Zygomatic Bone Fracture: Causes, Symptoms & Treatment

What is a Zygomatic Bone Fracture?

A zygomatic bone fracture (also called a zygoma fracture, malar fracture, or cheekbone fracture) is a break in the zygomatic bone (Os zygomaticum), which forms the bony prominence of the cheek. The zygoma is closely connected to the zygomatic arch, the orbital floor, and the maxilla. Due to its exposed position in the mid-face, it is particularly vulnerable to injury from external force.

Causes

Zygomatic bone fractures are typically caused by direct blunt force trauma to the cheek area. Common causes include:

• Road traffic accidents (e.g., impact with steering wheel or airbag deployment)
• Physical altercations (punch to the cheek)
• Sports-related injuries, especially in contact sports or cycling accidents
• Occupational accidents

Symptoms

Symptoms of a zygomatic fracture vary depending on severity. Typical signs include:

• Swelling and bruising (hematoma) over the cheek area
• Visible or palpable depression or flattening of the cheek
• Pain during chewing, yawning, or opening the mouth
• Numbness or altered sensation in the cheek, upper lip, or teeth due to involvement of the infraorbital nerve
• Double vision (diplopia) or restricted eye movement if the orbital floor is involved
• Nosebleed when the maxillary sinus is affected
• Limited mouth opening (trismus)

Diagnosis

Diagnosis is made through a combination of clinical examination and imaging:

• Clinical examination: Palpation of the facial bones, assessment of sensation and eye movement
• X-ray: Provides an initial overview but has limited detail for complex fractures
• Computed tomography (CT scan): The gold standard for precisely assessing fracture extent, displacement, and involvement of adjacent structures such as the orbit and maxillary sinus

Classification

Zygomatic fractures are classified according to their extent and severity. Common types include:

• Isolated zygomatic arch fracture: Only the zygomatic arch is fractured
• Zygomaticomaxillary complex (ZMC) fracture: The entire zygoma is separated from surrounding bones with displacement
• Orbitozygomatic fracture: Involves both the zygoma and the orbital walls

Treatment

Conservative Management

Non-displaced fractures without functional impairment may be managed conservatively with:

• Ice application and anti-swelling measures in the acute phase
• Pain management using analgesics
• Soft diet to reduce strain on the jaw
• Regular follow-up to monitor healing progress

Surgical Treatment

Displaced fractures or those causing functional deficits typically require surgical intervention. Common approaches include:

• Closed reduction: Repositioning the bone through small incisions or intraorally without full exposure
• Open reduction and internal fixation (ORIF): Surgical exposure of the fracture with fixation using titanium plates and screws
• Orbital floor reconstruction: In cases of orbital floor involvement, using titanium mesh or autologous cartilage to restore the orbital volume

Healing and Prognosis

With timely and appropriate treatment, the prognosis for a zygomatic bone fracture is generally favorable. Bony healing typically takes 6 to 8 weeks. Potential long-term complications include persistent sensory disturbances in the distribution of the infraorbital nerve, cosmetic deformity, or, in rare cases, ongoing double vision.

References

1. Lübbers H-T, Matthews F, Grätz KW, Kruse AL. Management of zygomaticomaxillary complex fractures. Oral Maxillofac Surg Clin North Am. 2013;25(2):233-243.
2. Kunz C, Audigé L, Cornelius CP, et al. The Comprehensive AOCMF Classification System: Zygomatic Complex Fractures. Craniomaxillofac Trauma Reconstr. 2014;7(Suppl 1):S84-S93.
3. Ehrenfeld M, Manson PN, Prein J (eds). Principles of Internal Fixation of the Craniomaxillofacial Skeleton. Thieme; 2012.