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Zygomatic Fracture – Numbness

What is Zygomatic Fracture – Numbness?

A zygomatic fracture, commonly called a cheekbone fracture, occurs when the bony prominence of the face—the zygomatic arch—breaks. The zygoma forms the lateral wall and floor of the orbit (eye socket) and contributes to the cheek contour. When the bone is broken, the nerves that travel through the facial skeleton—especially the infraorbital nerve—can be bruised, stretched, or transected, leading to numbness or altered sensation in the cheek, upper lip, lower eyelid, and sometimes the nose.

Patients may describe the feeling as “tingling,” “pins and needles,” or a complete loss of feeling on one side of the face. Numbness is an important clinical clue because it signals nerve involvement, which can affect healing time, the need for surgery, and the risk of long‑term sensory deficits.

Common Causes

While any trauma that impacts the cheek can cause a zygomatic fracture, the following situations are most frequently reported:

• Motor vehicle collisions – especially side‑impact or “T‑bodied” crashes.
• Falls – falling onto the side of the face while walking, running, or from height.
• Sports injuries – contact sports (football, boxing, hockey) or accidents while cycling, skateboarding, or skiing.
• Physical assaults – punches, kicks, or being struck with a blunt object.
• Animal bites – dog or other animal bites that deliver a high‑velocity impact.
• Work‑place accidents – construction or manufacturing sites where tools or debris strike the face.
• Gunshot or penetrating injuries – high‑energy projectiles can shatter facial bones.
• Explosive blasts – military or industrial explosions can produce complex facial fractures.
• Severe facial surgeries – rare iatrogenic fractures occurring during extensive maxillofacial procedures.
• Congenital bone weakness – conditions such as osteogenesis imperfecta that make bones more fragile.

Associated Symptoms

Because the zygomatic bone is part of the orbital rim and the mid‑facial skeleton, a fracture often presents with a cluster of other signs:

• Visible bruising or swelling over the cheek and lower eyelid.
• Flattening or flattening of the cheek contour.
• Displacement of the eye (diplopia or “double vision”) if the orbital floor is involved.
• Difficulty opening the mouth or “trismus” caused by muscle spasm.
• Bleeding from the nose or mouth (epistaxis or oral hemorrhage).
• Visible step‑off or palpable depression along the orbital rim.
• Loss of sensation (numbness) in the distribution of the infraorbital nerve: lower eyelid, side of nose, upper lip, and upper gums.
• Ear pain or “raccoon eyes” (periorbital ecchymosis) if there is concomitant skull base injury.
• Headache or facial pain that worsens with chewing.

When to See a Doctor

Any facial trauma that produces the symptoms above warrants prompt medical evaluation. Seek care immediately if you notice:

• Persistent or worsening facial numbness lasting more than a few hours.
• Visible deformity or a “step” in the cheek bone.
• Bleeding that won’t stop after applying gentle pressure for 10 minutes.
• Double vision, blurred vision, or any change in eye movement.
• Severe pain that is not relieved with over‑the‑counter analgesics.
• Difficulty breathing, speaking, or swallowing.
• Signs of a concussion (confusion, vomiting, loss of consciousness).

Even if the injury seems minor, an evaluation by an oral‑maxillofacial surgeon, otolaryngologist, or emergency physician is essential because hidden fractures can lead to long‑term functional problems.

Diagnosis

Healthcare providers use a combination of history, physical exam, and imaging to confirm a zygomatic fracture and assess nerve involvement.

1. Clinical Examination

• Inspection for swelling, bruising, and asymmetry.
• Palpation of the orbital rim and cheek for “step‑off” or mobility.
• Neurologic testing of the infraorbital nerve (light touch, cotton‑wool testing, two‑point discrimination).
• Eye examination – visual acuity, pupil response, and extra‑ocular movements.
• Assessment of occlusion (bite) to detect dental alignment issues.

2. Imaging Studies

• CT scan (computed tomography) – Gold standard. Thin‑slice (≤1 mm) axial and coronal images show fracture lines, displacement, and any involvement of the orbital floor or sinus cavities.
• Panoramic radiograph (OPG) – May be used in less severe cases but can miss subtle fractures.
• MRI – Rarely needed unless there is suspicion of soft‑tissue injury (e.g., optic nerve, muscle entrapment).

3. Additional Tests

• Blood work only if there is concern for infection or systemic injury.
• Dental models or intra‑oral scans for complex cases involving the maxilla.

Treatment Options

The management plan depends on fracture severity, displacement, and the extent of nerve injury.

1. Non‑Surgical (Conservative) Management

• Observation – Small, non‑displaced fractures often heal without surgery.
• Cold compresses – 15‑minute intervals during the first 48 hours to limit swelling.
• Analgesia – Acetaminophen or ibuprofen (if no contraindications) for pain and inflammation.
• Soft diet – Reduces strain on the facial muscles for 1‑2 weeks.
• Protective splint – In some cases, a lightweight facial bandage is used to limit motion.
• Follow‑up imaging – Repeat CT after 2–3 weeks if numbness persists to evaluate nerve recovery.

2. Surgical Intervention

Surgery is indicated when there is significant displacement, orbital floor involvement, or persistent numbness suggesting nerve entrapment.

• Open reduction and internal fixation (ORIF) – Small titanium plates and screws realign the zygomatic arch and secure it.
• Orbital floor reconstruction – If the floor is depressed, a porous polyethylene or titanium mesh restores orbital volume and protects the eye.
• Infraorbital nerve decompression – In selected cases, the surgeon may gently free the nerve from bony fragments.
• Post‑operative care – Includes antibiotics (usually a 5‑day course of amoxicillin‑clavulanate), analgesics, and a soft diet.
• Physical therapy – Jaw‑opening exercises after a week to prevent trismus.

3. Home Care & Rehabilitation

• Maintain head elevation (30°) to decrease facial swelling.
• Gentle facial massage (once swelling subsides) can promote circulation, but avoid pressure over the fracture site.
• Perform sensory re‑education exercises: lightly brush the numb area with a soft brush and describe the sensations to the brain; this may accelerate nerve recovery.
• Monitor for signs of infection (increasing redness, warmth, fever) and contact your provider promptly.

Prevention Tips

While accidents can happen, many facial injuries are preventable with simple precautions:

• Wear protective gear – Sports helmets, face shields, and mouthguards for high‑impact activities.
• Use seat belts – Always wear a seat belt and ensure children are in age‑appropriate restraints.
• Practice safe driving – Avoid distractions, obey speed limits, and never drive under the influence.
• Maintain a clutter‑free environment – Remove tripping hazards inside the home, especially for seniors.
• Strengthen facial muscles – Regular chewing exercises can improve muscular support, but they do not prevent fractures from high‑energy trauma.
• Wear appropriate footwear – Reduces risk of falls that could translate into facial impact.
• Educate children – Teach kids to avoid rough play that targets the face.
• Follow workplace safety protocols – Use face shields, hard hats, and proper tool handling.

Emergency Warning Signs

Key Takeaways

• Zygomatic fractures can cause numbness by damaging the infraorbital nerve.
• High‑energy impacts—vehicle accidents, sports, falls—are the most common causes.
• Associated signs include swelling, bruising, eye movement problems, and dental alignment changes.
• Prompt evaluation with a CT scan is essential to determine the need for surgery.
• Many non‑displaced fractures heal with conservative care, but displaced or nerve‑compressing injuries often require ORIF.
• Early recognition of red‑flag symptoms can prevent permanent vision loss or chronic facial numbness.

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References:

1. Mayo Clinic. “Zygomatic Bone Fracture.” mayoclinic.org. Accessed April 2026.
2. American Academy of Facial Plastic and Reconstructive Surgery. “Facial Fractures: Diagnosis and Management.” 2023.
3. Centers for Disease Control and Prevention. “Traumatic Brain Injury and Facial Injuries.” cdc.gov. 2022.
4. National Institutes of Health, National Institute of Dental and Craniofacial Research. “Orbital and Zygomatic Fractures.” 2024.
5. Cleveland Clinic. “Infraorbital Nerve Injury.” my.clevelandclinic.org. 2023.
6. World Health Organization. “Road Safety and Facial Injuries.” WHO Fact Sheet, 2021.

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