Zygomatic Arch Fracture – A Complete Patient Guide

Overview

The zygomatic arch is the bony “cheekbone” that forms the lateral border of the orbit and contributes to the contour of the face. A **zygomatic arch fracture** occurs when a direct or indirect blow breaks this prominent bone. Because the arch is superficial, it is one of the more common facial fractures seen in trauma patients.

Who it affects: Most fractures occur in males aged 15‑45 years (approximately 70 % of cases) due to higher participation in contact sports, motor‑vehicle collisions, and physical altercations. Children and elderly patients can also sustain these injuries, but the mechanisms differ (e.g., falls in the elderly).

Prevalence: Facial fractures account for 10‑15 % of all injuries presenting to emergency departments in the United States, and the zygomatic arch is involved in roughly 40‑50 % of those cases [1][2]. Worldwide, the incidence mirrors traffic‑related trauma rates, making it a significant public‑health concern in low‑ and middle‑income countries.

Symptoms

Symptoms may be mild or severe depending on the fracture’s displacement and associated injuries. Common findings include:

• Localized pain over the cheekbone, worsened by mouth opening or side‑to‑side jaw movement.
• Swelling and bruising (ecchymosis) around the lateral orbit and cheek, often appearing within 24‑48 hours.
• Flattening or depression of the cheek contour, giving a “sunken” appearance.
• Difficulty opening the mouth (trismus) due to spasm of the masseter muscle attached to the arch.
• Clicking, popping, or grinding sensations when moving the jaw.
• Altered sensation (numbness or tingling) in the cheek, upper lip, or teeth supplied by the infraorbital nerve.
• Visible step-off or palpable discontinuity of the bony ridge when pressing gently on the side of the face.
• Limited eye movement or double vision if the fracture extends into the orbital rim (less common).
• Risk of bleeding into the facial soft tissues or, rarely, intracranial bleeding if the force was severe.

Symptoms often develop gradually; however, a sudden “pop” feeling at the time of injury is a classic clue.

Causes and Risk Factors

Typical causes:

• Motor‑vehicle collisions – side‑impact or “T-bone” crashes deliver rapid lateral forces.
• Falls – especially onto a hard surface or from height; common in older adults.
• Sports injuries – boxing, martial arts, football, hockey, and bicycling without a helmet.
• Physical assaults – punches or blunt instruments directed at the cheek.
• Industrial accidents – tools or machinery striking the face.

Risk factors that increase likelihood of fracture or poor healing:

• Male gender and age 15‑45 y (higher exposure to high‑energy trauma).
• Alcohol or substance use → impaired judgement and decreased protective reflexes.
• Bone‑weakening conditions (osteoporosis, osteopenia, chronic steroid use).
• Previous facial fractures or congenital deformities that alter normal anatomy.
• Non‑use of protective equipment (helmets, faceguards, mouthguards).

Diagnosis

Prompt and accurate diagnosis prevents complications and guides treatment.

Clinical examination

• Inspection for swelling, bruising, facial asymmetry, and lacerations.
• Palpation of the arch for step‑off or mobility.
• Assessment of cranial nerve V (sensory) and VII (muscle function) to detect nerve injury.
• Evaluation of jaw range of motion, occlusion, and any dental malalignment.

Imaging studies

• Plain radiographs – Lateral and Waters views provide a quick overview but may miss nondisplaced fractures.
• Computed tomography (CT) scan – The gold standard. Thin‑slice (≤1 mm) axial, coronal, and sagittal reconstructions delineate fracture lines, displacement, and involvement of adjacent structures (orbit, maxillary sinus, temporomandibular joint).¹
• 3‑D reconstruction – Helpful for surgical planning and patient education.
• When orbital or intracranial injury is suspected, a CT angiography or MRI may be added.

Additional tests

• Neurologic exam if facial nerve involvement is suspected.
• Dental occlusion study or intra‑oral photographs for complex mid‑facial trauma.

Treatment Options

Treatment aims to restore facial contour, re‑establish normal function, and prevent complications. Management is individualized based on displacement, associated injuries, and patient factors.

Conservative (Non‑surgical) Management

• Indications: Nondisplaced or minimally displaced fractures (<2 mm), no functional impairment, and intact occlusion.
• Ice therapy – 15‑20 minutes every 2‑3 hours for the first 48 hours to reduce swelling.
• Analgesia – Acetaminophen or NSAIDs (ibuprofen 400‑600 mg q6‑8h) unless contraindicated. Opioids may be prescribed short‑term for severe pain.
• Soft diet – Limit hard chewing for 2‑3 weeks; encourage smoothies, soups, and mashed foods.
• Activity restriction – Avoid contact sports or activities that risk another blow for 4‑6 weeks.

Surgical Intervention

Surgery is recommended when the fracture is displaced, causes cosmetic deformity, interferes with jaw function, or involves the orbital rim.

1. Open reduction and internal fixation (ORIF)
   • Incision made either intra‑oral (less visible) or sub‑periosteal over the arch.
   • Fracture fragments are realigned and stabilized with titanium plates and screws (usually 1.5 mm or 2.0 mm). Resorbable plates are an option for younger patients.
   • Procedure typically lasts 60‑90 minutes; general anesthesia is standard.
2. Closed reduction (rare) – Manual manipulation under sedation to reposition a minimally displaced fragment without hardware.
3. Adjunctive procedures – May be combined with orbital floor repair, maxillary sinus drainage, or dental occlusion correction.

Post‑operative care

• Antibiotics (e.g., amoxicillin‑clavulanate 875/125 mg q12h for 5‑7 days) to prevent sinus or soft‑tissue infection.
• Analgesics as above; consider short course of corticosteroids (dexamethasone 4‑8 mg q24h for 2‑3 days) to reduce postoperative edema.
• Cold compresses for the first 48 hours.
• Soft diet for 2 weeks; gentle jaw exercises (mouth opening/closing, lateral movements) begin after 1‑2 weeks to prevent trismus.
• Follow‑up CT or plain X‑ray at 1‑2 weeks to verify hardware position.

Living with a Zygomatic Arch Fracture

Even after successful treatment, patients often need a short adjustment period.

Daily management tips

• Head positioning: Keep the head elevated (30‑45°) while sleeping to minimize swelling.
• Oral hygiene: Use a soft toothbrush, avoid vigorous rinsing for the first week; a chlorhexidine mouthwash can reduce bacterial load.
• Jaw exercises: Begin gentle opening (10‑15 mm) and lateral movement three times daily under the guidance of a physiotherapist.
• Nutrition: Prioritize protein‑rich foods to aid bone healing; consider a multivitamin with vitamin D and calcium.
• Sun protection: If plates are exposed, protect the skin with sunscreen (SPF 30+) to reduce irritation.
• Psychological coping: Facial injuries can affect self‑image. Support groups or counseling can help address anxiety or depression.

When to contact your provider

• Increasing pain or swelling after the first 48 hours.
• New numbness, tingling, or facial weakness.
• Difficulty opening the mouth beyond baseline (trismus >20 mm).
• Signs of infection: fever, purulent discharge, foul odor.
• Changes in vision or double vision.

Prevention

Many zygomatic arch fractures are preventable with simple safety measures.

• Wear protective gear – Helmets with full‑face shields for motorcycling, bicycling, and contact sports.
• Use mouthguards in boxing, MMA, hockey, and rugby.
• Practice safe driving – Seat belts, airbags, and obey speed limits.
• Home safety for seniors – Remove trip hazards, install grab bars, ensure adequate lighting.
• Limit alcohol consumption when engaging in activities that could lead to facial trauma.
• Strengthen facial muscles through regular jaw‑opening exercises; while not a guarantee, stronger musculature can sometimes attenuate blow impact.

Complications

Untreated or inadequately managed fractures can lead to short‑ and long‑term problems.

• Malunion or non‑union – Resulting in permanent facial asymmetry.
• Persistent trismus – May require surgical release or intensive physiotherapy.
• Infraorbital nerve dysfunction – Chronic numbness, dysesthesia, or neuropathic pain.
• Sinusitis – Fracture lines that communicate with the maxillary sinus can become a nidus for infection.
• Orbital complications – Enophthalmos (sunken eye), diplopia, or globe injury if the orbital rim is involved.
• Temporomandibular joint (TMJ) disorders – Pain, clicking, or limited movement.
• Scarring or skin contour irregularities – May require later cosmetic revision.
• Rare but severe: intracranial hemorrhage or carotid artery injury in high‑energy impacts.

When to Seek Emergency Care

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References

1. American Academy of Oral and Maxillofacial Surgery. Management of Zygomatic Complex Fractures. AAOMS Clinical Guidelines, 2022. aaoms.org.
2. Mayo Clinic. Facial bone fractures. Updated 2023. mayoclinic.org.
3. World Health Organization. Road traffic injuries: prevention and care. WHO Fact Sheet, 2021. who.int.
4. Centers for Disease Control and Prevention. Traumatic Brain Injury in the United States: Fact Sheet. 2022. cdc.gov.
5. Cleveland Clinic. Zygomatic (Cheekbone) Fracture. Patient Education, 2024. clevelandclinic.org.
6. National Institute of Dental and Craniofacial Research. Facial Trauma Guidelines. 2023.