Impact of zygomaticomaxillary complex fracture on masticatory muscle dysfunction and pain: systematic review and observational meta-analysis

Background: Zygomaticomaxillary complex (ZMC) fractures significantly affect facial aesthetics and masticatory function, necessitating effective rehabilitation strategies. This systematic review and meta-analysis investigated the effects of fractures on masticatory muscle function and pain management. Methods: Adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, conducted a comprehensive search across databases, including PubMed, MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, SciELO, Cochrane and Google Scholar, and selected studies that assessed masticatory function through metrics such as bite force, electromyography activity, and post-intervention pain levels in patients with ZMC fractures. Data were synthesized using a random-effects model. Results: Fourteen studies were included, which highlighted diminished bite force and altered muscle activity patterns in patients with ZMC fractures. Significant improvements in muscle function and pain management were observed postoperatively, with interventions including surgical repair and physical therapy proving to be effective. The meta-analysis demonstrated a marked reduction in pain, substantiated by changes in visual analog scale scores from an average of 7.5 pre-operatively to 2.3 post-operatively. Conclusions: ZMC fractures profoundly affect masticatory efficiency and cause notable pain, which can be substantially alleviated by targeted surgical and therapeutic interventions. The PROSPERO Registration: This systematic review and meta-analysis followed the PRISMA guidelines and was registered in PROSPERO (CRD42024595963).