Exodontia.Info
Fractures of the Cheek Bone /
Zygomatic Complex
Fractures of the Cheek Bone / Zygomatic Complex

This leaflet has been designed to improve your
understanding of your forthcoming treatment and contains
answers to many of the common questions.  If you have
any other questions that the leaflet does not answer or
would like further explanation please ask a member of the
medical or nursing staff.

The Problem

Your cheekbone has been broken.

The cheekbone forms part of the eye socket, both
protecting the eyeball and supporting it from below.  It is
also linked to the side of the nose and the upper jaw.

The number of
fractures, where they have occurred and
whether they need treatment to help them heal has already
been explained to you.  The treatment that is about to take
place involves a
general anaesthetic, i.e.: you will not be
conscious during the procedure.
What does the operation involve?

Once you are anaesthetised, the cheekbone will be put
back in the right place.  This usually involves a small cut
about an inch long through the hair in the temple.

Sometimes this is all that is required but if the surgeon does
not feel that your cheekbone will stay in the correct position
on its own, it may be necessary to hold it in place with small
metal plates and screws.  
Putting these plates and screws
into the cheekbone may require one or more alternative cuts:

  • A cut made close to the outside end of the eyebrow
  • A cut made on the inside of the mouth through the gum
    above the back teeth
  • A cut made in the skin crease just below the lower
    eyelashes or on the inside of the lower eyelid

These cuts are put back together again at the end of the
operation with stitches.  Stitches on the skin need to be
removed after a week but any stitches inside the mouth are
usually dissolvable although they can take a fortnight or
even longer to fall out.
Incisions made to access fractures around the
orbit & zygoma
Will anything else be done while I am anaesthetised?

Some fractures of the cheekbone produce a break in the
floor of the eye socket that needs attention.  In such cases,
a cut on the inside / outside of the lower eyelid is necessary
as described above.

Occasionally, the bones in the floor of the eye socket are
shattered and do not support the eyeball properly, even if
they are put back in the right position.  In these
circumstances it may be necessary to either “graft” the floor
of your eye socket to support the eyeball or put in a titanium
mesh to do the same thing.

The graft material that is going to be used will be discussed
with you before you sign any consent form for your
operation.  However, it can involve thin sheets of plastic or
bone grafted from other areas of your body.

What can I expect after the operation?

The area affected is likely to be sore and regular painkillers
will be arranged for you.  The discomfort is usually worse
for the first few days, although it may take a couple of
weeks to completely disappear.  
Cheekbone fractures
usually heal without infection but it may be necessary to
give you antibiotics, particularly if a “graft” has been used.  
Initially, it may be necessary to give you antibiotics through
a vein in your arm whilst you are in hospital.  You will be
sent home with painkillers and a course of
antibiotics if
necessary.

There is usually some swelling and bruising in the skin
around the eyelids.  Occasionally, the whites of the eyes
may become bruised giving them a red appearance.  All
these changes are most noticeable in the first 24 hours
after surgery and will have very much reduced by the end of
the second week.  Swelling and bruising can be improved
by using cold compresses / packet of frozen peas and
sleeping propped upright for the first few days after
surgery.  You usually stay in hospital for one night following
the surgery.  The following day the position of your
cheekbone may be checked with X-rays before you are
allowed home.

Even if the fracture has been held in the right place with
plates and screws, it still takes around six weeks for your
cheekbone to heal completely.  During this time, you need
to be careful to avoid an injury to this side of your face since
it may well push the cheekbone back out of position again.

You should also avoid blowing your nose on the side of the
fracture for a month following surgery because otherwise
this can produce swelling in and around the eye.

Before you leave hospital, an appointment will be arranged
to take out any stitches and review you in the outpatient
department.  It is important to keep any stitches or
dressings dry until they are removed.  If you have any
incisions inside your mouth, it may be difficult to clean your
teeth around the stitches because of soreness.  It is best to
keep the area free from food debris by gently rinsing your
mouth with an antiseptic mouthwash (such as
Corsodyl) or
warm salt water (dissolve a flat teaspoon of kitchen salt in a
cup of warm water) commencing the day after surgery.

Do I need to take any time off work?

Depending on the nature of your work it may be necessary
to take a fortnight or so off work and avoid strenuous
exercise for this time.  It is important to remember that you
will not be able to drive or operate machinery for 48 hours
after your general anaesthetic.

What are the possible problems?

  • Post-op Numbness.  There is a nerve (the Infra-Orbital
    Nerve) that runs through the cheekbone that supplies
    feeling to the cheek, side of your nose and upper lip.

    This nerve may have been bruised at the time of the
    fracture and as a result you might already feel some
    tingling or numbness over your face.  Tingling may also
    be caused / made worse by surgery.  In the majority of
    people, the numbness gets better on its own although it
    may take several months to do so (in some cases,
    normal sensation never recovers).

  • Post-op Bruising & Swelling.  There is likely to be
    swelling and bruising at the operation site post-
    operatively.  These will both settle with time.  there is a
    chance if this occurs around the eye, that you may
    develop a black eye.

  • Post-op Limitation of Mouth Opening.  This limitation of
    mouth opening should improve with time.

  • Facial Scarring.  Any cuts made on the face will
    produce a scar, which should fade with time and after a
    few months become difficult to see.

  • Post-op Bleeding.  Bleeding can occur from the incision
    sites, though this is unlikely to be a problem.  Should
    the area bleed when you get home, apply pressure
    over the site for at least 10 minutes with a rolled up
    handkerchief or swab.

  • Blindness.  Very rarely, bleeding in and around the eye
    socket can cause a problem with the eyesight
    immediately following surgery (Retro-bulbar
    haemorrhage).  You will be closely monitored in the
    first few hours after your operation to make sure that
    should this happens it is picked up quickly.  If you
    experience worsening vision or pain in and around your
    eye when you get home you should return to hospital
    immediately.

  • Lower Eyelid Malposition.  If a cut is made in the skin
    of the lower eyelid, the outside corner of the lid may
    occasionally be pulled down slightly (an ectropion).  
    This tends to settle on its own but may need further
    surgery.

  • Plate Removal.  Any plates or screws that it has been
    necessary to insert in your cheekbone to hold it in
    position are usually left in place, as they tend not to
    cause problems.  However, the plates are removed if
    they can be touched and cause discomfort; they cause
    pain, become infected or loosen.  Rarely, in cold
    weather, the titanium plates can be associated with
    pain.

  • Sinusitis.  A small minority of people develop, after
    having their cheek bone repaired, a postoperative
    sinusitis.  This was related directly to the severity of
    injury.

  • Facial Asymmetry.  Post-operative facial asymmetry
    occurs in 20 - 40% of patients.  Most postoperative
    irregularities require no surgical intervention; however,
    major asymmetry occurs in 3 - 4% of patients.

    Correction of these cosmetic defects may require
    further surgery.

Will I need further appointments?

A review appointment will be arranged before you leave
hospital.  It is usual to keep a close eye on you for several
months following treatment to make sure that your fracture
heals satisfactorily.
Last Updated 11th August 2010