Zygomatic Fracture: Causes, Symptoms, and Treatment

What is Zygomatic Fracture?

A zygomatic fracture, also known as a cheekbone fracture or malar fracture, is a break in the zygomatic bone, one of the main bones that form the structure of the face. This bone creates the prominence of the cheek and contributes to the shape of the eye socket. Zygomatic fractures are common facial injuries, often resulting from trauma to the face.

The zygomatic bone connects to several other facial bones, so fractures can affect nearby structures, including the eye socket (orbit), the maxilla (upper jaw), and the temporal bone (near the temple). These fractures can be simple cracks or more complex breaks that require surgical intervention.

Common Causes

Zygomatic fractures typically occur due to direct trauma to the face. Common causes include:

• Motor vehicle accidents: High-impact collisions can cause significant facial trauma, leading to zygomatic fractures.
• Falls: Falling from a height or slipping and hitting the face on a hard surface can result in a fractured cheekbone.
• Sports injuries: Contact sports like boxing, football, hockey, or rugby carry a higher risk of facial fractures due to collisions or impacts.
• Assaults or physical altercations: Punches, kicks, or blows to the face with objects can cause zygomatic fractures.
• Workplace accidents: Industrial or construction accidents, especially those involving heavy machinery or falling objects, can lead to facial injuries.
• Bicycle or motorcycle accidents: Even with helmets, riders can sustain facial fractures in crashes.
• Domestic accidents: Tripping, running into furniture, or other household mishaps can sometimes result in facial trauma.
• Gunshot wounds: High-velocity projectiles can cause severe, complex zygomatic fractures.
• Animal attacks: Bites or scratches from animals, particularly dogs, can lead to facial fractures.
• Recreational activities: Activities like skateboarding, skiing, or horseback riding without proper protective gear can increase the risk of facial injuries.

According to the National Institutes of Health (NIH), facial fractures, including zygomatic fractures, are more common in males and often occur in individuals between the ages of 20 and 40.

Associated Symptoms

A zygomatic fracture can cause a variety of symptoms, depending on the severity and location of the break. Common symptoms include:

• Pain and tenderness: Pain around the cheekbone, which may worsen with movement or touch.
• Swelling and bruising: Swelling around the cheek and under the eye (often called a "black eye"). Bruising may extend to the temple or jaw.
• Flattening of the cheek: The affected cheek may appear sunken or flattened due to displacement of the bone.
• Difficulty opening the mouth: Pain or limited movement when trying to open the mouth wide (trismus).
• Numbness or tingling: Numbness in the cheek, upper lip, or around the eye due to nerve damage.
• Double vision or blurred vision: If the fracture affects the eye socket, it can cause vision problems or difficulty moving the eye.
• Blood in the eye: Subconjunctival hemorrhage (bleeding in the white part of the eye) may occur.
• Nosebleeds: Fractures can sometimes affect the nasal cavity, leading to bleeding.
• Dental issues: Misalignment of the teeth or pain when biting, especially if the fracture extends to the upper jaw.
• Deformity: Visible asymmetry or deformity in the facial structure.

In some cases, the fracture may not be immediately obvious, especially if swelling masks the deformity. If you suspect a zygomatic fracture, seek medical attention promptly.

When to See a Doctor

It is important to see a doctor if you experience any of the following after facial trauma:

• Severe pain in the cheekbone or around the eye that does not improve with over-the-counter pain relievers.
• Significant swelling or bruising around the cheek or eye.
• Difficulty opening your mouth or chewing.
• Numbness or tingling in the face, especially around the cheek or upper lip.
• Changes in vision, such as double vision, blurred vision, or difficulty moving the eye.
• Visible deformity or asymmetry in the facial bones.
• Persistent nosebleeds or bleeding from the ear.
• Signs of infection, such as fever, increased pain, or pus draining from the site of injury.

Even if symptoms seem mild, it is wise to consult a healthcare provider. Some fractures may not be immediately apparent but can lead to complications if left untreated. The Mayo Clinic recommends seeking medical evaluation after any significant facial injury to rule out fractures or other serious issues.

Diagnosis

Diagnosing a zygomatic fracture typically involves a combination of physical examination and imaging studies. Here’s what to expect during the diagnostic process:

Physical Examination

Your doctor will perform a thorough examination, which may include:

• Inspecting the face for swelling, bruising, or deformities.
• Palpating (gently pressing) the cheekbone and surrounding areas to assess for tenderness, instability, or crepitus (a grating sensation indicating broken bone).
• Checking for numbness or tingling in the face, which may indicate nerve damage.
• Evaluating eye movement and vision to assess for involvement of the eye socket.
• Examining the inside of the mouth for signs of fracture extending to the upper jaw or sinus areas.

Imaging Studies

Imaging is essential for confirming the diagnosis and determining the extent of the fracture. Common imaging techniques include:

• X-rays: Standard facial X-rays can help identify fractures in the zygomatic bone and assess alignment. However, X-rays may not always provide a complete view of complex fractures.
• Computed Tomography (CT) Scan: A CT scan is the gold standard for diagnosing zygomatic fractures. It provides detailed, cross-sectional images of the facial bones, allowing doctors to see the exact location and severity of the fracture. CT scans are particularly useful for evaluating fractures involving the eye socket or other adjacent structures.
• Magnetic Resonance Imaging (MRI): While less common for diagnosing fractures, an MRI may be used if there is concern about soft tissue damage, such as injury to the muscles or nerves around the fracture site.

According to the Cleveland Clinic, CT scans are often preferred for facial fractures because they provide clearer images of the bones and can help guide treatment decisions.

Treatment Options

The treatment for a zygomatic fracture depends on the severity of the injury, the presence of complications (such as nerve or eye involvement), and the patient's overall health. Treatment options range from conservative management to surgical intervention.

Non-Surgical Treatment

For minor or non-displaced fractures (where the bone is cracked but not out of alignment), non-surgical treatment may be sufficient. This can include:

• Pain management: Over-the-counter pain relievers such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) can help manage pain and reduce inflammation. In some cases, prescription pain medication may be necessary.
• Ice therapy: Applying ice packs to the affected area for 15-20 minutes at a time, several times a day, can help reduce swelling and bruising.
• Rest and activity modification: Avoiding activities that could worsen the injury, such as contact sports or heavy lifting, is important for healing.
• Soft diet: Eating soft foods and avoiding chewing on the affected side can prevent further strain on the fractured bone.
• Nasal decongestants: If the fracture affects the sinuses, nasal decongestants may be recommended to reduce congestion and promote drainage.

Surgical Treatment

Surgery is often required for more severe or displaced zygomatic fractures, especially if the fracture affects the eye socket, causes significant deformity, or impairs function. Surgical options include:

• Open Reduction and Internal Fixation (ORIF): This is the most common surgical approach for zygomatic fractures. The surgeon makes incisions (often inside the mouth or near the eyebrow) to access the fractured bone. The bone is then realigned (reduced) and secured in place with small plates and screws made of titanium or other biocompatible materials.
• Closed Reduction: In some cases, the surgeon may be able to manipulate the bone back into place without making large incisions. This is less common for zygomatic fractures but may be used for minor displacements.
• Orbital Reconstruction: If the fracture involves the eye socket (orbital floor), additional surgery may be needed to repair the orbital bones and prevent long-term vision problems.

Surgery is typically performed under general anesthesia, and recovery can take several weeks. Patients may experience swelling, bruising, and discomfort after surgery, but these symptoms usually improve over time.

The National Center for Biotechnology Information (NCBI) notes that surgical intervention for zygomatic fractures generally has good outcomes, with most patients regaining normal function and appearance.

Post-Treatment Care

After treatment, whether surgical or non-surgical, proper care is essential for healing. Your doctor may recommend:

• Keeping the head elevated, especially when sleeping, to reduce swelling.
• Avoiding blowing your nose or sneezing forcefully, as this can increase pressure in the sinuses and disrupt healing.
• Following a soft or liquid diet for a period of time to avoid straining the jaw.
• Keeping incisions clean and dry to prevent infection. Your doctor will provide specific instructions for wound care.
• Attending follow-up appointments to monitor healing and ensure the bone is aligning properly.
• Avoiding smoking and alcohol, as these can impair healing.

Prevention Tips

While not all zygomatic fractures can be prevented, you can reduce your risk by taking precautions to protect your face from trauma. Here are some practical tips:

• Wear protective gear: Use appropriate protective equipment during sports or recreational activities. This includes helmets for cycling, motorcycle riding, or contact sports, as well as face shields or masks for activities like hockey or boxing.
• Use seat belts: Always wear a seat belt when driving or riding in a car. Ensure children are properly secured in car seats or booster seats.
• Childproof your home: Install safety gates, secure furniture to walls, and use corner protectors on sharp edges to prevent falls and injuries in young children.
• Practice workplace safety: Follow safety protocols at work, especially in industries where facial injuries are a risk (e.g., construction, manufacturing). Wear protective gear like face shields or goggles when necessary.
• Avoid risky behaviors: Refrain from activities that increase the risk of facial trauma, such as fighting, reckless driving, or participating in sports without proper training or equipment.
• Be cautious in hazardous conditions: Use extra care when walking on icy or uneven surfaces to prevent falls. Wear appropriate footwear with good traction.
• Supervise children: Keep an eye on children during play, especially around hard surfaces or objects that could cause facial injuries.
• Drive safely: Avoid distracted or impaired driving, and follow traffic laws to reduce the risk of motor vehicle accidents.

Prevention is key, but accidents can still happen. If you or someone else sustains a facial injury, seek medical attention promptly to assess for fractures or other serious conditions.

Emergency Warning Signs

Seek immediate medical attention if you or someone else experiences any of the following after a facial injury. These signs may indicate a severe zygomatic fracture or other life-threatening conditions:

• Severe bleeding: Uncontrolled bleeding from the nose, mouth, or ears that does not stop with pressure.
• Difficulty breathing: Trouble breathing or signs of airway obstruction, which could indicate a severe fracture affecting the nasal passages or throat.
• Loss of consciousness: Fainting, confusion, or inability to stay awake, which may signal a head injury or concussion.
• Severe head or neck pain: Intense pain that does not improve with pain relievers, or pain that radiates to the neck or back.
• Vision loss or severe eye injury: Sudden loss of vision, inability to move the eye, or a visible deformity in the eye socket.
• Clear fluid draining from the nose or ears: This could indicate a cerebrospinal fluid (CSF) leak, a serious condition requiring immediate attention.
• Severe deformity: Obvious misalignment or depression of the cheekbone or other facial bones.
• Signs of stroke: Sudden weakness or numbness on one side of the body, slurred speech, or difficulty walking. While rare, facial trauma can sometimes lead to stroke-like symptoms due to blood vessel damage.
• Seizures: Uncontrolled shaking or convulsions, which may indicate a brain injury.

If any of these emergency signs are present, call emergency services or go to the nearest emergency room immediately. Do not attempt to drive yourself if you are experiencing severe symptoms.

The Centers for Disease Control and Prevention (CDC) emphasizes that head and facial injuries should always be taken seriously, as they can lead to complications if not treated promptly.

In summary, a zygomatic fracture is a serious injury that requires prompt medical evaluation. Whether caused by a sports injury, fall, or accident, recognizing the symptoms and seeking appropriate care can prevent long-term complications and ensure proper healing. If you suspect a zygomatic fracture, consult a healthcare provider for a thorough assessment and personalized treatment plan.