The zygomatic bone, commonly known as the cheekbone, can indeed be broken, an injury medically termed a zygomatic fracture. This facial bone forms the prominence of the cheek and contributes significantly to the architecture of the midface. Its location dictates its dual purpose in both facial aesthetics and function. The zygoma provides structural support for the eyeball and protects the delicate contents of the orbit.
The Zygomatic Bone and Fracture Causes
The zygomatic bone articulates with the maxilla, frontal, and temporal bones, making it a buttress for the midface. Despite its strength, its prominent position on the face makes it particularly susceptible to injury from blunt force trauma. A fracture often involves the entire zygomaticomaxillary complex, affecting multiple joints and surrounding structures.
The mechanism of injury almost always involves high-impact kinetic force directed at the side of the face. Common causes include violent altercations and motor vehicle accidents. Other mechanisms of injury include accidental falls and participation in contact sports. The severity of the fracture is directly proportional to the energy of the impact.
Recognizing the Signs of a Zygomatic Fracture
The symptoms a person experiences immediately after a cheekbone injury often reflect the displacement of the bone and involvement of nearby nerves and the eye socket. One of the most common visual signs is a flattening of the cheek’s natural prominence, known as the malar eminence, which can be masked initially by significant swelling and bruising around the eye. Palpation may reveal a “step defect” or an abnormal break in the contour along the infraorbital rim or the edge of the cheekbone.
Functional signs are also common due to the bone’s connection to the jaw muscles and nerves. Difficulty or pain when attempting to open the mouth, known as trismus, may occur if the displaced zygomatic arch interferes with the movement of the lower jaw. Another frequent symptom is numbness or a tingling sensation, called paresthesia, in the cheek, upper lip, or gums, which results from trauma to the infraorbital nerve that runs through the area.
Since the zygoma forms a portion of the orbit, visual disturbances are a serious sign of injury. Double vision, or diplopia, can occur if the fracture has shifted the eyeball’s position or entrapped the muscles that control eye movement. Bleeding from the nose and bruising of the white part of the eye are also frequently observed following this type of facial trauma.
Medical Confirmation and Treatment Options
Diagnosis of a zygomatic fracture begins with a thorough physical examination, assessing facial symmetry, nerve function, and ocular movement. Confirmation is typically achieved through imaging studies, with a computed tomography (CT) scan being the preferred method. CT scans provide detailed reconstructions necessary to accurately assess the extent of the fracture, particularly checking for involvement of the orbital floor and any subtle displacement.
Treatment decisions depend on the degree of displacement and the presence of functional impairment. Fractures that are non-displaced or minimally displaced, without issues like vision problems or restricted jaw movement, are often managed conservatively. This non-surgical approach involves observation, pain control with analgesics, and activity restriction to allow for natural healing.
Surgical intervention is indicated for fractures that cause functional problems or significant cosmetic deformity. The goals of surgery are to restore normal facial contour, eye function, and sensory nerve and chewing function. The procedure often involves open reduction and internal fixation (ORIF), where the surgeon accesses the fracture sites, repositions the bone fragments, and secures them with small titanium plates and screws. Surgery is generally performed within three weeks of the injury.
Treatment Options
Surgical approaches are chosen to minimize visible scarring, with incisions sometimes placed inside the mouth, in the lower eyelid crease, or in the hairline. The most unstable fractures require multiple points of fixation to counteract the forces exerted by the chewing muscles. For complex fractures involving the orbital floor, the surgeon may need to reconstruct the area to support the eyeball and prevent it from sinking.
Recovery Process and Potential Long-Term Effects
Following either non-surgical or surgical management, patients are advised to refrain from strenuous activities for at least six weeks to allow the bone to heal completely. Swelling and bruising are expected, but they typically decrease significantly within the first two weeks post-injury. Patients must avoid activities that increase pressure in the head, such as forcefully blowing their nose, which can risk pushing air into the tissue around the eye.
A common potential long-term effect is persistent numbness in the cheek, upper lip, or gum area due to infraorbital nerve damage. While the sensation often improves over several months, patients may experience some degree of long-term sensory impairment. Cosmetic deformities, such as a subtle flattening of the cheek or facial asymmetry, can occur if the fracture reduction was not perfectly stable.
Vision problems, including residual double vision, are possible if the initial injury involved severe trauma to the orbit or if the eye muscles were permanently affected. Although rare, chronic pain and limited jaw movement can also persist in the long term. Regular follow-up appointments are necessary to monitor healing and ensure that both the function and appearance of the face are restored.