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Open reduction and internal fixation require radiographic control. Three-dimensional radiographs provide superior information on actual distances. The study aims to quantify and evaluate intraoperative reduction control by cone-beam computed tomography. The retrospective case-control study evaluates three-dimensional radiographs through linear measurements of defined skeletal landmarks from the median sagittal plane for symmetry. The study group received open reduction and internal fixation for zygomaticomaxillary fractures, and the control group consisted of a population without pathology of the midfacial region. The study group showed the same degree of symmetry as the control group. The mean absolute distance of all landmarks was 1.5 \u00b1 1.3\u00a0mm in the study group and 1.0 \u00b1 0.9\u00a0mm in the control group. There was a statistically significant likelihood of the right side being further away from the midline than the left. The study showed adequate reduction results of zygomaticomaxillary fractures. Moreover, the same degree of symmetry was ascertained compared to a control group. Intraoperative cone-beam computed tomography serves as a valid tool to check for immediate reduction control during surgery for zygomaticomaxillary fractures.<\/jats:p>","DOI":"10.1038\/s41598-025-90481-7","type":"journal-article","created":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T12:19:26Z","timestamp":1739881166000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Symmetry-based analysis after surgical treatment of zygomaticomaxillary complex fractures using intraoperative cone-beam computed tomography: a retrospective case-control study"],"prefix":"10.1038","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9324-9574","authenticated-orcid":false,"given":"Adrian","family":"Franke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Bernard","family":"Matschke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michaela","family":"Bu\u010dkova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lea","family":"Rahrisch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcnter","family":"Lauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Leonhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,18]]},"reference":[{"key":"90481_CR1","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1097\/00005373-199401000-00006","volume":"36","author":"K Hussain","year":"1994","unstructured":"Hussain, K., Wijetunge, D. 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