The zygomatic arch, commonly known as the cheekbone, is a bony structure on the side of the skull that forms the prominence of the cheek. It is composed of two main parts: the temporal process of the zygomatic bone and the zygomatic process of the temporal bone, which join together to form a curved arch. This arch serves a dual purpose, offering protection to the eye and acting as an attachment point for muscles involved in jaw movement. A zygomatic arch fracture specifically refers to a break in this bony structure, which can disrupt both facial contour and function.
Common Causes of Injury
Zygomatic arch fractures often result from direct blunt force trauma applied to the side of the face. The prominent location of the arch makes it susceptible to injury from various high-impact incidents. These injuries often occur due to motor vehicle accidents.
Physical altercations, such as fights, also represent a frequent cause of these fractures. Additionally, significant falls can lead to a zygomatic arch fracture if the impact directly affects the cheek area. Contact sports injuries, resulting from impacts like an elbow, helmet, or ball, are another common mechanism.
Signs and Diagnosis
A zygomatic arch fracture presents with noticeable signs and symptoms. Immediate pain and significant swelling are common, often appearing around the cheek and eye. A visible flattening of the cheek’s natural contour can also be observed, though initial swelling might obscure this.
Functional symptoms often include difficulty or pain when opening the mouth, known as trismus. Numbness or tingling in the cheek, upper lip, or side of the nose may indicate involvement of the infraorbital nerve. Double vision (diplopia) or a sunken appearance of the eye (enophthalmos) can also occur if the fracture extends to the orbital floor.
To confirm a suspected zygomatic arch fracture, a healthcare provider will conduct a physical examination, assessing facial symmetry, sensation, and jaw movement. Imaging studies are then performed to visualize the bone and determine the precise nature of the injury. A computed tomography (CT) scan is the standard diagnostic tool for these fractures. This imaging technique provides detailed, three-dimensional views of the facial bones, allowing medical professionals to accurately assess the fracture’s location, severity, and displacement, and identify any associated injuries.
Treatment Approaches
Treatment for a zygomatic arch fracture aims to restore facial contour, sensory nerve function, eye position, and chewing ability. The approach chosen depends on the fracture’s severity and whether the bone fragments are displaced. Non-surgical management is an option for fractures that are non-displaced or only minimally displaced, meaning the bone is cracked but largely remains in its proper alignment.
This conservative approach involves observation, pain control with medication, and adhering to a soft or liquid diet for several weeks to prevent putting pressure on the healing bone. Patients are monitored weekly to ensure proper healing. Non-surgical treatment may also be considered if a patient’s overall health prevents surgical intervention.
Surgical treatment becomes necessary for displaced fractures to restore proper facial symmetry and jaw function. The primary goals of surgery are “reduction,” which involves moving the fractured bone segments back into their correct anatomical position, and “fixation,” where small plates and screws are used to stabilize the bone during healing. For isolated zygomatic arch fractures, indirect reduction techniques like the Gillies lift are commonly employed. This procedure involves making a small incision to insert an instrument that lifts the depressed arch back into place. Surgical intervention is advised within three weeks of the injury to prevent scar tissue formation that could complicate reduction.
The Healing and Recovery Process
Following treatment for a zygomatic arch fracture, the healing and recovery process involves several steps. Patients are advised to consume a soft or liquid diet for several weeks, often one to two weeks initially, to protect the healing bone. Advancing to a non-chew diet can occur after two weeks, with soft foods introduced around four weeks, and a gradual return to a normal diet by six to eight weeks.
Pain and swelling are common immediately after treatment, with the first few days being the most intense. These symptoms can be managed with prescribed pain medication and by applying cold packs to the affected area. Keeping the head elevated, especially while sleeping, can also help reduce swelling and discomfort.
Initial bone mending takes six to eight weeks, though complete healing can extend beyond this period. During recovery, activity restrictions are necessary to protect the healing fracture. Strenuous physical activity should be avoided for at least two weeks, and engagement in contact sports or any activities with a risk of facial impact is prohibited for a longer duration, often eight weeks or more, to prevent re-injury. Adhering to all post-treatment instructions, including avoiding nose blowing, is important for proper healing.