Zygomatic Fracture

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The zygomatic bone (also called zygoma) is an irregular-shaped bone of the human skull. It is often referred to as the cheekbone, and it comprises the prominence just below the lateral side of the orbit. The zygomatic bone is closely quadrangular in shape and it features a total of three surfaces, five borders, and two processes. The zygomatic bone includes three surfaces, which are described below:

  • Lateral surface – The lateral (facial) surface faces towards the outside. It is smooth and convex, and it features a tiny opening called the zygomaticofacial foramen. This foramen transmits the zygomaticofacial nerve, artery, and vein between the orbit and the face. The lateral surface also serves as the attachment area of the zygomatic major muscle on its anterior half, and the zygomatic minor muscle on its posterior half.
  • Posteromedial surface – The posteromedial surface faces towards the temporal and infratemporal fossae. Its anterior-most portion is rough and serves for the articulation with the zygomatic process of maxilla through the zygomaticomaxillary suture.
  • Orbital surface – The orbital surface is smooth and concave, unlike the other surfaces. It faces towards the orbit and forms the anterolateral part of its floor and the anterior part of its lateral wall. It features the zygomatic-orbital foramen, which is a gateway to the bony canal located within the zygomatic bone.

Zygomatic fractures are the second most common fractures of the face and primarily occur in males during their twenties and thirties. The zygomatic bone plays an important role in the appearance of our faces. It contains small holes, also known as foramina, which allow for the passage of important neurovascular structures. In order for a fracture to happen in the zygomatic bone, kinetic force is required. Therefore, the severity of the injury is directly proportional to the force of the impact. The zygomatic bone is often sturdy as it serves as a buttress between the skull and the maxilla. However, its prominence makes it particularly vulnerable to injury, especially when impact occurs on either side of the face.

Causes & Symptoms

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Generally, a patient with a zygomatic fracture can present with a wide range of signs and symptoms depending on the kinetic force that caused the damage. There will certainly be pain and limitations with regards to movements that are associated with the zygomatic bone. If there is associated injury to the orbit and ocular structures, then there might be localized hemorrhaging as well as double vision.

Patients may also develop trismus (the inability to fully open the mouth) and have difficulty with chewing. There may also be bleeding through the nose, which depends on the severity of the injury. Additionally, the cheekbone of these patients may be flattened due to the malar eminence being depressed. There is a palpable defect along the infraorbital rim, lateral orbital region, or the zygomaticomaxillary buttress. Furthermore, there is what may be referred to as the “flame sign” that arises as a result of the tendon of the lateral canthal being depressed and disrupted. Lastly, most patients may report paresthesia in the areas that are supplied by the nerves that are affected by the injury.

Several causes that can lead to a zygomatic fracture occurring from:

  • Sports or recreational activities, such as ice hockey, basketball, rugby, soccer, or martial arts.
  • Work-related tasks or projects around the home or field.
  • Motor-vehicle accidents.
  • Falling then landing on your face.
  • Fights that involve targeting your facial bones.
  • Overall, zygomatic fractures (or facial injuries in general) may be caused by a direct blow, penetrating injury, or fall. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury.

 

Other symptoms linked to this condition include:

  • Facial numbness near the zygomatic injury.
  • Blood or discoloration in the white part of the eye in cases of double vision.
  • Flatness of the cheeks.
  • Swollen cheek under the eyes.
  • Decreased vision (diplopia).
  • Teeth not fitting together properly.

Who gets a Zygomatic Fracture?

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Zygomatic fractures are typically experienced by those with the following risk factors:

  • Age – Young children and young adults until the age of 30 are more prone to experiencing fractures located in the zygomatic bone. Additionally, older people ages 50 and up are also susceptible to experiencing this type of injury due to general wear and tear.
  • Sports – There are many sports activities that can lead you to fall and damage a bone in your face, such as ice hockey, basketball, soccer, tennis, skiing, martial arts, and boxing.
  • Vehicle trauma – One of the most common factors of a zygomatic fracture is trauma from a vehicle accident. Several conditions are presented after a vehicle crash whether it is whiplash, concussions, broken bones, etc. Zygomatic fractures happen to be one of the common causes that is lead from a car/motorbike accident.

How Do They Affect You? How Serious Are They?

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If you suffer from a facial injury (including a zygomatic fracture), it is recommended to seek immediate medical attention. Some fractures may appear minor, however, complex fractures may cause immense damage and can even become life-threatening. Located near the bones in your face are the nerves and muscles that are responsible for sensations, expressions, and eye movements.

The muscles and nerves are located near the facial bones. The face is closest to the brain and central nervous system (CNS). Fractures may result in damage to cranial nerves, depending on the particular type and location of the fracture. Fractures to the cheekbone (zygomatic) and orbit (eye socket) may result in problems with vision. Fractures of the nose may make it difficult for the injured patient to breathe or smell. Also, fractures of the jawbones may cause breathing problems or make it difficult to chew, speak, or swallow.

Recommended Treatment & Rehabilitation

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In order to diagnose a zygomatic fracture, a doctor will determine whether there are any life-threatening injuries within your face including the area where the zygomatic bone is found. These conditions may need to be addressed immediately before a more thorough examination of the face is performed.

A physician will check to see if there is anything blocking the airways or nasal passages, assess pupil size and reactions, and look for any damage to the central nervous system. Your doctor will then ask questions about how and when the injury occurred. Certain questions include how the injury occurred, if you had other facial injuries in the past, or if you have any family members who tend to have a long-term facial condition.

Afterward, a physical exam will be performed to check the face for signs of asymmetry (one side appears different than the other) and damage to motor functions (movement). Your doctor will then look at your face from several angles and examine the bones of the face by palpating them. He or she might also order a series of X-rays if the zygomatic bone is fractured. If a fracture is suspected, your doctor may order a computed tomography (CT scan) to help determine the exact location and type of the fracture or fractures. A basic series of X-rays may be sufficient in some cases to assess the fracture if a CT scan cannot be performed or if there is no indication of a midface or maxillary fracture.

During your recovery from a zygomatic fracture, a physiotherapist will help you regain the healthy pattern of movements that you may need for facial expressions and function. Your physiotherapist will also help design a treatment plan to help you relearn facial movements based on your zygomatic bone injury. Your exercise routine may change over the course of recovery. These specific exercises include the following:

 

Initiation exercises

In the early stages of a facial fracture, when you might have difficulty producing any facial movement at all, your physiotherapist will teach your exercises that “initiate” facial movement. Your therapist will also show you how to position your face to make it easier to move or how to “trigger” the facial muscles to do what you want them to do.

Facilitation exercises

Once you are able to initiate movement of the facial muscles, your physiotherapist will then design exercises to increase the activity of the muscles, strengthen the muscles, and improve your ability to use the muscles for longer periods of time.

Movement control exercises

Your physiotherapist will design movement exercises to improve the coordination of your facial muscles, refine your facial movements, and correct abnormal patterns of facial movement that can occur during recovery.

Relaxation

Your physiotherapist will design exercises to help reduce any unwanted muscle activity. Your therapist will teach you how to recognize when you are activating the facial muscle and when the muscle is at rest. By learning to contract the facial muscle forcefully and then stop, you’ll be able to relax your facial muscles at will and decrease further pain.

Facial exercises

Facial exercises and physiotherapy for zygomatic fractures help to increase muscle strength and to regain facial coordination from this temporary facial paralysis. Some of these facial exercises include:

 

Nose and cheek exercise

Using your fingers, gently push up the skin next to your nose on the affected side while trying to wrinkle your nose. Next, try to scrunch up your face, focusing on the cheeks and nose. Flare your nostrils and try to take some deep breaths through your nose. You can cover your unaffected nostril to force the affected muscles to work harder. Lastly, puff up your cheeks and blow the air out, then repeat this exercise 10 times a day.

 

Mouth exercise

Open your mouth as if you’re going to smile and then close it, then do the opposite and practice frowning. Gently pucker your lips and let them relax. Try lifting each corner of your mouth individually, one at a time. Finally, stick out your tongue and then aim it down toward your chin.

 

Eye exercise

Practice raising your eyebrows up and down. You can use your fingers to lift the affected eyebrow. Look down and close your eye while gently massaging the eyelid and eyebrow. Alternate opening your eyes wide and then gently squeezing them shut. Repeat this method 10 times a day.

Alternative & Homeopathic Treatment

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Commonly used homeopathic treatments to treat a zygomatic fracture include:

  • Acupuncture – This needle-based therapy may help lessen facial pain.
  • Eye care – If you have double vision, it is imperative that you protect it as the doctor recommends. Wearing protective glasses during the day, an eye patch at night, and using hydrating eye drops can help prevent long-term damage. 
  • Moist heat – Many find that a warm cloth may help resolve pain and discomfort.
  • Massage – Many patients find gentle massage of the face can ease symptoms and discomfort. 
  • Vitamin B12 – Associated with nerve growth and reduction in inflammation, vitamin B12 may be more effective than prescribed steroids. Studies have shown that complete recovery was significantly shorter in vitamin B12 group with a recovery time of just two weeks.

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