Q: Four years ago, I was injured and sustained a fractured zygomatic arch from a blow to the side of my face from a punch. I did not get it treated at the time because I had no medical insurance. After the swelling went down, I noticed an indentation over the side of my face which has remained ever since. Recently I visited a local plastic surgeon and he suggested to inject Artefill into the cheek area to lift up the dent. It is about the size of a dime or larger in diameter, a little less than an inch maybe. I had a CT scan which showed the zygomatic arch in the form of a U shape and it goes impressed in towards my skull. Please give me your opinion about his idea and yours.
A: The zygomatic arch is a very thin piece of bone that runs between the cheek bone (zygoma) in the front of the face back to the temple bone near the temporomandibular joint. It has a true arch shape as the large temporalis muscle runs underneath it. This arch shape provides fullness to the transition zone of the temple above to the rest of the face below.
Because of its thinness, it can be easily fractured with a direct blow. Once fractured, it changes from a convex arch to a V-shape as the fractured ends bow inward. This will create an indentation in the overly cheek skin. While easily repaired near the time of injury, it is very difficult to fix once it has healed in this position. If one has difficulty with opening one’s mouth because of the bone edges impinging on the masseter muscle, then some form of bony repair should be attempted.
If the zygomatic arch fracture is causing an external cosmetic deformity (indentation), there are multiple ways to fill out this bony deformity. Using an injectable filler is a simple and very reasonable method. While Artefill is a long-lasting filler, it is not permanent. Repeated injections may make it so however. Another method is to place a custom-shaped arch implant over the bone from an intraoral (inside the mouth) approach. This is easily done and would provide a permanent solution with a single procedure.
Dr. Barry Eppley