A broken cheekbone, medically known as a zygomatic fracture, occurs when the bony prominence of the cheek is fractured. The zygoma is a paired, diamond-shaped bone that forms the cheek’s contour and provides protection for the eye socket (orbit). It also serves as an anchor point for facial muscles involved in chewing and expression. When a fracture occurs, the primary question is whether the body’s natural healing process is sufficient to restore both form and function without medical intervention.
Identifying a Potential Cheekbone Fracture
A fracture of the zygoma is typically caused by significant blunt trauma, such as from an accident, a fall, or a sports injury. Following the impact, a person experiences intense pain and rapid swelling around the eye and cheek. Bruising around the eye socket is also a common initial sign.
The fracture may cause noticeable facial asymmetry, sometimes described as a flattened appearance of the cheek. Functional issues include difficulty or pain when attempting to open the mouth or chew, indicating involvement of the structures supporting the jaw. If the fracture involves the orbital floor, a person might experience double vision (diplopia), restricted eye movement, or numbness in the cheek, upper lip, or nose due to nerve involvement. These symptoms necessitate a medical evaluation to assess the extent of the injury and determine the appropriate course of action.
The Biological Process of Bone Regeneration
Bone tissue possesses a capacity for self-repair, following a defined sequence of biological events after a fracture. The initial step is the inflammatory phase, where a blood clot (hematoma) forms at the fracture site within the first few hours. This hematoma serves as a temporary scaffold and initiates the recruitment of specialized cells to the injury.
The next stage involves the formation of a soft callus, where fibroblasts and chondroblasts create a matrix of fibrocartilage that bridges the bone fragments. This temporary structure provides stability to the break over a few weeks. Subsequently, the soft callus transitions into a hard callus as osteoblasts deposit new, woven bone tissue, a process that can take several months.
Finally, the remodeling phase begins, which is the longest stage and can last for months or even years. During this time, osteoclasts resorb excess bone material, while osteoblasts refine the woven bone into mature, lamellar bone. This process ensures the bone regains its original strength and shape, adapting to mechanical stresses.
Key Factors Influencing Healing Without Intervention
Whether a broken cheekbone can successfully heal “by itself” depends on the characteristics of the fracture. Between 10% and 50% of zygomatic complex fractures may not require surgery. These cases typically involve fractures that are non-displaced or only minimally displaced, meaning the bone fragments have not significantly shifted from their normal position.
For conservative management to be successful, the fracture must not compromise the essential functions of the face. This includes maintaining the structural integrity necessary for chewing and protecting the eye. If the fracture causes functional deficits, such as double vision (diplopia), mechanical restriction of the jaw, or entrapment of the eye muscles, intervention is required.
Aesthetic concerns are also a strong factor, as a significant cosmetic deformity, like a noticeable flattening of the cheek, often necessitates surgical correction. If there are no functional problems, severe displacement, or significant aesthetic concerns, the body’s natural healing process can successfully bridge the gap and restore stability. However, the decision to forego surgery requires close observation to ensure no delayed functional issues arise.
Medical Treatment Options and Recovery
For non-displaced or minimally displaced zygomatic fractures showing no functional impairment, medical management is conservative. This approach involves rest, a soft diet to minimize stress on the healing bone, and pain medication. Patients are monitored closely, sometimes with weekly follow-up appointments, to confirm stable healing and ensure the fracture fragments do not shift over time.
Conversely, fractures that are displaced, unstable, or cause functional and aesthetic deficits require surgical intervention. The most common surgical method is Open Reduction and Internal Fixation (ORIF). This procedure involves making incisions to access the fracture site, manually repositioning the bone fragments to their correct anatomical alignment, and securing them permanently with small titanium plates and screws.
Surgery is typically performed within three weeks of the injury, before dense scar tissue forms and complicates the reduction. Post-surgical recovery involves monitoring for complications, particularly vision issues and nerve sensation. Recovery may include a soft diet for six weeks to allow for initial bone healing. The titanium hardware is usually left in place permanently unless it causes discomfort or infection.