Fractures of the Cheekbone

Your cheekbone has been fractured. The cheekbone forms part of the eye socket, protecting the eyeball and supporting it from below, and is also associated with the side of the nose and upper jaw. Your surgeon will examine you and determine the number of fractures and the treatment required. This will involve a general anaesthetic.

Once you are under the anaesthetic the cheekbone will be repositioned into the correct place. This usually involves a small incision about an inch long through the hair in the temple. Sometimes this is all that is required. Your surgeon may insert small metal plates and screws to hold it in place. Placing these plates and screws into the cheekbone may require one or more alternative incisions, including:

• An incision hidden in the hairline above your ear.
• An incision close to the outside end of the eyebrow.
• An incision made on the inside of the mouth through the gum above the back teeth.
• An incision made in the skin crease just below the lower eyelashes or on the inside of the lower eyelid or between the eyelid and eyeball.

These incisions are stitched together at the end of the operation. Stitches on the skin need to be removed after a week and any stitches inside the mouth are usually dissolvable. They may take a fortnight or longer to dissolve completely.

Some fractures of the cheekbone produce a break in the floor of the eye socket. In these cases, an incision on the inside/outside of the lower eyelid is necessary. Occasionally the bones in the floor of the eye socket are shattered and do not support the eyeball properly even when they are repositioned in the proper place. In these circumstances it may be necessary to graft the floor of your eye socket to support the eyeball. The graft material that is going to be used will be discussed with your surgeon prior to the surgery.

There is likely to be soreness and tenderness over the site. Pain relief will be given to you. The discomfort is usually worse within the first few days, although it may take a couple of weeks to completely disappear.

Cheekbone fractures usually heal without infection, although it may be necessary to take antibiotics, particularly if a graft has been used. Initially it may be necessary for you to take antibiotics through a vein in your arm whilst you are in hospital. You will be sent home with pain relief and a course of antibiotics if necessary.

There is a variable amount of swelling and bruising in the skin and around the eyelids. Occasionally the whites of the eyes may become bruised giving them a red appearance. All these changes are most evident within the first 24 hours following surgery and will gradually reduce by the end of the second week. Swelling and bruising can be improved by the use of cold compresses and sleeping with your head elevated during the first few days following surgery.

Generally, an overnight stay in hospital is required. The following day you will undergo an x-ray to check the positioning of your cheek bone.

Even if a fracture is held in place with plates and screws it still takes approximately six weeks for your cheekbone to heal completely. During this recovery period, you will need to be careful to avoid an injury to this area of your face, as it may cause the cheekbone to move out of position. You should also avoid blowing your nose on the side of the fracture for a month following surgery as this may cause swelling in and around the eye.

A follow up appointment will be arranged for you to be reviewed and to remove any stitches. It is important to keep any stitches or dressings as dry as possible until they are removed.

If you have any incisions inside your mouth it may be difficult to clean your teeth around the site of the stitches as it may be tender. It is advisable to keep the area free from food debris by gentling rinsing your mouth with a mouthwash or warm salt water. This is to be commenced on the day following surgery.

Depending upon the nature of your work, it may be necessary to take a couple of weeks off work and to avoid strenuous exercise for this period. It is important that 24 hours following a general anaesthetic you must not drive or operate machinery.

• The nerve that runs through the cheekbone that supplies sensation to the cheek, side of your nose and upper lip may have been bruised at the time of the fracture. As a result you may already experience numbness or tingling over your face. This tingling can sometimes be exacerbated by surgery. Most people report the symptoms of numbness improve on their own, although it may take several months.
• Any incisions made to the face will produce a scar, but these should fade with time and after a few months are usually difficult to see.
• Bleeding from the incisions is unlikely to be a problem, but should the area bleed this can be stopped by applying pressure over the site for at least ten minutes with a swab.
• Although rare, bleeding in and around the eye socket can cause a problem with eyesight immediately following surgery. You will be closely monitored in the first few hours after surgery to ensure that there is no bleeding. If you experience worsening of vision or pain in and around the eye, contact your surgeon immediately.
• If an incision is made in the skin of the lower eyelid, the outside corner of the lid may occasionally be pulled down slightly (this is known as “ectropion”). This tends to settle on its own but may require further surgery.
• If there are any plates or screws that have been inserted in your cheekbone to stabilise it, these are not normally removed as they tend not to cause any problems unless they become infected. The metal that is used is titanium which does not alert metal detectors in airports.

A follow up appointment will be arranged for you to see your surgeon so that you can be closely monitored for several months following treatment to ensure that your fracture heals completely.