Zygomatic Fracture (Cheekbone Fracture): Causes, Symptoms, and Treatment

What is Zygomatic Fracture (Cheekbone Fracture)?

A zygomatic fracture, commonly known as a cheekbone fracture, occurs when there 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. Fractures in this area can affect both the appearance and function of the face, potentially leading to complications if not properly treated.

The zygomatic bone is connected to several other facial bones, so fractures often involve these adjacent structures as well. This type of injury is typically the result of significant force or trauma to the face.

Common Causes

Zygomatic fractures are usually caused by high-impact trauma to the face. Common causes include:

• Motor vehicle accidents: Collisions, especially without proper seatbelt use, can cause facial trauma leading to cheekbone fractures.
• Falls: Falling from a height or slipping and hitting the face on a hard surface can result in this injury.
• Sports injuries: Contact sports like boxing, hockey, football, or rugby carry a higher risk of facial fractures due to collisions or impacts.
• Physical altercations: Punches or strikes to the face during fights can cause zygomatic fractures.
• Assaults: Intentional harm involving blunt objects or direct hits to the face.
• Workplace accidents: Industrial or construction accidents where debris or tools strike the face.
• Bicycle or motorcycle accidents: Even with helmets, facial injuries can occur during crashes.
• Pedestrian accidents: Being struck by a vehicle while walking or running.
• Recreational activities: Accidents during activities like skiing, snowboarding, or horseback riding.
• Domestic accidents: Tripping over objects or hitting the face on furniture or fixtures.

Sources: Mayo Clinic, National Center for Biotechnology Information (NCBI)

Associated Symptoms

Zygomatic fractures can cause a variety of symptoms, which may vary depending on the severity and exact location of the fracture. Common symptoms include:

• Facial pain or tenderness: Particularly around the cheekbone, which may worsen with movement or touch.
• Swelling and bruising: The cheek and surrounding areas, including under the eyes, may become swollen and discolored.
• Flattening of the cheek: The affected side of the face may appear sunken or asymmetrical.
• Difficulty opening the mouth: Pain or mechanical obstruction may limit jaw movement (trismus).
• Numbness or tingling: Damage to nerves in the area can cause altered sensation in the cheek, upper lip, or teeth.
• Double vision or blurred vision: If the fracture affects the eye socket, it may lead to vision problems.
• Blood in the sinus or nose: The maxilla (upper jaw) may be involved, leading to nosebleeds or blood in the nasal passages.
• Pain with eye movement: Due to involvement of the orbital (eye socket) structures.
• Loose or misaligned teeth: If the fracture extends to the upper jaw.
• Step-off deformity: A visible or palpable irregularity in the bone under the skin.

In some cases, the fracture may not be immediately obvious, especially if swelling masks the deformity. Symptoms can develop or worsen over time, so it's important to seek medical evaluation even if the injury seems minor at first.

When to See a Doctor

You should see a doctor if you experience any of the following after facial trauma:

• Persistent pain or swelling in the cheek or around the eye.
• Difficulty opening your mouth or chewing.
• Changes in vision, such as double vision or blurred vision.
• Numbness or tingling in the face that doesn’t go away.
• Visible deformity or asymmetry in the face.
• Bleeding from the nose or mouth that doesn’t stop.
• Loose or misaligned teeth.
• Signs of infection, such as fever, increased pain, or pus.

Even if symptoms seem mild, it’s wise to get evaluated. Early diagnosis and treatment can prevent complications like chronic pain, infection, or permanent deformity.

Diagnosis

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

Physical Examination

Your doctor will:

• Inspect your face for swelling, bruising, asymmetry, or deformities.
• Palpate (feel) the cheekbone and surrounding areas for tenderness, step-offs, or instability.
• Check your vision and eye movements to assess for orbital involvement.
• Evaluate your ability to open and close your mouth and check for trismus (lockjaw).
• Test sensation in your face to check for nerve damage.
• Examine your teeth and gums for misalignment or injury.

Imaging Studies

Imaging is crucial for confirming the diagnosis and planning treatment. Common imaging techniques include:

• X-rays: Standard facial X-rays can show fractures in the zygomatic bone and adjacent structures. However, they may miss subtle fractures.
• CT scan (Computed Tomography): This is the gold standard for diagnosing zygomatic fractures. A CT scan provides detailed 3D images of the facial bones, helping to assess the extent and displacement of the fracture. It also evaluates involvement of the orbital floor and other critical structures.
• MRI (Magnetic Resonance Imaging): Less commonly used for bone fractures, but helpful if there is suspicion of soft tissue or nerve damage.

Sources: NCBI - Imaging of Zygomaticomaxillary Complex Fractures, Mayo Clinic - CT Scan

Treatment Options

The treatment for a zygomatic fracture depends on the severity, displacement of the bone, and associated injuries. Options range from conservative management to surgical intervention.

Non-Surgical Treatment

For minor, non-displaced fractures (where the bone is cracked but not moved out of place), non-surgical treatment may be sufficient:

• Pain management: Over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil) can help manage pain. Follow your doctor’s recommendations for dosage.
• Ice packs: Apply ice to the affected area for 15-20 minutes every hour for the first 48 hours to reduce swelling. Use a cloth to protect your skin from direct ice contact.
• Soft diet: Eat soft or liquid foods to avoid putting pressure on the fracture. Avoid chewing on the affected side.
• Rest: Limit physical activity, especially contact sports or activities that risk further injury.
• Nasal decongestants: If the fracture affects the sinuses, your doctor may recommend decongestants to reduce swelling and improve drainage.

Surgical Treatment

Surgery is often required for displaced fractures or those involving the orbital floor. The goal is to realign the bones (reduction) and stabilize them (fixation) to restore normal function and appearance. Common surgical approaches include:

• Closed reduction: The bones are manually realigned without making large incisions. This is less common for zygomatic fractures but may be used in certain cases.
• Open reduction and internal fixation (ORIF): This is the most common surgical approach. The surgeon makes incisions (often inside the mouth or near the eyebrow) to access the fracture. The bones are realigned and held in place with small plates and screws made of titanium or other biocompatible materials.
• Orbital floor reconstruction: If the fracture extends into the eye socket, the surgeon may need to repair the orbital floor using synthetic materials or bone grafts to prevent long-term vision problems.

Surgery is typically performed under general anesthesia. Recovery time varies but often involves:

• Avoiding strenuous activity for several weeks.
• Following a soft or liquid diet initially.
• Keeping the surgical site clean and dry.
• Attending follow-up appointments to monitor healing.

Sources: NCBI - Management of Zygomatic Fractures, Cleveland Clinic - Orbital Fracture Repair

Home Care After Treatment

Whether you undergo surgery or not, proper home care is essential for recovery:

• Take prescribed medications, including pain relievers and antibiotics (if prescribed), as directed.
• Apply ice packs for the first 48 hours to reduce swelling, then switch to warm compresses if advised by your doctor.
• Avoid blowing your nose if the fracture involves the sinuses, as this can cause air to enter the tissues (surgical emphysema).
• Sleep with your head elevated to reduce swelling.
• Avoid smoking and alcohol, as they can impair healing.
• Follow your doctor’s instructions for oral hygiene, especially if you have incisions inside your mouth.

Prevention Tips

While not all zygomatic fractures can be prevented, you can reduce your risk by taking the following precautions:

• Wear seatbelts: Always use seatbelts in vehicles and ensure children are properly restrained in car seats.
• Use protective gear: Wear helmets and face guards during contact sports, cycling, or activities with a risk of facial injury.
• Drive safely: Avoid distracted or impaired driving, and follow traffic laws to reduce the risk of accidents.
• Prevent falls: Use handrails, keep walkways clear, and use non-slip mats in bathrooms, especially for older adults.
• Avoid altercations: Steer clear of situations that could lead to physical confrontations.
• Childproof your home: Secure furniture and use safety gates to prevent falls in young children.
• Wear appropriate footwear: Use shoes with good traction to prevent slips and falls.
• Follow workplace safety guidelines: Use protective equipment and adhere to safety protocols in high-risk environments.

Being aware of your surroundings and taking proactive steps to protect your face can significantly lower the risk of a zygomatic fracture.

Emergency Warning Signs

Seek immediate medical attention if you experience any of the following after a facial injury:

• Severe headache or confusion: Could indicate a traumatic brain injury.
• Loss of consciousness: Even brief unconsciousness requires urgent evaluation.
• Severe or worsening vision problems: Such as double vision, blindness, or inability to move the eye, which may indicate orbital damage or nerve injury.
• Persistent or heavy bleeding: From the nose, mouth, or ears that doesn’t stop with pressure.
• Clear fluid draining from the nose or ears: Could be a sign of a cerebrospinal fluid (CSF) leak, indicating a skull fracture.
• Severe pain not relieved by medication: Or pain that worsens over time.
• Signs of infection: Such as fever, increased swelling, redness, or pus at the injury site.
• Difficulty breathing: Could indicate airway obstruction or other serious complications.
• Seizures or neurological symptoms: Such as slurred speech, weakness, or numbness in other parts of the body.

If you or someone else experiences these symptoms, call emergency services or go to the nearest emergency room immediately. Delaying treatment for severe symptoms can lead to permanent damage or life-threatening complications.

Sources: CDC - Traumatic Brain Injury, World Health Organization (WHO) - Head Injuries