Zygomaticomaxillary Fractures

A zygomaticomaxillary fracture—often called a ZMC fracture or tripod/tetrapod fracture—is a break of the cheekbone where the zygoma (cheekbone) meets the maxilla (upper jaw) and the orbit (eye socket). The cheekbone is shaped like a strong arch that supports the face. It forms the outer rim and wall of the eye socket, the zygomatic arch just in front of the ear, and a “buttress” that connects down to the upper jaw. When a force hits the cheek, cracks can form at four weak points: the infraorbital rim, the lateral orbital wall, the zygomatic arch, and the zygomaticomaxillary buttress. Because these parts are connected, the cheekbone can shift as one block, moving inward, downward, or rotating. That is why people with this injury often have a flattened cheek, swelling and bruising around the eye, double vision, numbness in the cheek and upper lip (from the infraorbital nerve), and trouble opening the mouth if the depressed arch bumps the jaw’s coronoid process.

A zygomaticomaxillary fracture—often called a ZMC fracture or “cheekbone fracture”—is a break where the zygoma (cheekbone) meets the maxilla (upper jaw) and the nearby bony joints that shape the cheek and protect the eye. Because the cheekbone is part of a four-point “buttress” that supports your face and eye (at the frontozygomatic suture near the temple, infraorbital rim under the eye, zygomaticomaxillary buttress above the upper teeth, and the zygomatic arch), a ZMC break can change facial shape, cause pain with chewing, numbness under the eye (infraorbital nerve), double vision, trouble opening the mouth, and sometimes a “sunken eye” look (enophthalmos) if the fractures also involve the orbital floor. Treatment aims to restore the shape of the cheek and the function of the eye and jaw, either by careful observation (when the break is not displaced) or by surgery to realign and fix the bones (when displaced or causing symptoms). NCBI+1

This fracture matters because the cheekbone gives the face its width and protects the eye. If the broken bone heals in the wrong position, the face can look uneven, the eye can sit lower or further back, and the bite or mouth opening can be affected. Early, careful examination and imaging are important to decide whether the fracture needs surgery to put the bone back into place.

Types

1. Non-displaced ZMC fracture
   The bone is cracked but has not moved much. The cheek looks almost normal from the outside. Pain and swelling are present, but the eye and bite may be fine. Close observation is often enough.

2. Displaced ZMC fracture
   The bone fragment unit has shifted—usually inward and downward. The cheek looks flattened, the eye rim can feel “stepped,” and there may be double vision or numbness.

3. Tripod (tetrapod) fracture pattern
   Classic pattern with breaks at the infraorbital rim, lateral orbital wall, zygomatic arch, and zygomaticomaxillary buttress. The cheekbone moves as one piece.

4. Isolated zygomatic arch fracture
   The arch in front of the ear is pushed in (“depressed”). It may impinge on the coronoid process, causing trismus (reduced mouth opening), but the eye socket may be normal.

5. Comminuted ZMC fracture
   The bone is shattered into many pieces, often from high-energy trauma. These injuries are more unstable and may need complex fixation.

6. Greenstick ZMC fracture (children)
   Children’s bones can bend and crack on one side without a complete break through. The cheek shape may still change, so careful follow-up is needed.

7. Open (compound) ZMC fracture
   The skin or inner mouth lining is torn over the fracture. There is a higher infection risk and a need for wound cleaning and antibiotics.

8. Closed ZMC fracture
   The skin and inner lining are intact. The main issues are bony alignment and soft-tissue swelling.

9. Unilateral vs. bilateral ZMC fractures
   One side is far more common, but both sides can break in severe trauma, causing a broader, flattened midface.

10. Impacted/depressed ZMC fracture
    The cheekbone is pushed in and stuck. The face looks sunken on that side. The eye may sit lower (hypoglobus) or deeper (enophthalmos) if the orbit volume increases.

11. ZMC fracture with orbital floor involvement
    The “blowout” of the floor can trap muscles or fat, causing double vision and later sunken eye if not corrected.

12. ZMC fracture with maxillary sinus wall fractures
    Because the buttress is part of the sinus wall, blood can fill the sinus (hemosinus), leading to pain and tenderness in the cheek.

13. ZMC fracture with nasolacrimal involvement
    Rarely, the tear drainage system near the medial orbit is affected, leading to tearing (epiphora).

14. High-energy ZMC fracture with other facial fractures
    Often seen with Le Fort patterns, nasal fractures, or mandibular fractures. The whole midface can be unstable.

15. Delayed/malunited ZMC fracture
    A previously missed or untreated fracture that has healed in a wrong position, causing lasting asymmetry or visual problems.

Causes

1. Road traffic collisions (car)
   A direct hit from a steering wheel, dashboard, or airbag can strike the cheek, especially without a seatbelt.

2. Motorcycle or scooter crashes
   Falls at speed can throw the rider face-first. Helmets help but do not prevent all cheek injuries.

3. Bicycle handlebar impact
   A handlebar or the ground can focus force on one cheek, cracking the ZMC unit.

4. Pedestrian strikes
   Being hit by a vehicle can cause one-sided facial impact when falling.

5. Sports injuries (contact sports)
   Balls, elbows, or collisions in football, rugby, cricket, basketball, or hockey frequently hit the zygoma.

6. Combat sports
   Boxing or martial arts can deliver targeted blows to the cheekbone.

7. Falls from height
   Falling from stairs, ladders, or rooftops increases impact energy and fracture complexity.

8. Ground-level falls (elderly, seizures, syncope)
   Even a simple fall onto a hard floor can fracture the cheekbone, especially in older adults or during seizures.

9. Assault
   Punches or objects (bottles, sticks) often hit the prominent cheek.

10. Workplace accidents
    Tools, machinery parts, or heavy objects can strike the side of the face.

11. Cycling or e-scooter pothole crashes
    Sudden stops and face-first landings concentrate force on the zygoma.

12. Industrial or farm animal kicks
    A kick to the face from a horse or cow can cause a comminuted fracture.

13. Sports equipment impact
    Bats, sticks, or racquets hitting the cheek at speed can break the arch and orbital rim.

14. Explosions or blasts
    Pressure waves and debris can shatter facial bones, including the ZMC.

15. Heavy object drop
    Items falling from shelves or construction sites may strike the cheek.

16. Bicycle-car dooring
    A sudden door open can throw the rider into the door edge or ground, hitting the cheek.

17. Assisted falls (impaired balance)
    Alcohol, medications, or neuropathy can cause unprotected face-first falls.

18. Domestic violence
    Blunt strikes to the face may target the cheekbone, causing ZMC fractures.

19. High-speed sports without face guards
    Skiing, skating, or mountain biking crashes can lead to cheek impacts.

20. Wildlife encounters
    Headbutts or knocks from large animals can injure the zygoma and orbit.

Symptoms

1. Cheek pain and swelling
   The first signs are tender swelling and bruising over the cheek and around the eye.

2. Flattened cheek contour
   The prominent cheekbone may look sunken compared to the other side, especially in displaced fractures.

3. Periorbital bruising (“black eye”)
   Blood leaks into the eyelids and around the eye socket, causing purple discoloration.

4. Numbness or tingling of cheek, upper lip, or teeth
   The infraorbital nerve can be stretched or bruised, causing altered sensation.

5. Double vision (diplopia)
   Muscle swelling or entrapment in the orbit can misalign the eyes, causing two images.

6. Blurred vision or reduced vision
   Swelling, bleeding, or, rarely, optic nerve injury can reduce clarity.

7. Eye sits lower or deeper (hypoglobus/enophthalmos)
   Increased orbital volume after fractures can change eye position.

8. Pain with eye movement
   Involved muscles or soft tissues can make looking up or to the side painful.

9. Step-off along the eye rim
   Running a finger (gently) along the lower rim can feel a “step” where the bone edges no longer line up.

10. Nosebleed or blood in the cheek sinus
    The maxillary sinus can fill with blood, causing pressure and fullness.

11. Difficulty opening the mouth (trismus)
    A depressed zygomatic arch can bump the jaw’s coronoid process, blocking full opening.

12. Clicking or crunching sensation (crepitus)
    Air or bone fragments under the skin can crackle with gentle pressure.

13. Facial asymmetry in smile or expression
    Swelling and bone shift can make expressions look uneven.

14. Tearing (epiphora)
    If the tear drainage pathway is irritated or blocked, the eye may water.

15. Upper teeth feel “off” when biting
    If the zygomaticomaxillary buttress alignment alters, the bite can feel slightly mismatched.

Diagnostic tests

(Grouped into Physical Exam, Manual tests, Lab/Pathological, Electrodiagnostic, Imaging. Each item has a simple explanation.)

A) Physical Exam

1. Face inspection for symmetry and contour
   The clinician looks from the front and above to compare both cheeks. A flattened malar eminence or widened distance between the eyes may show displacement. Bruising patterns give clues to fracture lines.

2. Palpation of orbital rims and zygomatic arch
   Gentle fingertip pressure follows the lower eye rim and arch to feel tenderness, gaps, or step-offs. Crepitus (a crackling feel) suggests air or small fragments under the skin.

3. Infraorbital nerve sensation check
   Light touch and pinprick are tested on the cheek, upper lip, and gums supplied by the V2 (maxillary) nerve. Reduced or altered sensation supports nerve involvement.

4. Eye exam: visual acuity and pupils
   Simple reading charts or finger counting assess sharpness of vision. Pupil reaction to light checks for optic nerve function and rules out RAPD (a sign of serious optic pathway injury).

5. Extraocular movements and diplopia mapping
   The patient follows a target in all directions. Pain, restricted movement, or double vision may indicate muscle entrapment or soft-tissue obstruction in the orbit.

6. Oral exam and mouth opening measurement
   Interincisal distance (how far the teeth can separate) is measured. Limited opening suggests coronoid impingement by a depressed arch. Buccal sulcus bruising inside the cheek can point to buttress injury.

B) Manual Tests

7. Bimanual zygoma mobility test
   With gloved hands, the examiner stabilizes the upper jaw and gently moves the malar area to feel whether the cheekbone unit is abnormally mobile, which indicates a displaced fracture.

8. Forced-duction test (ophthalmology)
   With local anesthetic and sterile technique, the eye is gently moved with forceps while the patient relaxes the muscles. If the eye cannot move upward or outward passively, it suggests mechanical entrapment of muscle or fat.

9. Coronoid impingement check during opening
   The patient opens and closes the mouth while the clinician palpates the zygomatic arch. A sudden hard stop or pain at a consistent opening width supports arch depression touching the coronoid.

10. Infraorbital rim pressure and pain provocation
    Gentle pressure along the rim can reproduce deep ache or reveal a step. This helps localize the fracture edge before imaging.

C) Lab and Pathological Tests

11. Complete blood count (CBC)
    Checks for blood loss (low hemoglobin), infection (high white cells) if there is an open wound or sinusitis, and overall readiness for possible surgery.

12. Coagulation profile (PT/INR, aPTT)
    Ensures safe bleeding control if a procedure is needed, and assesses bleeding risk in patients on blood thinners.

13. Blood type and screen/crossmatch
    Prepared if surgical fixation is planned or if there was significant bleeding, to ensure compatible blood is available.

14. Wound culture or tetanus immunity check (as indicated)
    Open fractures or contaminated lacerations may be swabbed to guide antibiotics. Tetanus status is reviewed; serology may be used if unclear.

D) Electrodiagnostic Tests

15. Visual evoked potentials (VEP)
    If visual loss is unexplained, VEP measures the brain’s response to visual signals. A delayed or reduced signal hints at optic nerve dysfunction, which can rarely occur with severe orbital trauma.

16. Infraorbital nerve conduction or blink-reflex study
    Specialized tests can document V2 (infraorbital) nerve injury when numbness persists, helping with prognosis and medico-legal documentation.

E) Imaging Tests

17. Thin-slice CT of the facial bones (gold standard)
    A helical CT with 1–2 mm cuts shows the fracture lines, displacement, orbital floor defects, and sinus blood levels (hemosinus). It guides decisions about surgery and fixation points.

18. 3-D CT reconstruction
    Computer-built 3-D images make it easy to see how far the cheekbone has rotated or sunk. Surgeons use it to plan the best approach and to counsel patients.

19. Waters (occipitomental) view X-ray
    A simple X-ray can show infraorbital rim steps and maxillary sinus opacification. It is less detailed than CT but helpful where CT is not immediately available.

20. Submento-vertex (SMV) X-ray for zygomatic arch
    This view looks up from below the jaw to highlight the arch depression. It is useful for quick screening of isolated arch fractures.

Non-pharmacological treatments (therapies & others)

(Each item includes Description, Purpose, and Mechanism in short paragraphs.)

1. Initial head elevation and cold compresses
   Description: Keep the head propped up and apply cool packs (wrapped cloth) over the cheek for 10–15 minutes at a time for the first 48–72 hours.
   Purpose: Reduce pain and swelling.
   Mechanism: Elevation lowers venous pressure; cold causes vasoconstriction, limiting fluid leakage into tissues.

2. Sinus precautions
   Description: Do not blow your nose; sneeze with your mouth open; avoid straws and scuba/air travel early on if advised.
   Purpose: Prevent air forcing through fractured sinus walls, which can cause swelling, infection, or orbital emphysema.
   Mechanism: Reduces pressure spikes across disrupted sinus walls while they heal. SpringerLinkUniversity of Michigan Medical School

3. Soft, no-chew or minimal-chew diet
   Description: Choose soft foods (soups, yogurt, mashed items) and cut food small.
   Purpose: Limit pain and movement at the zygomaticomaxillary buttress during early healing.
   Mechanism: Reduced bite force lowers micromotion at fracture lines.

4. Oral hygiene and gentle saline mouth rinses
   Description: Brush gently; use lukewarm saltwater rinses after meals; be careful near incisions if present.
   Purpose: Lower oral bacterial load to reduce infection risk, especially if there’s a maxillary sinus connection.
   Mechanism: Mechanical plaque control plus saline’s mild cleansing effect.

5. Smoking cessation
   Description: Stop smoking (and vaping) completely during healing.
   Purpose: Improve bone and soft-tissue healing.
   Mechanism: Nicotine and carbon monoxide impair blood supply and osteoblast function.

6. Alcohol limitation
   Description: Avoid alcohol during the acute phase.
   Purpose: Prevent dehydration, falls, bleeding risk, and poor wound care adherence.
   Mechanism: Alcohol disturbs platelet function, judgment, and sleep.

7. Eye protection and activity restriction
   Description: Avoid contact sports, heavy lifting, and risky activities until cleared.
   Purpose: Prevent further displacement and protect the orbit.
   Mechanism: Limits external forces on healing midface buttresses.

8. Observation with scheduled re-checks
   Description: For nondisplaced, stable fractures: regular clinic review with symptom checks and imaging as indicated.
   Purpose: Ensure the cheek contour, bite, mouth opening, and eye function remain acceptable.
   Mechanism: Early detection of late displacement or diplopia allows timely switch to surgery if needed. PMC

9. Jaw rest
   Description: Avoid wide yawning, hard chewing, or jaw clenching.
   Purpose: Reduce strain across the zygomaticomaxillary buttress.
   Mechanism: Lowers mechanical load that could shift fragments.

10. Heat and gentle stretching for trismus (later phase)
    Description: After acute pain subsides (per clinician advice), warm compresses and gentle jaw opening exercises.
    Purpose: Improve mouth opening if the masseter or coronoid is irritated.
    Mechanism: Heat increases blood flow; graded stretching remodels muscle and fascia.

11. Sleep position training
    Description: Sleep with the injured side up initially.
    Purpose: Reduce dependent swelling and tenderness.
    Mechanism: Gravity limits fluid pooling on the injured side.

12. Wound care (if lacerations/incisions)
    Description: Keep incisions clean and dry; follow surgeon’s instructions for suture care.
    Purpose: Prevent wound infection and promote neat scars.
    Mechanism: Minimizes bacterial colonization and maceration.

13. Scar care once closed
    Description: After full epithelialization, use silicone gel/sheets as advised.
    Purpose: Improve scar appearance.
    Mechanism: Occlusion and hydration modulate collagen remodeling.

14. Protective eyewear on return to activity
    Description: Use appropriate sports face shields and safety goggles.
    Purpose: Prevent re-injury.
    Mechanism: Distributes impact forces away from healing bones.

15. Nasal saline irrigation (gentle)
    Description: Isotonic saline sprays/irrigation if approved by the clinician.
    Purpose: Thin secretions, lower infection risk without pressure.
    Mechanism: Mechanical lavage; avoids Valsalva.

16. Nutritional optimization (high protein)
    Description: Ensure adequate calories and protein (see supplements below).
    Purpose: Provide building blocks for bone and soft-tissue repair.
    Mechanism: Supports collagen and bone matrix synthesis.

17. Sun protection for facial scars
    Description: Sunscreen/hat when outdoors after wounds heal.
    Purpose: Prevent hyperpigmentation of scars.
    Mechanism: UV avoidance reduces melanocyte stimulation.

18. Education on red flags
    Description: Teach warning signs: new double vision, worsening numbness, vision loss, fever, pus, inability to open mouth, malocclusion.
    Purpose: Enable early medical review.
    Mechanism: Timely care prevents complications.

19. Timed return to work/school with accommodations
    Description: Light duty first, no heavy lifting or risky tasks.
    Purpose: Support safe recovery.
    Mechanism: Gradual load increases allow bone consolidation.

20. Psychological support and reassurance
    Description: Address anxiety about appearance/function.
    Purpose: Improve adherence and coping.
    Mechanism: Lowers stress hormones that can affect sleep and healing.

Drug treatments

(Doses are typical adult examples—clinicians individualize based on age, kidney/liver function, allergies, pregnancy, and comorbidities.)

1. Acetaminophen (Paracetamol) – Analgesic/antipyretic
   Dose/Time: 500–1,000 mg every 6–8 h (max 3,000–4,000 mg/day depending on local guidance).
   Purpose: First-line pain relief.
   Mechanism: Central COX inhibition.
   Side effects: Rare liver toxicity at high doses or with alcohol.

2. Ibuprofen – NSAID
   Dose/Time: 400–600 mg every 6–8 h with food.
   Purpose: Pain and swelling control.
   Mechanism: COX-1/COX-2 inhibition reduces prostaglandins.
   Side effects: Stomach upset/bleeding risk, kidney strain.

3. Naproxen – NSAID
   Dose/Time: 250–500 mg every 12 h with food.
   Purpose: Longer-acting anti-inflammatory pain control.
   Mechanism: COX inhibition.
   Side effects: GI irritation/bleeding, renal risk.

4. Celecoxib – COX-2 selective NSAID
   Dose/Time: 100–200 mg every 12 h.
   Purpose: Anti-inflammatory with less gastric irritation than nonselective NSAIDs (not zero).
   Mechanism: COX-2 selective inhibition.
   Side effects: Cardiovascular/thrombotic risk in some patients.

5. Short-course opioid (e.g., oxycodone or tramadol) – Analgesic
   Dose/Time: Lowest effective dose for the shortest time if severe pain persists despite non-opioids.
   Purpose: Breakthrough pain.
   Mechanism: μ-opioid receptor agonism.
   Side effects: Sedation, constipation, nausea, dependence; avoid driving.

6. Gabapentin – Neuropathic pain adjuvant
   Dose/Time: 100–300 mg at night, then titrate.
   Purpose: Infraorbital nerve–type burning/tingling pain.
   Mechanism: Modulates calcium channels to reduce neuronal excitability.
   Side effects: Drowsiness, dizziness.

7. Topical ocular lubricating ointment (if corneal exposure risk)
   Dose/Time: Nightly or as directed.
   Purpose: Protects eye surface if lid closure is affected by swelling.
   Mechanism: Forms protective film.
   Side effects: Temporary blurred vision.

8. Antiemetic (e.g., ondansetron)
   Dose/Time: 4–8 mg every 8–12 h as needed.
   Purpose: Control nausea; prevent Valsalva from vomiting.
   Mechanism: 5-HT3 receptor blockade.
   Side effects: Headache, constipation.

9. Stool softener (e.g., docusate) ± mild laxative
   Dose/Time: Docusate 100 mg 1–2×/day.
   Purpose: Prevent straining if using opioids or if painful to bear down.
   Mechanism: Softens stool by increasing water penetration.
   Side effects: Cramps (rare).

10. Intranasal decongestant (e.g., oxymetazoline spray)
    Dose/Time: 1–2 sprays per nostril twice daily for ≤3 days.
    Purpose: Ease nasal blockage without blowing nose.
    Mechanism: Alpha-adrenergic vasoconstriction of nasal mucosa.
    Side effects: Rebound congestion if overused.

11. Isotonic saline nasal spray
    Dose/Time: Several times daily.
    Purpose: Moisturize and gently clear nasal passages.
    Mechanism: Mechanical lavage.
    Side effects: Minimal.

12. Chlorhexidine 0.12% mouth rinse
    Dose/Time: 15 mL swish 30 s twice daily (short course).
    Purpose: Oral antisepsis if intraoral wounds/incisions.
    Mechanism: Disrupts bacterial cell membranes.
    Side effects: Temporary taste changes, staining with long use.

13. Proton-pump inhibitor (e.g., omeprazole)
    Dose/Time: 20 mg daily while on NSAIDs if GI risk.
    Purpose: Protect stomach.
    Mechanism: Blocks gastric H+/K+ ATPase.
    Side effects: Headache; long-term issues if used chronically.

14. Antibiotics for open fractures, contaminated wounds, or sinus communication (when indicated)
    Dose/Time: Common choices include amoxicillin-clavulanate 875/125 mg twice daily; if penicillin-allergic, clindamycin per local guidance; duration often ≤24 hours peri-op or short course only when justified.
    Purpose: Reduce infection risk where bone and sinus/oral flora are involved.
    Mechanism: Broad coverage of skin/oral organisms.
    Side effects: GI upset, C. difficile risk. Note: Evidence shows no proven benefit for routine prophylaxis in closed, clean midface fractures; if used, shorter courses are favored. PMCcdn.hs.uab.eduTSACO

15. Tetanus immunization (if due)
    Dose/Time: As per immunization schedule after wounds.
    Purpose: Prevent tetanus in lacerations.
    Mechanism: Toxoid stimulates protective antibodies.
    Side effects: Sore arm, low-grade fever.

16. Short course systemic corticosteroid (peri-operative, selected cases)
    Dose/Time: Example: dexamethasone single peri-op dose per surgeon’s protocol.
    Purpose: Reduce severe orbital/periorbital edema; may aid surgical exposure.
    Mechanism: Anti-inflammatory, anti-edema effects.
    Side effects: Hyperglycemia, infection risk; use selectively because mixed evidence and potential complications. surgeryreference.aofoundation.org

17. Topical antibiotic ointment for skin lacerations
    Dose/Time: Thin layer 1–2×/day until closed.
    Purpose: Lower superficial wound infection risk.
    Mechanism: Local antibacterial effect.
    Side effects: Contact dermatitis (rare).

18. Allergy control (non-sedating antihistamine, if congestion from allergies)
    Dose/Time: Cetirizine 10 mg daily as needed.
    Purpose: Reduce sneezing/pressure spikes.
    Mechanism: H1 receptor blockade.
    Side effects: Mild drowsiness in some.

19. Topical nasal steroid (short course if allergic swelling)
    Dose/Time: Fluticasone 1–2 sprays each nostril daily.
    Purpose: Control mucosal edema in allergic rhinitis (not for acute trauma swelling).
    Mechanism: Local anti-inflammatory.
    Side effects: Nasal irritation/bleed (rare).

20. Antibiotic eye drops/ointment (only if ocular surface abrasion or as prescribed)
    Dose/Time: Per ophthalmologist.
    Purpose: Prevent infection if corneal abrasion/exposure.
    Mechanism: Topical antimicrobial action.
    Side effects: Local irritation, allergy.

Dietary molecular supplements

(Dietary supplements support healing but don’t replace medical/surgical care.)

1. Vitamin D3 (cholecalciferol)
   Dose: 1,000–2,000 IU daily (or per blood level guidance).
   Function: Supports bone mineralization.
   Mechanism: Enhances calcium absorption and osteoblast activity.

2. Calcium (elemental)
   Dose: 1,000–1,200 mg/day from diet ± supplement.
   Function: Bone matrix mineral supply.
   Mechanism: Provides substrate for hydroxyapatite.

3. Vitamin C (ascorbic acid)
   Dose: 500–1,000 mg/day (short course).
   Function: Collagen synthesis and immune support.
   Mechanism: Cofactor for prolyl/lysyl hydroxylases in collagen.

4. Zinc
   Dose: 8–15 mg/day (avoid long high doses).
   Function: Wound healing and enzyme function.
   Mechanism: Cofactor in DNA synthesis and collagen cross-linking.

5. Magnesium
   Dose: 200–400 mg/day (as tolerated).
   Function: Bone quality and muscle relaxation.
   Mechanism: Cofactor for hundreds of enzymes, including those in bone turnover.

6. Vitamin K2 (MK-7)
   Dose: 90–120 µg/day.
   Function: Directs calcium to bone, not soft tissue.
   Mechanism: Carboxylates osteocalcin and matrix Gla protein.

7. Omega-3 fatty acids (EPA/DHA)
   Dose: ~1,000 mg/day combined EPA/DHA.
   Function: Modulates inflammation and supports cardiovascular health.
   Mechanism: Shifts eicosanoid profile toward less pro-inflammatory mediators.

8. Collagen peptides
   Dose: 10–15 g/day.
   Function: Provide amino acid building blocks for connective tissue.
   Mechanism: Supplies glycine/proline/hydroxyproline for collagen.

9. Arginine
   Dose: 3–6 g/day (divided).
   Function: Supports wound healing.
   Mechanism: Substrate for nitric oxide and polyamine synthesis in repair.

10. Glutamine
    Dose: 5–10 g/day (divided).
    Function: Fuel for rapidly dividing cells in healing tissues.
    Mechanism: Preferred substrate for enterocytes/immune cells.

Regenerative / stem-cell–type” therapies

Important: There are no routine, approved “stem cell drugs” for ZMC fracture healing. The options below are specialist-only and often off-label or investigational. They should not be used outside surgeon-led care or clinical trials.

1. rhBMP-2 (recombinant bone morphogenetic protein-2)
   Dose: Surgeon-applied on a carrier in the operative field (device-specific).
   Function: Stimulate bone formation in selected reconstructions.
   Mechanism: Osteoinductive signaling that recruits and differentiates progenitors.
   Caution: Swelling/ectopic bone risks; cost; labeled uses are limited—not routine for ZMC.

2. rhBMP-7 (OP-1)
   Dose: As per device protocol where available.
   Function/Mechanism: Similar osteoinduction; limited availability and indications.
   Caution: Off-label in many regions.

3. Autologous bone marrow aspirate concentrate (BMAC)
   Dose: Intra-op graft augmentation per surgeon.
   Function: Add mesenchymal progenitors to bone graft sites.
   Mechanism: Provides osteogenic cells and cytokines.
   Caution: Evidence mixed; adjunct only.

4. Platelet-rich plasma (PRP)
   Dose: Intra-op application as adjunct.
   Function: Deliver growth factors (PDGF, TGF-β, VEGF).
   Mechanism: May enhance soft-tissue/wound healing.
   Caution: Variable protocols; inconsistent fracture-healing benefit.

5. Teriparatide (PTH 1-34)
   Dose: 20 µg subcutaneously daily (standard osteoporosis regimen) in selected off-label cases of delayed healing—specialist decision only.
   Function: Anabolic bone remodeling.
   Mechanism: Intermittent PTH signaling stimulates osteoblasts.
   Caution: Not standard for ZMC; avoid without endocrine/trauma oversight.

6. Abaloparatide / other bone-anabolic agents
   Dose: As per labeled osteoporosis regimens if ever considered off-label.
   Function/Mechanism: Similar PTHrP-based anabolic signaling.
   Caution: Not indicated for routine facial fracture care.

Surgeries

1. Closed reduction of the zygomatic arch or ZMC (e.g., Gillies or Keen approach in selected cases)
   Procedure: Elevate the depressed zygoma/arch with instruments via small temporal or intraoral incisions; no plates.
   Why: For isolated arch depression or minimally displaced ZMC when stability is achievable without plating. surgeryreference.aofoundation.org

2. Open Reduction and Internal Fixation (ORIF) – 1-point fixation at the zygomaticomaxillary buttress
   Procedure: Intraoral incision to expose the buttress; reduce the bone; place a plate and screws.
   Why: Many ZMC fractures can be stabilized at this buttress alone when other points are aligned, minimizing external scars. PMC

3. ORIF – 2- or 3-point fixation (e.g., ZM buttress + frontozygomatic + infraorbital rim)
   Procedure: Precise reduction with plates at two or three buttresses to restore cheek projection and eye support.
   Why: For displaced/comminuted fractures requiring rigid, anatomic reduction and stable fixation to restore form and function. PMC

4. Orbital floor reconstruction (with ORIF as needed)
   Procedure: Repair the orbital floor with autograft or implant to correct enophthalmos/diplopia; combined with ZMC fixation.
   Why: To restore orbital volume and prevent a sunken eye/double vision after ZMC-related orbital damage. Medscape

5. Secondary revision for malunion/nonunion
   Procedure: Osteotomies to re-mobilize mal-set bones, reposition, and refixate ± bone graft/implants.
   Why: Correct late cheek asymmetry, trismus, or persistent diplopia when initial healing settled in the wrong position. PMC

Preventions

1. Always wear seatbelts; use airbags and child restraints.

2. Wear helmets/face shields for bikes, motorcycles, and high-risk sports.

3. Use workplace PPE (face protection) for tools and machinery.

4. Fall-proof homes: good lighting, remove clutter, railings, non-slip mats.

5. Avoid interpersonal violence; seek support and de-escalation strategies.

6. Don’t drive distracted or under the influence.

7. Manage bone health (nutrition, vitamin D, treat osteoporosis).

8. Quit smoking; limit alcohol.

9. Keep vision corrected to reduce falls/accidents.

10. Use proper sports technique and conditioning.

When to see doctors

• Immediately/urgent: sudden double vision, vision loss, eye pain, severe headache, unequal pupils, increasing facial numbness, worsening cheek deformity, inability to open mouth, fever with facial swelling, pus or foul drainage, breathing problems, or a snapping/clicking sensation with eye movement.

• Soon (within 24–72 h): new/worsening numbness under the eye, persistent nosebleeds, sinus pressure that won’t settle, bite feels off, or pain not controlled with simple medicines.

• Routine follow-up: as scheduled to check cheek symmetry, mouth opening, bite, and eye movement; earlier if anything worsens.

What to eat” and “what to avoid”

Eat more of:

1. Soft proteins (eggs, yogurt, tofu, fish, tender chicken).

2. Broths, soups, smoothies with fruits and greens.

3. Well-cooked vegetables and mashed sides (potatoes, squash).

4. Oats, porridge, soft rice, pasta.

5. Healthy fats (olive oil, avocado, nut butters if tolerated).

Avoid/limit early on:

1.  Hard, crunchy foods (nuts, chips), tough meats that need forceful chewing.
2.  Very hot or spicy foods if they irritate incisions.
3. Carbonated drinks if they increase pressure or discomfort.
4.  Alcohol (bleeding/fall risk and delays healing).
5. Straws (negative pressure) until cleared.

Frequently Asked Questions (FAQs)

1. Can a cheekbone fracture heal without surgery?
   Yes—nondisplaced and stable fractures can be observed with precautions. If the cheek sinks, the jaw sticks, or double vision occurs, surgery is considered. PMC

2. How do doctors decide on surgery?
   They look for displacement/instability, jaw movement restriction, double vision, enophthalmos, or nerve problems affecting function or facial shape. The aim is accurate reduction and rigid fixation when needed. NCBIMedscape

3. When is the best time for surgery?
   Often after some swelling settles but before scar tissue stiffens things—commonly within about 3 weeks from injury, depending on the case and team preference. Medscape

4. Will I need plates and screws?
   If the break is displaced, surgeons typically use rigid internal fixation at one to three “buttress” points to restore projection and stability. PMC

5. Do I need antibiotics?
   Not routinely for closed, clean fractures. They’re used for open wounds, contaminated injuries, or clear sinus/oral communication, and even then, short courses or limited peri-operative dosing are favored. Follow your surgeon’s protocol. PMCcdn.hs.uab.eduTSACO

6. Why can’t I blow my nose?
   It can push air or bacteria through the fractured sinus walls into the orbit or soft tissues, causing swelling/infection. Sneeze with your mouth open and avoid straws at first. SpringerLink

7. What if my upper lip/cheek feels numb?
   The infraorbital nerve can be bruised or compressed. Sensation often improves gradually; report any worsening or new pain. ScienceDirect

8. How long does swelling last?
   Peak is usually in the first few days, then fades over 1–2 weeks; subtle changes can take longer.

9. Can I fly?
   Ask your surgeon. Early flying can alter sinus pressures; many teams advise waiting until sinuses and fractures are stable.

10. When can I return to work/sports?
    Desk work may resume in days if pain allows; contact sports and heavy lifting are delayed until cleared to prevent displacement.

11. What scars should I expect?
    Many approaches are intraoral (hidden). If external incisions are needed (e.g., at the eyelid or temple), they’re placed in natural lines and usually fade well. PMC

12. Will plates be removed later?
    Usually no, unless they cause symptoms or you need revision. Low-profile plates are designed to stay in. SpringerLink

13. Is steroid medication helpful for swelling?
    Selected teams may give limited peri-operative steroids for severe orbital edema, but benefits must be weighed against risks. surgeryreference.aofoundation.org

14. What if I develop double vision after the injury?
    Seek prompt review. It may reflect orbital floor involvement or muscle entrapment and sometimes requires repair. Medscape

15. What happens if treatment is delayed?
    Late malposition can lead to persistent asymmetry or jaw issues, sometimes needing secondary osteotomies to correct. Early follow-up helps avoid this. PMC

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 30, 2025.

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