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Zygomatic Bone Fracture: Causes, Symptoms & Treatment

A zygomatic bone fracture is a break in the cheekbone, a prominent bone of the mid-face. It typically results from blunt trauma and often requires surgical treatment.

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Things worth knowing about "Zygomatic Bone Fracture"

A zygomatic bone fracture is a break in the cheekbone, a prominent bone of the mid-face. It typically results from blunt trauma and often requires surgical 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

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.
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.
Ehrenfeld M, Manson PN, Prein J (eds). Principles of Internal Fixation of the Craniomaxillofacial Skeleton. Thieme; 2012.

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