A lateral midface fracture or a fracture of the cheekbone belongs to the category of head and facial injuries and manifests itself primarily through swelling and bleeding from the nostril and the maxillary sinus. The flattened cheek of the injured person is characteristic of a broken cheekbone. Not every fracture needs to be treated surgically; there are also conservative treatment methods.
What is a lateral midface fracture?
Injuries to the cheekbones mainly occur when playing football when both players collide their heads – for example during a header duel. See AbbreviationFinder for abbreviations related to Lateral Midface Fracture.
The cheekbone is located in the middle of the face and forms the outer edge of the eye socket. The zygomatic bone (medical: Os zygomaticum) can be palpated above the cheek region without any problems. If a mechanical or direct force is applied to the bone, the cheekbone can break. Doctors then speak of a lateral midface fracture. However, the fracture can also injure adjacent bones. Fractures or injuries to the temporal bone, the lower jaw, the eye socket and the frontal bone are possible.
Causes
A strong, mechanical and direct impact of violence, which is specifically exerted on the cheekbone, is one of the most common causes of a cheekbone fracture. This type of violence can occur in the context of a fall, a collision and a blow. Injuries to the cheekbones mainly occur when playing football when both players collide their heads – for example during a header duel. Traffic accidents and falls from a bicycle also increase the risk of a cheekbone fracture. Occasionally, violent confrontations, such as fights, can also cause an injury to the cheekbone.
Symptoms, Ailments & Signs
A lateral midface fracture is initially recognizable by the conspicuous injury in the facial area. After an accident or fall, those affected notice severe pain, bleeding, hematomas and functional disorders of the nose, eyes, mouth and jaw. In most cases, the injury can be recognized at first glance, and the diagnosis can be strengthened by the characteristic symptoms.
If the eye sockets are involved, the eyeball may sink. This can lead to visual disturbances (e.g. double vision). In addition, a spectacle hematoma can develop, which often increases in size and causes severe pain. Abnormal mobility can be seen in the facial area.
Typically, swelling occurs in the affected area, which is characterized by redness and tenderness. Bleeding from the mouth and nose is also possible. If the jaw is affected, jaw clenching may occur. Then there is severe pain when the jaw moves.
If the nose is involved, odor disorders up to and including loss of smell can occur. An inadequate or poorly treated lateral midface fracture can lead to the development of a malocclusion. Serious jaw injuries occasionally result in osteoarthritis of the temporomandibular joint, which manifests itself as chronic pain.
Diagnosis & course of disease
The doctor first scans the injured area of the face. If there is a suspicion of a broken cheekbone, an x-ray is taken. Imaging diagnostics can not only identify the fracture, but also its extent. In the further course, the doctor examines the adjacent bones in order to be able to determine or rule out any injuries.
Aesthetic impairments or complications are not to be feared if professional treatment is carried out. In very few cases does the “flattened” cheek remain. However, if the patient so wishes, this can be corrected by means of an operation.
Complications
This midface fracture usually causes relatively severe pain. In most cases, these also spread to other areas of the body and can lead to headaches or earaches. Furthermore, there can also be discomfort at the temples, so that those affected suffer from severe nausea or vomiting.
Not infrequently, the lateral midface fracture also leads to the patient becoming unconscious. The further course usually depends heavily on the respective violence and its damage. There is also severe swelling and bruising on the face. Pressure pain can be felt in the affected areas. Sleep problems can occur, especially at night, and the patient can become irritable due to the lack of sleep.
Complications can arise if the skin is directly cooled too much, resulting in burns. The eye socket can also be injured, leading to visual problems. In most cases, those affected require surgical intervention. This can alleviate the symptoms and fix the fracture again. As a rule, the course of the disease is positive.
When should you go to the doctor?
A doctor should always be consulted after a fall or serious injury. If the injured person is in severe pain, bleeding or showing signs of a concussion, it is best to call an ambulance. The same applies to loss of consciousness or an open wound on the head. The lateral midface fracture heals within a few weeks if treated early. For this reason, a doctor should always be consulted, even in the case of minor injuries. People who notice vision or smell problems after a collision or fall should see their family doctor or neurologist.
External changes such as a dropped eyeball or swelling should always be examined and treated by a doctor. During treatment, a doctor should be consulted regularly. Close monitoring ensures that the wound does not become inflamed and that no other complications arise. Should dizziness attacks, sudden tiredness or even loss of consciousness occur during the recovery phase, the medical emergency service is the right contact person. Any side effects and interactions of the prescribed medication should be reported to the doctor.
Treatment & Therapy
The cheekbone fracture is a relatively serious injury. As a rule, the injury is corrected surgically. However, if there is no displacement of the bone, conservative therapy can also bring the desired success.
If the doctor finds a non-displaced fracture (not displaced), it can be treated without surgery in some cases. The patient should observe physical rest for several weeks. Swelling that occurs in the facial area needs to be cooled. It is important that the affected person never holds the cooling material directly on the skin surface, otherwise skin damage is possible. The cooling material should therefore be placed on the affected area in a towel.
If there is a displacement of the bone or if the doctor has determined that pieces of bone have splintered off, an operation is carried out. During the operation, special plates and screws are used to join the bone fragments and then fix them in their original position. During the procedure, the patient is under general anesthesia. In a few cases, however, local anesthesia or local anesthesia can also be administered.
The doctor makes a small skin incision that extends from the lower eyelid to the eyebrow. Another surgical method, which is rarely used, is through the patient’s oral cavity. If there is an injury to the eye socket, the skin incision is made directly behind the hairline.
In the further course of the operation, the doctor tries to return the bone fragments, which are not in their natural position, to their original position. Then metal plates and screws are used to fix the fragments together. If the patient only has a cheekbone fracture – without further injuries – the position can be fixed with a “hook technique”. If the hook technique is successful, no screws are used.
If the eye socket is also affected by an injury, an extensive reconstruction of the midface must be created. Vessels can also be injured, so that the doctor often needs balloons and tamponades. If the doctor determines during the procedure that pronounced defects are present, a transplant may also be necessary, among other things.
In addition to foreign materials, pieces of cartilage and bone obtained from the ribs and hips can also be used. The plates and screws needed to fix the cheekbone can be removed from the bone one year after the operation. However, such an intervention requires a further operation, which is why many patients – as long as the plates and screws do not cause any problems – refrain from removing the foreign materials.
If there is a significant impairment of the aesthetics, the specialist in oral and maxillofacial surgery treats the patient in the further course of the operation and restores the affected area – to the satisfaction of the person concerned. These reasons are also what make a relatively good prognosis possible. As a rule, an operation is sufficient to fix the bone or correct the face so that there are no aesthetic impairments. Only in the case of very complex injuries is it possible that a second operation must be performed.
Outlook & Forecast
The prognosis of a lateral midface fracture is favorable. Although there is such severe pain and impairment in coping with everyday life, freedom from symptoms is usually documented after completion of the treatment. The healing process takes several months. In the majority of cases, no surgical intervention is required.
After clarification of the bone position in the face and any existing damage, the treatment plan is drawn up. If the broken bones have not been displaced, rest and rest are ordered. If the affected person follows the doctor’s instructions during the healing process, the prognosis is good.
If an operation is required, this can lead to complications. Every operation carries risks and side effects that can occur at any time. Nevertheless, it is a routine process that in most cases takes place successfully without further incidents. If the person concerned does not follow the doctor’s instructions, the healing process can be significantly delayed or the symptoms can increase in character.
In very rare cases, there is an unfavorable course of the disease. This requires a transplant, among other things. In addition, there may be a temporary insertion of foreign materials. These have to be removed later. With both treatment methods, the probability of consequential damage or the development of other diseases is increased.
Prevention
There are no preventive measures that prevent a cheekbone fracture. It is important that special caution is required in sports that increase the risk of a cheekbone fracture. Helmets that also protect the cheekbones do not yet exist.
Aftercare
In the case of a midface fracture, those affected often only have a few follow-up measures available. First and foremost, a doctor should be consulted quickly and, above all, at an early stage, so that further complications or incorrect fusion of the bones do not occur. The sooner a doctor is consulted, the better the further course of the disease.
In most cases, the symptoms can be solved relatively well with minor surgical interventions. The face must be protected particularly well after such an operation so that infections or inflammation do not occur. Likewise, the patient should rest after the procedure and take care of his body. Efforts or stressful and physical activities should be avoided in order not to unnecessarily burden the body.
The symptoms of a midface fracture can usually be completely healed, although in some cases scars can remain. These can be treated with various creams or ointments so that they do not diminish the aesthetics of the sufferer. In most cases, the midface fracture has no negative impact on the life expectancy of those affected and does not limit it.
You can do that yourself
In most cases, a midface fracture must be treated with surgery. However, conservative options are also available to those affected to support the treatment.
The swelling in this fracture can be reduced with the help of cold applications. Care should be taken to ensure that the cool material never touches the skin directly. This means that ice, for example, should always be wrapped in a cloth before being placed on the skin. In the case of bone displacement or splinters, however, surgical intervention is always necessary to ensure that the bone grows together properly. In the case of pain, those affected are dependent on taking painkillers. It should be noted that long-term use of painkillers can damage the stomach and should therefore only be taken after consulting a doctor.
In some cases, those affected may also suffer from depression or psychological problems due to reduced aesthetics. Conversations with close friends and parents are helpful here in order to alleviate inferiority complexes. Talking to other people affected by this fracture also helps. In most cases, however, all symptoms can be alleviated so that there are no permanent aesthetic restrictions.