Objective <p>This systematic review aimed to compare the extraoral and intraoral approaches for the closed reduction of isolated zygomatic arch fractures (IZAF) in terms of approach type, instrumentation, stabilization methods, complications, and clinical outcomes.</p> Method <p>Database search was done in PubMed, Google Scholar, Semantic Scholar, and the Cochrane Library from inception to August 2024. Studies included were focusing on closed reduction of IZAF via extraoral or intraoral approaches. Data extraction included approach type, reduction instruments, stabilization methods, anesthesia type, complications, and clinical outcomes. The Joanna Briggs University tool was used to assess the risk of bias.</p> Results <p>Sixty-three studies involving 726 patients were included. The Gillies temporal and Keen's intraoral approaches were the most commonly used methods. The Rowe zygomatic elevator was the most commonly used instrument for extraoral approach while extraction forceps for intraoral approach for reduction. Foleys catheter was used for stabilisation post reduction in extraroal approach. Notably, complication rates were comparable between the two approaches, indicating that both are considered safe.</p> Conclusion <p>The intraoral approach can be considered as the first surgical option for managing IZAF, given its advantages, including reduced risk of nerve injury and no visible scarring. Future randomised control trails are warranted to further evaluate the effectiveness of these approaches.</p>