value will be the numerical score on this scale.	6 months postoperatively

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Study Director: Prof. Ramy Ragab Elbialy, prof. of maxillofacial surgery, Department of Oral and maxillofacial surgery,Faculty of dentistry, Cairo university; Study Director: Dr. Mohamed Ali Zain Elabden, lecturer of maxillofacial surg, department of oral and maxillofacial surgery, faculty of dentistry, Cairo university

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2025
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): September 1, 2027

Study Registration Dates

• First Submitted: April 29, 2026
• First Submitted That Met QC Criteria: May 19, 2026
• First Posted (Actual): May 27, 2026

Study Record Updates

• Last Update Posted (Actual): May 27, 2026
• Last Update Submitted That Met QC Criteria: May 19, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: virtual surgical planning; Zygomaticomaxillary Complex Fracture; Zygoma Fracture; custom made titanium plate; positioning guide
• Additional Relevant MeSH Terms: Nervous System Diseases; Wounds and Injuries; Fractures, Bone; Craniocerebral Trauma; Trauma, Nervous System; Facial Injuries; Maxillofacial Injuries; Skull Fractures; Zygomatic Fractures
• Other Study ID Numbers: OMFS3319

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No