Zygomatic fracture belongs to the category of head as well as facial injuries. Not every fracture needs to be treated surgically; there are also conservative treatment methods.
What is a zygomatic bone 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 problems, above the cheek region. If the bone is subjected to mechanical or direct force, the zygomatic bone can break. Physicians also always speak of a lateral midface fracture . The fracture can also injure adjacent bones. Thus, fractures or injuries to the temporal bone, the mandible, and the orbit and 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 zygomatic bone fracture manifests itself primarily through severe pain. These usually occur immediately after the accident or fall that caused the fracture. The pain is accompanied by swelling and profuse bleeding from the nostril, maxillary sinus, and, in the case of an open fracture, from the injured area. Hematomas form around the eyes, which are dark in color and slightly painful to the touch. However, the flattened cheek is characteristic of the disease. As a result of the fracture, the bone is pushed inward or shifts to one side, resulting in the noticeable appearance of the cheek and surrounding area. The symptoms of a zygomatic fracture occur acutely and persist for several days. Pain subsides after a few hours, although diffuse pain often remains. Swelling increases over the first few days and changes color from red to blue to yellow and green before eventually subsiding. Bleeding subsides after a few minutes, assuming prompt treatment. In isolated cases, blood may enter the tissue layers or even the trachea, causing further discomfort.
Diagnosis and course of the disease
The physician first palpates the injured part of the face. 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
As a rule, a zygomatic fracture results in relatively severe pain. This can also lead to unconsciousness and significantly limits the patient’s quality of life. Likewise, in most cases, the pain from the affected region spreads to other regions of the face and can also cause discomfort there. Furthermore, severe swelling and bleeding occur. Nosebleeds may also occur. Hematomas may form around the eyes, causing slight visual impairment. If the zygomatic bone fracture is not treated early, irreversible consequential damage may occur in the patient. However, this fracture does not need to be treated in every case. In most cases, the affected person suffers from aesthetic discomfort and no longer feels beautiful. Furthermore, inferiority complexes or a reduced self-esteem also occur. Treatment of zygomatic hernia does not lead to further complications. With the help of surgical interventions and medication, the discomfort can be limited relatively well. Aesthetic complaints are also usually well corrected. Life expectancy is not reduced by this hernia.In most cases, however, there are other injuries to the face and entire body in addition to the zygomatic fracture, so they may eventually lead to complications.
When should you go to the doctor?
If the affected person suffers from severe pain in the facial area after an accident, violence or a fall, a doctor should be consulted. Although surgery is not always required, imaging techniques should be used to analyze the bone damage in detail. Only then can an appropriate and optimal treatment be decided. In the event of bleeding in the face, the development of hematomas, severe swelling or discoloration of the skin, a doctor is required. If the affected person suffers from severe nosebleeds or if bleeding is noticed in the area of the jaw, a visit to the doctor should be made. If the face can no longer be moved without pain, if the facial muscles cannot be tightened or loosened as usual, and if a deformity of the face is noticed, a doctor should be consulted. A flattened cheek is considered unusual and should be evaluated by a physician. Abnormalities or pain with chewing movements, a refusal to eat, headache or toothache are indications of injury. A physician should be consulted so that medical care can be initiated as soon as possible. Impaired vision, a stuffy nose, or irregularities in breathing are also among the clues that should be clarified by a physician. If there is sensitivity of the skin throughout the facial area, a pain to the touch or numbness, a doctor is needed.
Treatment and therapy
Zygomatic bone 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 a year after surgery. However, such a procedure requires another operation, which is why many patients – provided the plates and screws do not cause any discomfort – choose 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
A nondisplaced zygomatic fracture can usually be treated conservatively with rest and usually heals within a few weeks, even without surgery. A zygomatic fracture with multiple bone fragments present and marked dislocation requires good surgical correction. Specialists in oral and maxillofacial surgery can usually also fully restore facial aesthetics in most patients. Therefore, the prognosis for a zygomatic fracture is also very good. In the majority of patients, one operation is sufficient to reconstruct the original appearance. Only in exceptional cases is a second corrective surgical procedure necessary. This is the case when the cheek is still somewhat flattened compared to the opposite side. About four weeks after the surgical procedure, the zygomatic bone has grown back together and healed, but often adequate stability is not achieved for eight to nine weeks. The duration of a zygomatic bone fracture varies greatly from patient to patient, and the healing process can be accelerated by rest. However, patients may not be completely symptom-free after a zygomatic fracture for up to six months.
Prevention
There are no preventive measures that will prevent a zygomatic bone fracture. It is important to take extra care when playing sports that increase the risk of a zygomatic fracture. Helmets, which also protect the zygomatic bone, do not yet exist.
Aftercare
Early diagnosis of recurrence is an essential element of follow-up care. Doctors hope this will provide the best possible treatment for life-threatening signs. In the case of zygomatic fracture, however, such follow-up is not indicated. The impact of force on the bones is usually accidental and unpredictable. Helmets can only be used to protect oneself during certain high-risk sports and thus prevent a fracture. However, the patient is responsible for this type of preventive aftercare. Moreover, a repeated zygomatic fracture does not result in a shortened life span. A final recovery occurs instead. Aftercare also includes support functions in everyday life. The patient experiences these as long as the fracture has not completely healed. He is given a sick note and called in for a follow-up examination. The course of healing is documented in this examination. Suitable imaging procedures include X-rays and computer tomography. In addition, an ophthalmological examination is required. If the zygomatic fracture is completely healed, the affected person can continue his life without discomfort and without having to fear consequences from the disease. Therefore, no reason for follow-up care arises after healing.
What you can do yourself
If a zygomatic fracture is suspected, the first thing to do is to take it easy and cool it. An open fracture should be covered with a germ-free dressing until the emergency physician arrives. After the initial treatment, the affected bone must continue to be spared. The attending physician will prescribe appropriate medications for the pain. In addition, various natural remedies – such as blackroot and bamboo tabashir – as well as a healthy and balanced diet are recommended. Foods with a lot of calcium, magnesium and potassium are especially recommended. The active ingredient silicon can also promote bone healing. In addition, sporting activities that could jeopardize recovery should be temporarily reduced. Regular exercise, on the other hand, can promote the healing process. In consultation with the doctor, physiotherapy, yoga or Pilates can be performed, for example. Gentle massages or a visit to the sauna also promote healing. Both stimulate blood circulation and support wound healing of skin and bones. Finally, care should be taken to ensure good wound care.If the cheekbone fracture has not healed after ten weeks at the latest, the doctor must be informed. In the case of permanent changes, it is sometimes also advisable to talk to a plastic surgeon.
