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Cheekbone (Arch) Fracture
Zygomatic Arch Fracture |
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INTRODUCTION:
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The zygoma (cheekbone) is not only very prominent on the face, but it also makes up a large component of the bony orbit (space in the facial skeleton where the eye sits). Trauma to the face whether from a fist, other blunt object, or during motor vehicle accidents can result in fracture of this bone. Although sometimes these fractures can be severe and involve the bony orbit, sometimes the only fractured component of the bone is what is referred to as the arch. This is a thin extension of the cheekbone towards the skull.
SYMPTOMS:
Patients that have a fracture of the cheekbone can present with a multitude of symptoms that are the direct result of the location of this bone on the face, and its association to other structures. However when only the arch is fractured, the symptoms are less severe than when the whole bone is fractured. Besides the usual swelling, bruising, pain, and associated depression on that side of the face, there might be some associated trismus or inability to fully open the mouth. This occurs because certain muscles that function to close the mouth run underneath or attach directly to the fractured bone. Spasms in these muscles can make it difficult for the patient to fully open the mouth.
TREATMENT:
In evaluating these kinds of injuries, not only clinical exam is important but radiologic evaluation in the form of a CT scan is also very informative. It is extremely important with the radiologic evaluation, to differentiate these fractures from the much more involved zygomatic (ZMC) fracture, which involve the support structures of the eye and require more extensive surgery.
Once all other injuries are ruled out and the diagnosis of an arch fracture is done, the principle of treatment involves realigning the fractures segments. Because reaching this bone is technically very difficult without making obvious scars on the face, this fracture is usually treated by making incisions either behind the hairline or in the mouth and reaching the fracture (blindly) with instruments alone. Alignment of the fractured bone can be accomplished this way but not the placement of any metal bone plate or wires. Fortunately, realignment of the fractured bones is often all that is needed as the bones will remain in position until healing occurs. If this option is used, the surgeon will usually place or tape some sort of guard on the outside of the face to remind the patient not to rest or lie on that side of the face while the bone is healing.
There are times however, when simple realignment of the bones without plates and screws is not enough, as the fracture is not stable and the bone segments collapse spontaneously. If this is the case, then direct access to the arch is usually necessary in order to place a metal bone plate and screws to maintain the bony segments in their proper position. This is accomplished through a coronal incision, a more extensive incision made behind the hairline which allows, after some dissection, direct visualization and access to the fractured zygomatich arch. This approach is utilized only as a last result on these cases, because it can compromise the nerve which is responsible for motion of the forehead and eyebrow, which happens to run very close to the zygomatic arch and is in the field of dissection.
AFTER THE SURGERY:
With the manipulation of the fractured bone during the surgery, there will be associated swelling and bruising which might be evident for a few days after the surgery. With time however, all this will disappear leaving a normal facial contour and good support for the eye. For the care of the incision inside the mouth, it is extremely important that it is maintained as clean as possible. This is usually done by rinsing thoroughly especially after meals. Over the course of the next few weeks, as the swelling disappears, the final contour of the cheek will be delineated. If the fracture is realigned and the bone heals in its proper position, the final outcome should be almost imperceptible from the opposite, nonfractured side.
The information provided above is for educational purposes only. Individual results may vary. A personal consultation with your plastic surgeon is the best way to gain information about your particular complaint, and about potential treatment options to address the same |
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Address |
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South Miami
6200 Sunset Drive
Suite #402
South Miami, Fl 33143
T (305) 665-8730
F (305) 665-8736
South Beach
1000 5Th Street
Suite #402
Miami Beach, Fl 33139
T (305) 604-3216
F (305)-665-8736
Email: info@mosasurgery.com
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