Can My Old Cheekbone Fracture Be Cut And Repositioned To Improve My Pain And Facial Asymmetry?

Q: Dr. Eppley, Two years ago I had a displaced fractured cheekbone and other fractures.  No surgery was done at the time or since. I have been left with a major cosmetic defect and chronic 24hr/7days pain/painful pressure above my upper center and side teeth -same side as the fractured cheekbone. The pain is very debilitating and the cosmetic defect is destroying my self esteem. I am in search of an experienced and talented surgeon that can re-break the cheek fracture/s and put the cheekbone back in place which I hope will not only mostly correct my facial symmetry but also unimpinge whatever nerve is causing the pain and/or remove the stress that the inward rotation of the cheekbone might be putting on the muscles, tendons, ligaments, etc. 

A: Thank you for your inquiry and sending your pictures and x-rays. As you know and have well described, you have the classic untreated ZMC (cheekbone) fracture with its typical and inward rotation into the maxillary sinus. You are correct in that refracturing the cheekbone and repositioning it out and up (derotation) is the correct procedure in your case. Cosmetic camouflage in untreated ZMC fractures is only the best approach if the rotation is very slight or the only issue is soft tissue atrophy over the bone.

The keys to successfully treating the secondary impacted ZMC fracture is rigid fixation and bone gratting  after it is cut and repositioned. The plates will hold it into a better position but derotating the ZMC complex will reveal bony defects particularly along the posterior zygomatic buttress and maxillary sinus walls and possibly the orbital floor.

But the first step is to get a 3D face CT scan so the exact ZMC anatomy in the traumatized side is fully understood before surgery.

Dr. Barry Eppley

World-Renowned Plastic Surgeon