Plastic Surgery Repair of Cheek Bone Fractures


Cheek bone (zygomatic) fractures are one of the most common facial fractures, Over the years, I have seen many cheek bone (malar) fractures and they are commonly the result of personal assaults (being punched in the face) and sports injuries. The cheek bone sits on a very prominent part of the face and, as a result, is easily struck. It acts as a protector for the eye which is situated above and behind it.

The bulk of the cheek bone is what we see but it sticks out as such because it is attached by four ‘legs’ to the deeper parts of the face. When the cheek bone breaks, it moves because these attachments fracture, allowing it to collapse inward and downward. As it falls back and in, it goes directly into the underlying maxillary sinus which is just an open air space. Because part of the cheek bone makes up a portion of the floor of the eye, a fractured cheek bone results in loss of the cheek prominence and an eye which make look like it is fallen lower.

Repair of these fractures involves putting it back in place and securing one or more of these legs with plates and screws. Fixing the fracture can be done by an incision inside the mouth, through the lower eyelid, or both depending upon the degree of bone displacement. Plate and screw fixation composed of the metal titanium and being very small in size works quite well for repairing these facial bone injuries. I have done many with this metallic method and it is the standard of care today.

Over the past ten years, I have also repaired cheek bone fractures with a resorbable plate and screw system composed of the polymer, LactoSorb. These resorbable plates and screws have been used in over 100,000 craniofacial cases since 1996 and has a proven track record of safety and effectiveness. In properly selected cheek bone fractures, LactoSorb plates and screws can provide good stable results. Plates of 2.0mm size are placed vertically along the posterior maxillary buttress (if possible) and obliquely from the zygoma to the pyriform aperture. (which is always possible). Plates smaller than 2.0mm are not of adequate strength. The cheek fractures that work best with this resorbale fixation method are what I call simple fractures, where an intraoral approach with only one or two plates is all that is needed to adequately restore their pre-injury anatomic position.

Repositioning the cheek bone back in place will almost always leave a bone gap between it and the front wall of the maxillary sinus. If this bone gap is unduly large, one might want to consider a bone graft for long-term stability.

My experience with repairing cheek fractures with LactoSorb fixation has always been satisfactory. I have not experienced any infections, collapse of the cheek bone, or adverse reactions to the material as the bone heals up and the material absorbs up to a year after surgical repair.