A lateral midface fracture or a zygomatic bone fracture belongs to the category of head as well as facial injuries and is mainly manifested by an occurring swelling and bleeding from the nostril as well as from the maxillary sinus. Characteristic of the zygomatic bone fracture is the flattened cheek in the injured person. Not every fracture requires surgical treatment; conservative treatment methods are also available.
What is a lateral midface fracture?
The zygomatic bone is located in the middle area of the face and forms the outer rim of the eye socket. The zygomatic bone (medically: Os zygomaticum) can be palpated without difficulty, above the cheek region. If the bone is subjected to mechanical or direct force, the zygomatic bone can fracture. Doctors then speak of a lateral midface fracture. The fracture can also injure adjacent bones. Thus, fractures or injuries of the temporal bone, the mandible as well as the orbit and the frontal bone are possible.
Causes
A strong, mechanical as well as direct impact of force, which is specifically exerted on the zygomatic bone, is among the most frequent causes of a zygomatic bone fracture . This kind of force can be exerted in the course of a fall, a collision as well as a blow. Mostly, injuries of the zygomatic bone occur during soccer games, when both players collide with their heads – for example during a header duel. Traffic accidents and falls on bicycles also increase the risk of a zygomatic bone fracture. Sometimes violent altercations, such as fights, can also cause a zygomatic bone injury.
Symptoms, complaints and signs
A lateral midface fracture can first be recognized by the noticeable injury in the facial area. Sufferers notice severe pain, bleeding, hematoma, and dysfunction of the nose, eyes, mouth, and jaw after an accident or fall. In most cases, the injury can be seen at first glance, and the diagnosis can be solidified by the characteristic symptoms. If the eye sockets are involved, for example, there may be a drooping of the eyeball. This can lead to visual disturbances (for example, double vision). In addition, a spectacle hematoma may develop, which often increases in size and causes severe pain. Abnormal mobility may be noted in the facial area. Typically, swelling occurs in the affected area, characterized by redness and pressure pain. Bleeding from the mouth and nose is also possible. If the jaw is affected, lockjaw may occur. Then severe pain sets in during jaw movements. If the nose is involved, olfactory disturbances and even loss of smell may occur. An inadequate or poorly treated lateral midface fracture can lead to the development of a malocclusion. Serious jaw injuries occasionally result in osteoarthritis of the temporomandibular joint, which is manifested by chronic pain.
Diagnosis and course of the disease
The physician first palpates the injured facial area. If a zygomatic fracture is suspected, an x-ray is taken. Diagnostic imaging can detect not only the fracture but also its extent. In the further course, the physician examines the adjacent bones in order to be able to determine or exclude any injuries. Aesthetic impairments or complications are not to be feared if professional treatment is carried out. In very few cases, the “flattened” cheek remains. However, at the patient’s request, this can be corrected by means of a surgical procedure.
Complications
This midface fracture usually results in relatively severe pain. In most cases, these spread to other areas of the body and can lead to headaches or earaches. Furthermore, discomfort may also occur at the temples, causing the affected person to suffer from severe nausea or vomiting. Not infrequently, the lateral midface fracture also leads to unconsciousness of the patient. The further course usually depends strongly on the respective violent impact and its damage. Furthermore, there is also severe swelling and bruising of the face. Pressure pains may become noticeable in the affected areas.Particularly at night, sleep complaints may occur, causing the patient to become irritable due to the lack of sleep. Complications can occur if the skin is directly cooled too much, resulting in burns. Similarly, the eye socket can also be injured, causing visual problems. In most cases, those affected have to undergo surgical intervention. This can alleviate the discomfort and fix the hernia again. As a rule, there is a positive course of the disease.
When should one go to the doctor?
After a fall or a serious injury, a doctor should always be consulted. If the injured person is in severe pain, bleeding or showing signs of a concussion, it is best to call 911. The same applies if there is loss of consciousness or an open wound on the head. The lateral midface fracture heals within a few weeks, provided it is treated early. That is why a medical professional should always be called, even for minor injuries. People who notice visual or olfactory disturbances after a collision or a fall should see their family doctor or a neurologist. External changes such as a sunken eyeball or swelling should always be examined and treated by a physician. A physician should be consulted regularly during treatment. Close monitoring ensures that the wound does not become infected and that no other complications occur. If dizzy spells, sudden fatigue or even impaired consciousness occur during the recovery phase, the emergency medical service is the appropriate contact. Any side effects or interactions of prescribed medications should be reported to the physician.
Treatment and therapy
Zygomatic fracture is a relatively severe injury. Usually, the injury is corrected surgically. However, if there is no displacement of the bone, conservative therapy may also bring the desired success. If the physician determines a non-displaced fracture (not displaced), in some cases this can also be treated without surgical intervention. The patient should observe physical rest for several weeks. Swelling that occurs in the facial area must be cooled. However, it is important that the affected person never holds the cooling material directly against the skin surface, as otherwise skin damage is possible. The cooling material should therefore be placed in a towel on the affected area. If the bone is displaced or the physician has determined that pieces of bone have splintered off, surgery is performed. During the operation, special plates and screws are used to join the bone fragments and fix them in their original position. During the procedure, the patient is under general anesthesia. In a few cases, however, local anesthesia or local anesthesia can be administered. The physician makes a small skin incision that extends from the lower eyelid to the eyebrow. Another surgical method, but rarely used, is performed through the patient’s oral cavity. If there is an injury to the eye socket, the skin incision is made just behind the hairline. In the further course of the operation, the surgeon tries to restore the bone fragments, which are not in their natural position, to their original position. Then metal plates and screws are used to fix the fragments together. If the patient has only a zygomatic bone fracture – without any other injuries – the position can be fixed with a “hook technique”. If the hook technique is successful, no screws are used. If the orbit is also affected by an injury, an extensive reconstruction of the midface must be created. Vessels may also be injured, so that in many cases the physician requires balloons as well as tamponades. If the physician determines during the procedure that pronounced defects are present, a transplantation may also be necessary, among other things. In addition to foreign materials, cartilage as well as bone pieces obtained from the ribs as well as the hip can also be used. The plates and screws needed to fix the zygomatic bone can be removed from the bone one year after surgery.However, such an intervention requires a further operation, which is why many patients – provided the plates and screws do not cause any discomfort – decide not to have the foreign materials removed. If there is a significant impairment of aesthetics, the specialist for oral and maxillofacial surgery treats the patient in the further course of the operation and restores the impaired area – to the satisfaction of the affected person. Those are also the reasons that make a relatively good prognosis possible. As a rule, one operation is sufficient to fix the bone or correct the face so that there are no aesthetic impairments. Only in the case of very complex injuries is it possible that a second operation will have to be performed.
Outlook and prognosis
The prognosis of lateral midface fracture is favorable. Although there is so very severe pain and impairment in coping with everyday life, freedom from symptoms is usually documented after completion of treatment. The healing process takes several months. In the majority of cases, no surgical intervention is required. After clarifying the position of the bones in the face and any existing damage, the treatment plan is drawn up. If the fractured bones are not displaced, rest and sparing are ordered. If the patient follows the doctor’s instructions during the healing process, the prognosis is good. If surgery is needed, it may lead to complications. Any surgery carries risks and side effects that can occur at any time. Nevertheless, it is a routine procedure that in most cases takes place successfully without further incident. If the affected person does not adhere to the doctor’s instructions, the healing process may be considerably delayed or complaints may show an increasing character. In very rare cases, an unfavorable course of the disease is seen. In this case, among other things, a transplantation becomes necessary. In addition, foreign materials may be temporarily inserted. These must be removed again in the further course. With both treatment methods, the probability of secondary damage or the development of other diseases is increased.
Prevention
There are no preventive measures that will prevent a zygomatic fracture. It is important to take special care during sports that increase the risk of a zygomatic fracture. Helmets, which also protect the zygomatic bone, do not yet exist.
Aftercare
The affected person often has only a few measures of aftercare available in the case of a midface fracture. First and foremost, a doctor should be consulted quickly and, above all, at an early stage to prevent further complications or incorrect fusion of the bones. The earlier a doctor is consulted, the better the further course of the disease usually is. In most cases, the symptoms can be relatively well solved by minor surgical interventions. However, the face must be protected particularly well after such an operation to prevent infections or inflammations. Likewise, the patient should rest and take care of his body after the procedure. Efforts or stressful and physical activities should be refrained from in order not to put unnecessary strain on the body. As a rule, the symptoms of the midface fracture can be completely healed, although in some cases scars may remain. These can be treated with various creams or ointments so that they do not reduce the aesthetics of the affected person. In most cases, the midface fracture does not negatively affect or limit the life expectancy of the affected person.
Here’s what you can do yourself
In most cases, a midface fracture must be treated with surgery. However, conservative options are also available to the affected person to help with treatment. The swelling associated with this fracture can be relieved with the use of cold applications. Care should be taken to ensure that the cool material never touches the skin directly. This means that ice, for example, should always be wrapped in a cloth before being placed on the skin. However, in the case of bone dislocation or splinters, surgical intervention is always necessary to ensure proper fusion of the bone. In case of pain, the affected persons depend on taking painkillers.It should be noted that long-term use of painkillers can damage the stomach and should therefore be done only after consultation with a doctor. In some cases, those affected may also suffer from depression or psychological discomfort due to reduced aesthetics. In this case, conversations with close friends and parents are helpful in alleviating inferiority complexes. Likewise, conversations with other sufferers of this fracture also help. In most cases, however, all discomfort can be alleviated so that there are no permanent aesthetic limitations.
