Cheekbone fracture

What is a cheekbone fracture?

A cheekbone fracture refers to a fracture of the zygomatic bone, which is a facial bone forming the bony side of the cheek and the lower portion of the eye socket.

Strictly speaking, a zygomatic fracture is frequently a combined fracture that involves the zygomatic arch, the floor of the eye socket and the wall of the maxillary sinus. In a wider sense, isolated zygomatic arch fractures are also often considered zygomatic fractures.

Because of their exposed location, zygomatic bone and zygomatic arch fractures comprise 40% of all bony injuries to the facial skull making them one of the most common fractures in this area.

How do cheekbone fractures occur?

A cheekbone fracture is caused by direct force on the bone. This can happen, for example, in traffic or sports accidents, such as falling off a bicycle or collisions during head-to-head fights, or even as a result of a hit during a physical argument.

How does a cheekbone fracture present?

Just like any other fracture, a zygomatic fracture may present with the usual certain and uncertain signs of fracture around the injured bone:

• Pain

• Swelling

• Bruising

• Restricted movement

• Warming

• Misalignment

•  Crepitation ( crackling noise from bone fragments grinding against each other)

• Excessive mobility

• Open fracture showing visible bone fragments

Other symptoms may occur according to the exact location of the zygomatic fracture:

• Loss of skin sensitivity between upper lip and eye on the affected side as a result of injury to the infraorbital nerve, which passes just below the zygomatic bone

• Double vision or " monocle hematoma" (bleeding into the eyelids) from injury to the eye socket

• Lockjaw (difficulty or inability to open the mouth or difficulty or inability to close the mouth) following injury to the chewing muscles or severely dislocated bone fragments

What happens during zygomatic fracture surgery?

Not every zygomatic bone fracture requires surgery. In cases where the bone fragments are not or only minimally displaced and no other structures such as nerves or eye muscles are affected, it is possible to observe spontaneous healing. The cheekbone can heal properly under medical supervision, with pain medication adapted to the patient's needs, cooling and relief of the damaged structures with soft food and the administration of decongestant nose drops.

Because of the particularly rapid bony consolidation (compression and consolidation after a fracture) of fractures of the midface, surgery, if necessary, must ideally be performed within 7-14 days, but no later than 21 days. In this case, the best time also depends on the extent of the soft tissue swelling, symptoms and possibly other factors such as the use of anticoagulant drugs.

Surgery is indicated if the bone fragments are displaced or if symptoms occur that suggest the involvement of other structures such as nerves or eye muscles.

Occasionally, especially in isolated fractures of the zygomatic arch, a closed reduction can be successful. In this case, a hook is inserted through a very small incision in the skin, which helps to bring the dislocated bone fragment back into its normal position. Afterwards, spontaneous healing is checked and monitored.

For an open reduction, a number of different surgical approaches can be selected depending on the exact appearance of the fracture and the type of osteosynthesis planned ( joining of bone fragments, for example using screws, plates or wires). It is also possible to access the fracture via the oral cavity. The broken bone fragments are repositioned manually, after which osteosynthesis is performed. In most cases, plate osteosynthesis is chosen for zygomatic fractures. Other existing injuries are also treated. For instance, a titanium mesh or absorbable foil can be used to reconstruct the orbital floor (floor of the eye socket). After the operation, the skin is closed with a suture.

Since spinal anesthesia is not possible in the facial region, operations to repair zygomatic fractures are always performed under general anesthesia. In the event of an open fracture, an antibiotic is given to prevent infection.

The patient should be monitored in the hospital following the operation to ensure that any postoperative complications, such as bruising, double vision or even loss of vision in the affected eye, can be detected and treated quickly.

How long will a zygomatic fracture take to heal?

Full healing of the fracture takes around six weeks.

During this time, patients usually only have to spend the first two to four days in the hospital. Before being discharged, an x-ray is taken to check the fracture. Patients also need to visit an ophthalmologist for a follow-up examination.

Following this, outpatient follow-up appointments should be scheduled, during which the stitches are removed if no self-dissolving suture was used. In addition, patients are instructed not to blow their nose for the first two weeks. Any further force to the face should be prevented until the fracture has healed completely after six weeks. Any sports that involve this risk should therefore be avoided for this period.

Biocompatible osteosynthesis material can remain in the body for life.

However, as the skin becomes thinner with age and screws and plates can become visible, particularly on the face, it is generally recommended to remove the osteosynthesis material in a later, smaller operation for people without an increased risk of surgery or anesthesia or pronounced osteoporosis after zygomatic fractures.

Which doctors & clinics specialize in zygomatic fractures?

Fractures of the zygomatic bone are treated by oral and maxillofacial surgeons. These specialists have graduated from medical school as well as dental school and then completed further specialist training and specialize in facial injuries.

If you're in need of a doctor, you expect the best medical care possible. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience.

Let us help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in the field of cheekbone fractures and are looking forward to your inquiry or wish for treatment.