Aims: To compare the effectiveness of the endoscope-assisted approach with the open surgical technique for reduction of zygoma arch fractures. Study design: Randomized controlled study. Place and Duration of Study: Maxillofacial surgery unit, Otolaryngology department, Tanta University hospital, Tanta, Egypt, between April 2019 and October 2020. Methodology: We included 18 patients (15 men, 3 women; age range 16-63 years) with fracture of zygoma arch. Ten cases were operated by the endoscope-assisted approach while the other 8 cases were operated by the open surgical technique. Operative time, intraoperative blood loss, adequacy of reduction and any complications were recorded and documented. Results: The endoscope assisted group showed a statistically significant lower risk of complications with risk reduction rate of 67.5%. In other terms, the number needed to treat was 1.5, that is to say we must treat 1.5 patients with the endoscope-assisted method to prevent 1 adverse event that would have happened with the traditional open approach. Other outcome measures of operative time and blood loss showed no statistically significant difference (P value equals .25 and .52 respectively). The outcome of rate of inadequate reduction has quite wide 95% CI (-19.38 to 19.38) that reflects imprecision due to lack of events. Conclusion: The endoscope-assisted method showed statistically significant superiority in the domain of incidence of complications risk reduction (67.5%). No statistically significant difference was recorded in other outcome measures. Thus, the endoscope assisted approach for the zygoma arch fracture is in our opinion a better option than the traditional open incision approach.