Specialist Management of Cheekbone Injuries
Zygomatic fractures involve the cheekbone (zygoma) and are common in contact sport.
The cheekbone is a key structural component of the midface that contributes to facial contour, eye support, and jaw function.
Injury to this area can affect both appearance and function, and requires careful assessment to determine whether surgical treatment is needed.
Elite Sport and Return to Play
Dr Tom Pepper understands that facial trauma in athletes requires a different approach to standard care. Alongside accurate reconstruction, there is a need to:
- Minimise time away from sport
- Protect the injury during recovery
- Restore functional performance as early as possible
Drawing on his experience treating high-level athletes in the USA, surgical care is structured to minimise downtime while preserving long-term function.
This includes rapid intervention where required, an accelerated return-to-play strategy, and the use of custom-fitted facial protective equipment to enable earlier reintroduction to training while reducing the risk of re-injury.
How Zygomatic Fractures Present
Symptoms may include:
- Flattening of the cheek or facial asymmetry
- Swelling and bruising around the eye
- Pain on opening the mouth
- Difficulty chewing
- Numbness of the cheek or upper lip (infraorbital nerve involvement)
- Double vision or visual disturbance (in some cases)
Initial swelling can mask underlying deformity, so reassessment is often required.
Assessment
Assessment involves:
- Clinical examination of facial symmetry and function
- Evaluation of eye movements and vision
- Assessment of jaw function
- CT imaging to define the fracture pattern
This allows identification of:
- Displacement of the cheekbone
- Involvement of the orbital floor
- Impact on surrounding structures
When Treatment Is Required
Not all fractures require surgery.
Treatment depends on:
- Degree of displacement
- Functional symptoms (e.g. vision, jaw movement)
- Cosmetic impact
Conservative Management
- Minor, non-displaced fractures may be managed without surgery
- Observation and follow-up ensure appropriate healing
Surgical Management
Surgery is recommended where there is:
- Visible facial asymmetry
- Functional impairment (restricted jaw movement, visual symptoms)
- Significant displacement
Surgical Treatment (Open Reduction and Fixation)
When required, surgery involves:
- Precise repositioning of the fractured cheekbone into its correct anatomical position
- Stabilising it using low-profile titanium fixation
- Accessing the fracture through carefully concealed incisions (often inside the mouth or along natural skin lines)
Timing of Surgery
Timing is important:
- Surgery is typically performed 1–2 weeks after injury
- This allows swelling to reduce while avoiding healing in a displaced position
Delayed treatment may require more complex reconstructive procedures.
Recovery
Recovery varies depending on severity.
- Swelling and bruising are common in the early weeks
- Cheek contour improves as swelling settles
- Mouth opening improves gradually
- Normal activity is resumed progressively
Risks and Considerations
Potential risks include:
- Residual asymmetry
- Persistent numbness in the cheek or upper lip
- Infection or bleeding (uncommon)
- Double vision (usually temporary if present)
- Need for further surgery in complex cases
Careful planning and technique minimise these risks.
Specialist Assessment and Treatment
Zygomatic fractures require both functional and aesthetic judgement.
As a dual-qualified (medical and dental) Consultant Maxillofacial Surgeon, treatment is guided by:
- Detailed understanding of midfacial anatomy and biomechanics
- Experience in facial trauma and reconstruction
- Ability to assess both orbital and occlusal function
- Focus on restoring facial balance and symmetry
This ensures treatment is appropriately tailored, whether surgical or conservative.
Consultation
A consultation allows full assessment, imaging where required, and discussion of the most appropriate treatment approach.
Book a Consultation
For assessment and management of zygomatic fractures in London, arrange a consultation to discuss your injury and treatment options.