Q: Nearly 15 years ago I was assaulted and punched repeatedly while unconscious. This resulted in broken bones in my face which were never fixed at the time. I have a sunken cheek and I believe my eye has dropped slightly with it. Can my cheek be repaired being that it was so long ago?
A: It sounds like your original facial fracture was of the zygomatic-orbital complex variety which displaced in its classic manner, downward and into the maxillary sinus. When this ‘cheekbone complex’ falls down like this it creates a depressed or sunken cheek (lack of cheek projection/prominence) as well as moving the floor of the eye down with it. (eyeball moves downward)
Just because it has been allowed to heal and needs secondary correction does not preclude that it can be treated. But the type of treatment changes when the injury is old like yours as opposed to when it was a freshly broken. Depending upon the degree of bone displacement, there are two options. If the cheek displaccement is fairly mild, it can be treated with a cheek implant and possibly an orbital floor implant and repositioning of the corner of the eye tendon. (lateral canthoplasty) If the bone displacement is more severe, however, it is better to cut the cheekbone complex (osteotomy) and do bone grafting. Simply trying to build up bone with implants that is way out of position does not produce a result that looks very natural.
Dr. Barry Eppley
Q: When I was younger, around 14 years old, I was punched on the left side of my cheek which caused my left side (cheekbone) to be larger than my right side. I did not notice this until my ex-g/f, then current, informed me of this. It’s maybe 4 to 6mms bigger than the right side. I didn’t get it fixed since I didn’t realize there was a problem until the bones had already repaired itself. I suspect a lot of it is bone growth making my cheekbone larger. Could you tell me if this is possible to fix?
A: This is an unusual reaction to a traumatic facial injury. Usually the cheekbone would have gotten fractured causing the opposite problem long-term, cheek indentation or flattening. The observation that it got bigger would indicate that an actual fracture of the bone did not occur.
It is more likely that you sustained a traumatic hematoma (blood collection) to the tissues. This could result in either extra bone being deposited on the outer surface of the cheekbone (appositional bone development with blood as the stimulant which could happen in a growing bone such as a teenager) or scar tissue which has thickened the soft tissue.
The question is how do you make that determination as to which it is? A plain x-ray (Water’s view) would be a simple and useful diagnostic test. Or you could just treat the problem the only way you can which is cheekbone reduction. Even if it is soft tissue thickening, bone reduction would still be the treatment method. Through an incision inside the mouth, the outer surface of the cheekbone would be burred down. If the difference was greater, a cheekbone reduction osteotomy could be done. But for 5mms or less, simple outer cortical burring of the cheekbone is the best way to go. Because it is done through the mouth, there would be no scarring and just a temporary period (four to six weeks) before you would see the final result,.
Dr. Barry Eppley