Cheekbone Fracture: Symptoms, Treatment & Recovery Guide

What Is a Cheekbone Fracture?

A cheekbone fracture (zygomatic bone fracture) is a break in the prominent bone forming the cheek prominence and part of the eye socket. It typically results from direct impact to the face and can affect facial appearance, sensation, and jaw movement. The zygomatic bone connects to four other facial bones, so fractures often involve multiple structures.

The zygomatic bone, commonly called the cheekbone or malar bone, is one of the most prominent bones of the face. It forms the characteristic contour of the cheek and contributes to the lower and outer walls of the eye socket (orbit). This bone plays a crucial role in protecting the eye and providing attachment points for the muscles used in chewing.

Because of its prominent position, the zygomatic bone is particularly vulnerable to direct trauma. When struck with sufficient force, the bone can fracture in various patterns depending on the direction and intensity of the impact. The most common fracture pattern involves the zygomaticomaxillary complex (ZMC), where the zygomatic bone separates from its four main connections to the rest of the skull.

Understanding the anatomy helps explain why cheekbone fractures cause such varied symptoms. The infraorbital nerve, which provides sensation to the cheek, lower eyelid, side of the nose, and upper lip, runs through a canal just below the eye socket. This nerve is frequently affected in cheekbone fractures, explaining the characteristic numbness many patients experience. Additionally, the zygomatic arch (the bridge of bone connecting the cheekbone to the temporal bone near the ear) can restrict jaw movement when fractured or displaced.

Anatomy of the Zygomatic Bone

The zygomatic bone articulates with four surrounding bones: the frontal bone (forehead), maxilla (upper jaw), temporal bone (side of skull), and sphenoid bone (deep skull bone). These connections are called sutures, and fractures typically occur along these natural weak points. The zygomaticomaxillary complex fracture involves separation at multiple suture lines, which is why these injuries are sometimes called "tripod" or "tetrapod" fractures.

The bone also forms part of the orbital floor and lateral orbital wall, which is why cheekbone fractures can cause eye-related symptoms such as double vision or a sunken eye appearance. The close relationship between the cheekbone and the eye socket makes careful evaluation essential to ensure no orbital complications exist.

Types of Cheekbone Fractures

Cheekbone fractures are classified based on the pattern and extent of bone displacement. Simple fractures involve a single break with minimal displacement, while complex fractures may involve multiple fragments and significant displacement from the normal anatomical position. Isolated zygomatic arch fractures affect only the bony bridge on the side of the face and may cause specific problems with jaw movement.

What Are the Symptoms of a Cheekbone Fracture?

Symptoms of a cheekbone fracture include pain and tenderness over the cheek, swelling and bruising around the eye and cheek, flattened or asymmetric facial contour, numbness of the cheek and upper teeth, difficulty opening the mouth wide, and in some cases double vision. Symptoms are typically most noticeable 12-24 hours after the injury.

The symptoms of a cheekbone fracture can vary significantly depending on the severity and pattern of the fracture. Some patients have dramatic swelling and obvious facial deformity, while others may have more subtle findings that become apparent only after the initial swelling subsides. Understanding the full range of symptoms helps ensure appropriate medical evaluation.

Pain is usually the first and most immediate symptom following a cheekbone injury. The pain is typically localized to the cheek area and may worsen with touching, chewing, or attempting to open the mouth wide. The severity of pain does not always correlate with the severity of the fracture, as even significant fractures may cause only moderate discomfort in some patients.

Swelling and bruising develop rapidly after the injury, often within the first few hours. The swelling can be substantial and may extend from the cheekbone area to involve the tissues around the eye (periorbital ecchymosis or "black eye"). This swelling can initially mask the underlying bony deformity, which is why some facial asymmetry only becomes apparent days later as the swelling resolves.

Common Symptoms

• Pain and tenderness: Localized to the cheek area, worse with touch or chewing
• Swelling: Can be significant and affect the entire cheek and around the eye
• Bruising: Typically develops around the eye ("black eye") and over the cheek
• Facial asymmetry: Flattened cheek appearance or uneven facial contour
• Numbness: Over the cheek, side of nose, upper lip, and upper teeth on the affected side
• Difficulty opening mouth: Limited jaw movement (trismus) due to mechanical obstruction

Eye-Related Symptoms

Because the zygomatic bone forms part of the eye socket, cheekbone fractures can cause various eye-related symptoms. Double vision (diplopia) may occur if the orbital floor is involved and the eye muscles are affected. Some patients notice that their eye appears lower or more sunken on the injured side (enophthalmos), though this is often not apparent until after swelling resolves.

Visual changes should always be taken seriously and evaluated promptly. While most eye symptoms from cheekbone fractures are related to swelling and mechanical factors rather than direct eye injury, any vision changes warrant thorough ophthalmologic assessment to rule out more serious complications.

Numbness and Sensory Changes

One of the most characteristic symptoms of cheekbone fractures is numbness over the cheek and upper lip. This occurs because the infraorbital nerve, which provides sensation to this area, passes through a bony canal just below the eye socket. Even minor fractures can affect this nerve, causing tingling, decreased sensation, or complete numbness.

The numbness typically affects the cheek, side of the nose, lower eyelid, and upper lip and gums on the affected side. Many patients describe the sensation as similar to when dental anesthesia is wearing off. While this numbness can be disconcerting, it often improves gradually over several months as the nerve heals. However, some degree of permanent sensory change may persist in a proportion of patients.

What Causes Cheekbone Fractures?

Cheekbone fractures are caused by direct trauma to the face, most commonly from physical assault (punches to the face), falls, sports injuries, bicycle accidents, and motor vehicle accidents. Young adults aged 20-40 are most frequently affected, with males experiencing these injuries 3-4 times more often than females.

The zygomatic bone's prominent position on the face makes it vulnerable to direct impact injuries. Any force sufficient to overcome the bone's structural integrity can result in a fracture. The amount of force required depends on factors including the direction of impact, the area of contact, and individual bone density.

Understanding the common causes of cheekbone fractures helps in prevention efforts and also provides healthcare providers with important context when evaluating these injuries. The mechanism of injury can influence the fracture pattern and guide treatment decisions.

Physical Assault

Interpersonal violence, particularly punches to the face, represents the most common cause of cheekbone fractures in many populations. The cheekbone is often the point of impact during altercations, as it is a prominent target area. These injuries are particularly common in young adult males and are often associated with alcohol consumption.

Assault-related cheekbone fractures may have medicolegal implications, and healthcare providers typically document these injuries carefully. If you have experienced an assault resulting in a facial injury, it is important to report this to the police and seek appropriate support services in addition to medical care.

Falls

Falls represent another major cause of cheekbone fractures, affecting all age groups. Ground-level falls onto the face can generate sufficient force to fracture the cheekbone, particularly if the person is unable to protect their face during the fall. Falls from height or falls involving loss of consciousness (such as from syncope or seizure) carry higher risk of significant facial injuries.

In older adults, falls are often related to factors such as balance problems, medication effects, or environmental hazards. Fall prevention strategies are important for reducing the risk of facial fractures and other injuries in vulnerable populations.

Sports and Recreational Injuries

Contact sports and recreational activities account for a significant proportion of cheekbone fractures, especially in younger patients. Sports with high risk include boxing, martial arts, rugby, hockey, and football. Cycling accidents, both competitive and recreational, are also common causes, particularly when protective helmets do not extend to cover the midface.

The use of appropriate protective equipment can reduce the risk of facial fractures in sports. Face guards, helmets with facial protection, and mouthguards all play roles in preventing or reducing the severity of facial injuries during athletic activities.

Motor Vehicle Accidents

Motor vehicle collisions can cause high-energy facial trauma resulting in cheekbone fractures, often as part of more extensive facial or head injuries. Modern vehicle safety features including airbags and seatbelts have reduced the incidence of facial fractures from car accidents, though these injuries still occur, particularly in unrestrained occupants or in high-speed collisions.

When Should You Seek Medical Care?

Seek medical care immediately if you suspect a cheekbone fracture after facial trauma. Visit an emergency department or urgent care if you have facial swelling and pain after impact, difficulty opening your mouth, numbness in your cheek or teeth, visual changes or double vision, obvious facial deformity, or a black eye developing after facial trauma.

Any significant facial trauma with persistent symptoms warrants medical evaluation. While not all cheekbone fractures are surgical emergencies, proper diagnosis through imaging is essential to guide appropriate treatment. Delayed diagnosis can lead to suboptimal outcomes, particularly if surgical repair becomes more difficult as initial healing begins.

The timing of medical care matters because certain treatment options become more challenging as time passes. Surgical repair of displaced cheekbone fractures is typically most straightforward when performed within the first 2 weeks after injury, before significant bone healing begins. However, this does not mean you need to rush to the emergency room in the middle of the night for a stable injury; it means you should seek evaluation within a reasonable timeframe.

Signs Requiring Immediate Evaluation

Certain symptoms suggest more serious injury and warrant urgent medical attention. These include significant facial deformity, inability to open or close the eye, severe pain not controlled with over-the-counter medications, progressive swelling that affects breathing or vision, and any signs of head injury such as confusion, loss of consciousness, or severe headache.

Visual symptoms deserve particular attention. While some blurred vision may result from swelling around the eye, persistent double vision, loss of vision, or a feeling of pressure within the eye socket should prompt immediate evaluation to rule out orbital complications that may require urgent treatment.

What to Expect at the Hospital

When you arrive at the hospital or clinic with a suspected cheekbone fracture, healthcare providers will first assess for any life-threatening injuries and ensure you are medically stable. They will take a detailed history of how the injury occurred and your symptoms, then perform a careful physical examination of your face.

The examination typically includes inspection for asymmetry and deformity, gentle palpation of the facial bones, assessment of eye movements and vision, testing of facial sensation, and evaluation of jaw movement. Based on these findings, imaging studies will be ordered to confirm the diagnosis and characterize the fracture pattern.

How Is a Cheekbone Fracture Diagnosed?

Cheekbone fractures are diagnosed through physical examination and imaging studies. The doctor will examine your face visually and by touch to assess for deformity, then order imaging. CT scan with 3D reconstruction is the gold standard for detailed fracture assessment, while X-rays may be used for initial screening.

Accurate diagnosis of a cheekbone fracture requires a combination of clinical examination and radiographic imaging. While experienced clinicians can often suspect a fracture based on physical findings, imaging is essential to confirm the diagnosis, characterize the fracture pattern, and plan appropriate treatment.

The physical examination begins with visual inspection, comparing both sides of the face for symmetry. Swelling can obscure the underlying bony contours, so the examiner will gently palpate the facial bones to feel for steps, irregularities, or areas of tenderness. Special attention is paid to the orbital rim, zygomatic arch, and the cheek prominence.

Physical Examination Findings

Several clinical signs suggest a cheekbone fracture. Flattening of the malar eminence (cheek prominence) indicates displacement of the bone. A palpable step or irregularity along the infraorbital rim or zygomatic arch suggests a fracture line. Periorbital ecchymosis (bruising around the eye) is common with cheekbone fractures, as is subconjunctival hemorrhage (bleeding in the white of the eye).

Testing facial sensation is an important part of the examination. Decreased or absent sensation over the cheek, side of the nose, and upper lip on the affected side indicates involvement of the infraorbital nerve, which is commonly affected in cheekbone fractures. Jaw opening is also tested, as restricted movement may indicate that a displaced zygomatic arch is impinging on the muscles of mastication.

Imaging Studies

Computed tomography (CT) scanning has become the imaging modality of choice for facial fractures. CT provides detailed cross-sectional images that allow precise assessment of fracture patterns and displacement. Modern CT scanners can produce three-dimensional reconstructions that are particularly helpful for surgical planning.

Plain X-rays may still be used for initial screening, particularly where CT is not readily available. Traditional views used for cheekbone assessment include the Waters view (occipitomental), which provides a good view of the cheekbones and maxillary sinuses, and the submentovertex view, which shows the zygomatic arches. However, X-rays have limited sensitivity compared to CT and may miss subtle fractures or fail to adequately characterize complex injuries.

How Are Cheekbone Fractures Treated?

Treatment of cheekbone fractures depends on the severity and displacement. Minor, non-displaced fractures can be treated conservatively with pain management, soft diet, and activity restrictions. Displaced fractures typically require surgical repair (open reduction internal fixation) to restore facial contour and function. Surgery is ideally performed within 2 weeks of injury.

The treatment approach for cheekbone fractures is determined by several factors including the degree of displacement, the presence of functional problems (such as restricted jaw movement or double vision), and cosmetic concerns. Not all cheekbone fractures require surgery, but those with significant displacement generally benefit from operative repair.

The goal of treatment is to restore the normal anatomical position of the bone, ensure proper function of the jaw and eye, and achieve an acceptable cosmetic result. Treatment decisions are typically made collaboratively between the patient and the surgical team after careful review of the imaging and clinical findings.

Conservative (Non-Surgical) Treatment

Conservative management may be appropriate for fractures that show minimal or no displacement, where the bone fragments remain in essentially normal position. This approach involves allowing the fracture to heal naturally while managing symptoms and protecting the healing bone.

Conservative treatment typically includes pain management with appropriate analgesics, application of ice packs to reduce swelling (especially in the first 48-72 hours), a soft diet to minimize stress on the healing bone, and avoidance of activities that could cause re-injury. Patients are typically advised not to blow their nose, as this can force air into the facial tissues and potentially cause complications.

Close follow-up is essential with conservative treatment to ensure the fracture heals properly and to identify any problems that might require surgical intervention. Repeat imaging may be obtained after swelling subsides to reassess the fracture position.

Surgical Treatment

Surgical repair is typically recommended when there is significant displacement of the fracture, functional impairment (such as restricted jaw movement or persistent double vision), or unacceptable cosmetic deformity. The surgical approach aims to restore the bone to its normal anatomical position and hold it there while healing occurs.

The most common surgical procedure is open reduction internal fixation (ORIF). This involves making small incisions to access the fracture site, repositioning the bone fragments to their normal alignment (reduction), and securing them with small titanium plates and screws (internal fixation). These plates and screws are typically left in place permanently and do not usually cause problems.

Several surgical approaches can be used to access the fractured bone. The surgeon chooses the approach based on the fracture pattern and which areas need to be addressed. Common incision locations include the eyebrow area, lower eyelid, inside the mouth (along the gum line), and the temporal scalp. These incisions are designed to minimize visible scarring.

The Gillies Approach

For some fractures, particularly isolated zygomatic arch fractures, a closed reduction technique called the Gillies approach may be used. This involves making a small incision in the hairline of the temple, inserting an instrument beneath the bone, and elevating the depressed fragment back into position. This technique avoids the need for plates and screws in appropriately selected cases.

What Is the Recovery Process Like?

Recovery from a cheekbone fracture typically involves 6-8 weeks for bone healing. Swelling and bruising improve significantly within 2-3 weeks. Numbness in the cheek may persist for 3-6 months or longer. Most patients return to normal activities within 2-4 weeks, though contact sports should be avoided for 6-8 weeks.

The recovery process following a cheekbone fracture varies depending on the severity of the injury and whether surgical treatment was required. Understanding what to expect during recovery helps patients plan appropriately and recognize any problems that might require additional medical attention.

In the immediate period following injury or surgery, swelling and bruising are prominent features. These typically peak at 48-72 hours and then gradually improve over the following 2-3 weeks. Cold compresses applied during the first few days can help minimize swelling. Keeping the head elevated, including during sleep, also helps reduce swelling.

Timeline of Recovery

During the first week, patients typically experience the most significant swelling, bruising, and discomfort. Pain medication is usually needed during this period, and activities should be limited. A soft diet is recommended to avoid stressing the healing bone, and patients should be careful not to blow their nose.

Between weeks 2-4, swelling continues to decrease, and most patients begin feeling more comfortable. Those who had surgery will have follow-up appointments to check wound healing and fracture position. Many patients can return to desk work or light activities during this period, though strenuous activities remain restricted.

From weeks 4-8, bone healing progresses toward completion. The fracture typically achieves solid union by 6-8 weeks. After this point, restrictions on activities can usually be lifted, though contact sports and activities with high risk of facial trauma should be discussed with the treating surgeon.

Numbness and Sensory Recovery

Numbness of the cheek, related to infraorbital nerve involvement, is one of the most persistent symptoms following cheekbone fractures. The recovery of sensation is typically gradual and can take several months. Most patients experience significant improvement within 3-6 months, though some degree of altered sensation may persist permanently in a proportion of cases.

The numbness can be an unusual sensation to live with, particularly in the early weeks when it is most pronounced. Patients may need to take care when eating hot foods or beverages, as they may not feel temperature normally on the affected side. The tingling or "pins and needles" sensation that often accompanies nerve recovery can be bothersome but is generally a positive sign indicating nerve regeneration.

Long-Term Outcomes

With appropriate treatment, most patients with cheekbone fractures achieve good long-term outcomes. The goals of treatment, to restore facial symmetry, ensure normal function, and minimize complications, are achieved in the majority of cases. However, some patients may have persistent issues such as subtle facial asymmetry, ongoing sensory changes, or restriction in jaw movement.

Follow-up care is important to monitor healing and address any concerns that arise during recovery. Patients should not hesitate to contact their healthcare team if they experience new symptoms, worsening of existing symptoms, or concerns about their recovery progress.

What Are the Potential Complications?

Potential complications of cheekbone fractures include persistent numbness of the cheek and upper lip, facial asymmetry if the fracture heals in a displaced position, restricted jaw movement, double vision or sunken eye appearance if the orbital floor is involved, and infection (rare with proper treatment). Early appropriate treatment minimizes complication risk.

While most cheekbone fractures heal without significant problems, complications can occur. Understanding potential complications helps patients recognize warning signs and seek appropriate care if needed. The risk of complications is generally higher with more severe fractures and with delayed or inadequate treatment.

Infraorbital Nerve Damage

The most common long-term issue following cheekbone fractures is altered sensation from infraorbital nerve involvement. While most patients experience improvement over time, some degree of permanent sensory change occurs in a significant proportion of cases. This may manifest as numbness, tingling, or abnormal sensations over the cheek and upper lip.

The nerve is often stretched or compressed at the time of fracture, and surgical manipulation can cause additional trauma. In most cases, the nerve recovers function gradually, but complete recovery is not guaranteed. Patients should be counseled about this possibility before treatment.

Facial Asymmetry

If a cheekbone fracture heals in a displaced position, permanent facial asymmetry can result. This may manifest as a flattened cheek prominence, an uneven appearance when comparing both sides of the face, or a visible "step" along the orbital rim. Proper initial treatment with adequate reduction and stabilization minimizes this risk.

Late correction of malunited cheekbone fractures is more complex than primary repair, as it requires cutting the healed bone and repositioning it (osteotomy). This is another reason why appropriate early treatment is important for fractures with significant displacement.

Orbital Complications

When the cheekbone fracture involves the orbital floor, specific eye-related complications can occur. These include persistent double vision (diplopia) from entrapment or damage to eye muscles, enophthalmos (sunken eye appearance) from increased orbital volume, and restricted eye movement. Some patients may require additional surgery specifically to address orbital floor issues.

Trismus (Restricted Jaw Opening)

Limited mouth opening can result from fracture fragments impinging on the muscles of mastication or from scar tissue formation. This is particularly associated with zygomatic arch fractures that displace medially (toward the center). Physical therapy exercises may help improve jaw mobility, though some patients require surgical intervention.

What First Aid Should Be Given?

For suspected cheekbone fracture, apply a cold compress wrapped in cloth to reduce swelling, keep the head elevated, avoid touching or pressing on the injured area, do not blow your nose, and seek medical evaluation. Do not attempt to realign any visible deformity. If there are signs of serious injury, call emergency services.

Knowing what to do immediately after a facial injury can help minimize complications and prepare for medical evaluation. While first aid cannot treat a cheekbone fracture, it can help manage symptoms and prevent additional harm while awaiting professional medical care.

Immediate Steps

First, assess the situation for any life-threatening injuries. If the person is unconscious, having difficulty breathing, or has other serious injuries, call emergency services immediately. For isolated facial injuries where the person is alert and stable, the following measures can help:

• Apply cold compress: Wrap ice or a cold pack in a cloth and apply gently to the swollen area. Apply for 15-20 minutes at a time, with breaks in between. This helps reduce swelling and provides some pain relief.
• Keep head elevated: Sit upright or prop up on pillows to help minimize swelling.
• Do not touch or press: Avoid pressing on the injured area or attempting to feel the extent of the injury.
• Do not blow your nose: This is very important, as blowing can force air into the facial tissues (subcutaneous emphysema), which can cause serious complications.
• Control any bleeding: If there are cuts, apply gentle pressure with a clean cloth.

Things to Avoid

Several actions should be avoided following a suspected cheekbone fracture. Do not attempt to move or realign any deformity. Do not apply pressure to the injured area. Avoid eating hard foods or chewing on the affected side. Do not take aspirin or other blood-thinning medications without medical advice, as these may increase bruising.

If the person wears contact lenses, these should ideally be removed if this can be done safely and without pressing on the injured area. However, if there is any concern about eye injury, leave the contact lenses in place for medical professionals to remove.