Diagnosis and surgery of cheek fractures and trauma

The article was professionally consulted by Specialist Doctor II Nguyen Khanh Nam - Doctor of Odonto-Stomatology - Department of General Surgery - Vinmec Nha Trang International General Hospital.

Cheekbone is a component of the eye bone mass, thick and strong. Cheek injuries are relatively common, especially zygomatic fractures. Depending on the type of cheek injury, doctors may recommend a number of different treatments, including surgery.

Cheekbone is a component of the facial bone mass. This is a thick and strong bone mass, consisting of 4 sides articulating with 4 bones: the frontal bone, the temporal bone, the large wing of the sphenoid bone, and the maxillary bone (forehead zygomatic, temporal zygomatic, and zygomatic molar).
The structure of cheekbones consists of 3 faces, 3 corners and 4 edges.

Learn about the face of the cheekbones:
The inner side: also called the orbital face – the anterior part of the outer wall of the eye.
Concave posterior surface: also known as the temporal face, related to the fossa and the temporal fossa. The outer surface: also known as the cheekbones face, has a skin-attached muscle structure. Boundary structure of the cheekbones:
Anterior and superior margins: part of the orbital rim. The anterior and inferior margins will fuse with the maxillary bone. The posterior and superior margins, anterior and inferior to the temporal fossa, consist of two pieces, the transverse and the straight, with underbites. The posterior and inferior margins have a continuous structure with the continuous underbite of the temporal bone.

Learn about the angle of the cheekbones:
Upper angle: pterygium, synapse with the lateral orbital process at the frontal bone. Anterior and inferior angles: articulating anterior and inferior margins of the maxillary bone. Posterior angle: anterior apex, anastomosis with the contiguous region of the temporal bone.

Currently, there are many ways to classify cheekbone injuries or cheekbone fractures.
The classification of posterior cheekbone fractures is relatively easy to remember, so it is commonly used today, including 6 types:
Type 1: there is displacement when the cheekbone is broken but it is not significant. Type 2: Zygoma arch fracture. Type 3: Fracture with displacement inward, subsidence but without axial rotation. Type 4: fracture with inward displacement. Type 5: fracture with outward rotation. Type 6: complex zygomatic fracture with 3 or more fractures.

Clinical symptoms
The cheekbones lose their curvature and the outer corner of the eye is displaced, creating the feeling that the patient has a prolapsed eyelid. Nosebleeds and pneumothorax may occur if the patient has a ruptured maxillary sinus. The zygoma arch (temporomandibular joint area) has sharp, discontinuous or angled pain points. The patient's mouth opening was limited because the lower jaw area was entangled in the cheekbone fracture area. The patient opens his mouth to the side of the fracture when there is no occlusal problem. Bleeding under the conjunctiva, possibly protruding eyes... Other joint signs/symptoms, sensation... in the cheekbones and surrounding area Diagnose a cheek injury by examination – Test
The diagnosis of cheekbone injuries/fractures is currently based on a number of additional tests such as ophthalmoscopy, Lancaster test to assess eyeball movement. In addition, imaging techniques such as X-ray or cross-sectional/vertical scanner also play a particularly important role in diagnosing cheek trauma in a visual and complete manner.

Surgery to treat cheekbone fractures is only applicable to displaced fractures, performed by an Ear - Nose - Throat specialist or a Dentist. Depending on the case of cheekbone injury, the surgical technique may be different.
Fracture of the cheekbone continues to move much, affecting the temporomandibular joint. This case needs to be corrected by Gillies method: start with a 2cm skin incision at the hairline to dissect the exposed area of ​​the temporal fascia. Next, make an incision through the temporal fascia area to insert the trap into the next arc, and adjust the next arc to the normal position.
Cheekbone fracture with moderate displacement: Use the Gillies method of correction above or chiropractic surgery combined with a screw brace at the position below the orbit, the cheekbone is next.
Severe cheekbone fractures: Complicated surgery is required as this can displace a lot and cause many fragments to break, often with eye injuries. First, the doctor will make an incision in the skin or mucous membranes depending on the position to be combined, then adjust the bone combination with a screw brace or steel thread.
Fracture of the orbital floor: The case of cheekbone fracture accompanied by damage to the orbital floor causes the organization around the orbit to herniate into the maxillary sinus, resulting in limited movement of the eyeball. Therefore, it is necessary to perform surgery to reconstruct the orbital floor. If the patient has lost a lot of bone, it is necessary to use autologous materials such as costal cartilage, septum cartilage... or artificial materials to repair.

During and after cheekbone fracture surgery, patients may experience some risks as follows:
Infection: antibiotic injection. Edema: use anti-inflammatory drugs - anti-edema. Problems with eyeball movement, mouth ulcers: need to be monitored for timely correction. Maxillofacial trauma is a common injury, in which trauma to the cheekbone and zygomatic arch are common. The main cause is usually traffic accidents.
Cheekbones and cheekbones are the main bones, the structure that creates the face shape when the cheekbones and cheekbones are damaged (broken), greatly affecting the aesthetic function for the customer if not corrected. Correct and timely treatment can cause complications on eyes, nerves, aesthetics and chewing function. Diagnosis and treatment planning need to be carefully examined, surgery is applied to the following cases. displaced fractures, helping to restore function and aesthetics.
Fractures of the cheekbones and zygomatic arch are detected clinically and subclinically.
Clinically we can detect symptoms such as facial swelling, deformation, bruising around the eyes, pressure points with pain, glare, difficult opening of the mouth, pain...
On clinical examination, the fracture is detected on the upper part of the body. X-ray films such as CT, BLondeur, hirtz, ...
Treatment of cheekbone + cheek arch fractures have many methods such as conservative treatment, osteopathy, surgery to combine bones with screw splints.
Injuries with displacement of the cheekbones are usually treated surgically. This is a basic technique but requires a high level of expertise from the performing doctors as well as the coordination of patients and relatives.
Currently, at Vinmec International General Hospital, the surgical method of jaw bone correction has been applied with the advantage of correcting malocclusion due to bone structure, returning the function of chewing, biting, and breathing well. cosmetic facial harmony and radical change in beauty.
Applied only to patients with deformity, malocclusion, sequelae of maxillofacial fracture, cleft palate.