How Can An Old Depressed Cheekbone Fracture Be Fixed?

Q : I have broken my cheekbone 2 times and never had surgery. Now my face is assymetrical and I have frequent headaches and can’t breath thru one side of my nose. People close to me say that my face looks caved in. It also affects my vision and I sometimes have localized pain in my cheek. Do you think my insurance will pay for reconstructive surgery? How would this be fixed?

A: Cheekbone, or zyomatic or malar, fractures are common facial bone injuries. They are second in frequency to the most common facial fracture, that of the nose. When a cheek bone fractures, a classic set of problems results from the bone rotating downward into the maxillary sinus. The cheek prominence will become flatter (caved in), one may develop sinus congestion, and numbness or pain may occur from the infraorbital nerve being bruised or pinched. (the fracture line usually goes through the nerve foramen) It does not usually cause any vision problems.

If not repaired early, the secondary cosmetic deformity is that of an asymmetrical face with a flatter cheekbone prominence. There are two ways for its correction after the bone has healed. Building out the depressed cheekbone with a cheek implant is often very successful and is certainly the easiest. The other approach is to re-cut the cheekbone and move it back into its proper place. This is obviously more complicated with a longer recovery but can also be successfully done. Which approach is best is largely determined by the magnitude of the cheekbone depression and whether it extends into the surrounding orbital (eye) area.

Typically, reconstructive surgery from a facial bone fracture should be covered by one’s medical insurance. However, this must be determined by a written pre-determination process before proceeding to surgery.  

Dr. Barry Eppley