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Zygomatic Bone Fracture

What is Zygomatic bone fracture?

A zygomatic bone fracture (commonly called a cheekbone fracture) is a break in the zygomatic arch – the bony prominence that forms the cheek and part of the lateral wall of the orbit (eye socket). The zygomatic bone articulates with the frontal, temporal, maxillary, and sphenoid bones, giving the face its contour and structural support. When this bone is fractured, the shape of the cheek may become flattened or displaced, and the surrounding soft tissues can swell, bleed, or become bruised.

Because the zygomatic bone is close to the orbit, the infra‑orbital nerve, and the sinus cavities, a fracture can affect vision, sensation, and sinus drainage. Most zygomatic fractures are “tripod” injuries that involve three points of the bone: the orbital rim, the maxillary buttress, and the zygomatic arch. Prompt evaluation is essential to prevent long‑term facial asymmetry, nerve damage, or chronic sinus problems.

Common Causes

• Motor vehicle collisions – especially when a passenger’s face strikes the steering wheel, dashboard, or airbag.
• Sports injuries – contact sports (football, hockey, rugby) or high‑impact activities like skateboarding and snowboarding.
• Falls – slipping and landing on the side of the face or hitting the cheek on a hard surface.
• Physical assaults – punches, kicks, or being struck with a blunt object.
• Violent accidents – industrial or construction mishaps involving falling tools or debris.
• Motorcycle or bicycle accidents – lack of protective gear increases facial impact.
• Gunshot or blast injuries – high‑velocity projectiles cause complex facial fractures.
• Animal bites – large dogs or other animals can deliver enough force to fracture the cheekbone.
• Medical procedures – rare complications from facial surgeries or osteotomies.
• Severe sinus infections – chronic pressure may weaken bone, making it more susceptible to fracture after minor trauma.

Associated Symptoms

Symptoms often appear immediately after injury, but some may develop over several hours as swelling increases.

• Pain and tenderness over the cheekbone, especially when touching or moving the jaw.
• Visible flattening or depression of the cheek.
• Bruising (ecchymosis) that spreads from the cheek to the eyelid (“black eye”).
• Swelling of the periorbital (around the eye) area.
• Blurred or double vision caused by orbital involvement.
• Numbness or tingling in the cheek, upper lip, or lower eyelid due to infra‑orbital nerve injury.
• Difficulty opening the mouth (trismus) if the fracture extends to the maxillary buttress.
• Bleeding from the nose or mouth.
• Whistling sound when blowing air through the nose (indicates a sinus communication).
• Dental malocclusion – the upper and lower teeth may not fit together properly.

When to See a Doctor

While minor facial bruises can be observed at home, the following signs merit immediate medical evaluation:

• Severe, worsening pain that does not improve with over‑the‑counter pain relievers.
• Visible deformity of the cheek or eye socket.
• Persistent or worsening swelling after 24‑48 hours.
• Blurred, double, or loss of vision.
• Uncontrolled nosebleeds or bleeding from the mouth.
• Loss of sensation in the cheek, upper lip, or lower eyelid.
• Difficulty breathing through the nose due to swelling or blockage.
• Signs of concussion (confusion, vomiting, loss of consciousness).

Even if the injury seems minor, a prompt evaluation by a facial trauma specialist or oral‑maxillofacial surgeon is recommended to rule out hidden fractures.

Diagnosis

Physicians use a stepwise approach to confirm a zygomatic bone fracture and assess its severity.

Clinical Examination

• Inspection for asymmetry, bruising, and swelling.
• Palpation of the cheekbone, infra‑orbital rim, and zygomatic arch for step-offs or crepitus.
• Neurological assessment of sensation in the infra‑orbital nerve distribution.
• Ophthalmologic exam to check eye movement, visual acuity, and pupil reaction.

Imaging Studies

• Plain X‑ray (Caldwell and Waters views) – quick, but may miss subtle fractures.
• CT scan (computed tomography) – gold standard; provides 3‑D images of bone fragments, orbital involvement, and sinus communication. Thin‑slice (≤1 mm) CT is preferred for surgical planning.
• CBCT (cone‑beam CT) – lower radiation dose; useful in dental and maxillofacial offices.
• In rare cases, MRI may be ordered to evaluate soft‑tissue injury or intra‑orbital involvement.

Additional Tests

If there is concern for associated injuries, doctors may order:

• Neurological imaging (CT head) for suspected brain injury.
• Sinus X‑ray or CT to assess sinus involvement.

Treatment Options

Treatment depends on the fracture’s location, displacement, and associated injuries.

Conservative (Non‑Surgical) Management

• Cold compresses – 15‑minute intervals during the first 24‑48 hours to reduce swelling.
• Analgesics – acetaminophen or ibuprofen (if no contraindications) for pain and inflammation.
• Soft diet – avoid hard or chewy foods for 1–2 weeks to minimize jaw stress.
• Head elevation – sleeping with the head raised 30° helps limit edema.
• Observation – small, non‑displaced fractures often heal without surgery within 4–6 weeks.

Surgical Management

Indications for surgery include displacement >2 mm, orbital floor involvement, infra‑orbital nerve entrapment, or cosmetic deformity.

• Open reduction and internal fixation (ORIF) – small titanium plates and screws are placed through incisions (often intra‑oral or sub‑ciliary) to realign bone fragments.
• Closed reduction – for minimally displaced fractures, surgeons can manually reposition the bone without incisions, followed by a splint.
• Orbital floor reconstruction – if the fracture extends into the eye socket, a synthetic or bone graft may be inserted to support the globe.
• Infra‑orbital nerve decompression – performed when persistent numbness is due to nerve entrapment.

Post‑operative care includes antibiotics (usually a 5‑day course of amoxicillin‑clavulanate), pain control, and a soft diet. Sutures are typically removed after 5–7 days, and patients return for follow‑up imaging to confirm proper healing.

Rehabilitation

• Gentle facial exercises after 2 weeks to improve range of motion.
• Physical therapy for jaw function if trismus persists.
• Psychological support for patients concerned about facial appearance.

Prevention Tips

• Wear appropriate protective gear – helmets with full‑face coverage for motorcycling, bicycling, skating, and contact sports.
• Use seat belts – they reduce face‑impact risk in car crashes.
• Maintain safe environments – keep walkways clear of tripping hazards; use non‑slip mats in bathrooms.
• Strengthen facial muscles – regular facial and jaw exercises can improve resilience.
• Control sinus infections – treat chronic sinusitis promptly to avoid bone weakening.
• Avoid high‑risk activities when intoxicated – alcohol impairs coordination and increases fall risk.
• Supervise children during play – ensure safe play areas and discourage roughhousing near hard surfaces.
• Follow workplace safety protocols – wear face shields when working with tools that could cause blunt trauma.

Emergency Warning Signs

• Severe, uncontrollable bleeding from the nose or mouth.
• Sudden loss of vision or double vision that does not improve.
• Pronounced facial deformity with a sunken or protruding cheek.
• Increasing pain despite medication, especially if accompanied by fever (possible infection).
• Persistent numbness or tingling that spreads beyond the cheek (possible nerve injury).
• Difficulty breathing or swallowing due to swelling.
• Signs of concussion: confusion, vomiting, loss of consciousness, or severe headache.

Key Take‑aways

A zygomatic bone fracture can impact both appearance and function of the face, eyes, and sinuses. Early recognition, proper imaging, and timely treatment—whether conservative or surgical—greatly improve outcomes. When in doubt, especially if vision, breathing, or neurological signs are involved, seek emergency medical care.

References

• Mayo Clinic. “Facial fracture (cheekbone fracture).” https://www.mayoclinic.org
• Cleveland Clinic. “Zygomatic (Cheekbone) Fracture.” https://my.clevelandclinic.org
• American Academy of Oral and Maxillofacial Radiology. “Imaging of Maxillofacial Trauma.” https://www.aaomr.org
• National Institutes of Health (NIH). “Facial Trauma Guidelines.” https://www.ncbi.nlm.nih.gov
• World Health Organization. “Road Safety and Facial Injuries.” https://www.who.int

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