Study Design: Retrospective with follow-up.

Objective: This study described the long-term outcomes of patients who received either conservative or surgical treatment for zygomaticomaxillary complex (ZMC) fractures. It accounted for the perspectives of both patients and surgeons, and explored factors associated with patient satisfaction.

Methods: Patients with unilateral ZMC fractures 2007-2018 were invited to follow-up clinical examinations and photographic documentation. Patient experiences were recorded using a questionnaire. A review panel assessed computed tomography (CT) scans and photographs. Patient and surgeon perspectives of detecting functional sequelae were assessed, and a correlation matrix was used to evaluate different perspectives of perceiving malar asymmetry.

Results: The study sample consisted of 180 patients, of which conservative treatment was given to 43 patients and surgical treatment to 137 patients. Median follow-up time was 72.5 months after trauma. Overall satisfaction was 92.8%, with no significant difference between treatment groups. Patients and surgeons showed marked differences in detecting functional sequelae. Predicted malar asymmetry on CT scans did not correlate to findings on photographs or reports by patients.

Conclusions: A predicted sunken cheek on CT imaging does not necessarily lead to long-term visible asymmetry of the malar region. Surgeons should acknowledge different perspectives when predicting and assessing long-term sequelae of ZMC fractures, and seek consensus on when to perform surgical reconstructions.