Q: Dr. Eppley, several weeks ago I had surgery to repair a cheekbone fracture. However, I am not satisfied with the results. The cheek bone fracture was repaired through an incision in my temple hair. I was told by the surgeon the fracture couldn’t be accurately aligned and fixed together without significant scarring so this was the best way to do it. Is this possible for you to do? Is it too late? I have attached a picture of how I look now so you can see that my cheek is flat but the side of my face is wider than before.
A: Your history and picture are very helpful in understanding what type of zygomatic fracture that you have.It appears you have a classic ZMC fracture with inward rotation of the cheekbone complex into the maxillary sinus. This is the classic direction that it rotates when displaced, down and in. That explains the orbital rim-zygomatic flattening with the lateral facial widening (bowing out of the zygomatic arch) that you have.
I wonder why a Gilles approach as used for your repair that as that would never work. The Gilles approach is for an isolated zygoimatic ARCH fracture not a body fracture. Your cheekbone fracture repair could be fixed by either an intraoral incision alone or combined with a lower eyelid approach. The bones could be realigned and then secured by plate and screw fixation. That would not result in any significant scarring. That is the classic and best approach with hat appears to be your zygomatic fracture.
Dr. Barry Eppley
Q: Dr.Eppley, my fiance was hit in his face with a softball. We went to the doctor and the doctor told us that a part of it had shattered and recommended us to see a specialist. Approximately how much will his cheekbone surgery be? He doesn’t have a job, or any insurance. It is only I with an income and I’m supporting a family of five will that take part in paying for it?
A: It would be impossible for me to say exactly what needs to be done with your fiance’s facial bone fracture. I am assuming, having seen a lot of ball injuries to the face, that it is a cheekbone fracture that may or may not involve the orbital floor. Some types of cheek bone fractures can be repaired simply through a single intraoral incision. If the orbital floor is significantly displaced, the fracture is more complex and would require a combined intraoral and a lower eyelid incision. Because of these differences, it is difficult to provide an accurate cost estimate. I would need to see some x-rays of his facial fracture to provide a good estimate.
Q: I have an old indented fracture of my left cheekbone. I fell several years ago on my face and was diagnosed with an ‘infracture of my zygoma’. It didn’t seem to bad at the time but maybe the swelling made it look better than it was. Now that side of my cheek is flatter and asymmetric to the opposite cheek. Can it be repaired?
A: Zygomatic, or cheekbone fractures, are common facial injuries. When fractured, the cheekbone rotates downward and inward, causing loss of prominence of the cheek. While the swelling may camouflage the ultimate degree of cheek flattening, eventually an asymmetric cheek will result if not repaired as the swelling goes away and the overlying soft tissue contracts.
Secondary correction of the cheek flattening can be done by one of two approaches. A cheek implant can be placed through the mouth to build the depressed part of the cheek back out. With some many different styles and sizes of cheek implants available today, a lot of cheek reshaping can be done with an implant alone. The other more extensive alternative is to re-fracture the cheekbone and move it back into its original position. (cheek osteotomy) Generally, a cheek osteotomy is reserved for those cheek deformities where the amount of cheek flattening is severe, the position of the corner of the eye is pulled down, and/or there is numbness of the lip and nose from the infraorbital nerve being impinged from the bone displacement.
I suspect your cheek deformity is more modest, since it was not initially repaired, and an implant would be the simplest and less complicated treatment approach.
Dr. Barry Eppley
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