Does a depressed fracture of the zygomatic arch need to be repaired if there is no pain or noticeable cosmetic change?

Question

24 yr old son's nose and zygomatic arch were broken 5 wks ago. Maxillofacial surgeon wants to try to force both the nose and arch into place. Is this realistic since the surgery will actually be 6 wks post injury? Cheek looks fine and he has no pain, is repair necessary? Surgeon will be making an incision in his palate. Could it make things worse? Nose has a bump on one side of bridge and tip points the other way.

William Portuese, MD · Answer

At 6 weeks  most bones are fairly well healed into place and will be very difficult to re-set them without osteotomies. As long as the zygomatic arch isn't creating a functional or cosmetic issues, it is best to leave it alone.The nasal fracture can be  repaired at any time, but will require osteotomies and shaving the hump down and straightening the tip.

Stephen Weber MD, FACS · Answer

Neither his cheek nor nasal fracture have to be treated. Six weeks is a long delay for closed reduction of either injury. There is a reasonable chance that any movement in the nasal or cheek bone will be short-lived without actually creating cuts (osteotomies) in the fracture (now healed) bones. Regardless of the timing the indications to fix the cheek bone fracture would be difficulty opening the jaw, discomfort or cosmetic deformity. It does not sound like any of these are occurring at this time. There is a small risk that as your son heals more fully swelling will resolve and unmask a deformity of the broken cheek bone.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Does a depressed fracture of the zygomatic arch need to be repaired if there is no pain or noticeable cosmetic change?

Answers (2)

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