At UKRMED Clinic in Kyiv, displaced fractures of the zygomatico-orbital complex are assessed with facial examination and CT imaging. Treatment may involve reduction of the zygomatic bone, internal fixation with plates and screws, and, when the orbit is also affected, separate assessment of the orbital wall.
Facial swelling can hide quite a lot. After a blow to the cheek, one side may simply look bruised at first. Then other details begin to appear. The cheek feels numb. Looking upward produces double vision. Once the swelling settles a little, one cheekbone seems flatter than the other. Those findings can point to a displaced zygomatico-orbital complex fracture.
The zygomatic bone is part of the shape of the cheek, but it also contributes to the orbital rim and connects with several other bones of the midface.
That makes these fractures three-dimensional. A fragment can move backwards and reduce cheek projection. Another part of the fracture may involve the orbital rim or extend towards the zygomatic arch. The visible bruise is therefore only one part of the injury.
The surgeon also needs to know whether the orbit has changed shape and whether the displaced bone is affecting nearby nerves or eye movement.
Swelling makes facial symmetry difficult to judge during the first examination. CT provides a much clearer map. It can show the position of the zygomatic bone, fracture displacement, involvement of the orbital rim and whether the orbital floor is damaged. The infraorbital canal is another important landmark.
The nerve inside it supplies sensation to the cheek, side of the nose and upper lip. A fracture crossing this area helps explain why some patients describe the cheek as feeling “still numb from anaesthetic” long after the original injury. A 3D facial CT can also make the direction of displacement easier to understand when several fracture lines meet.
Reduction means returning displaced facial bone fragments to their intended anatomical position. With a zygomatic fracture, this involves more than pushing the cheekbone forward.
The surgeon checks several contact points around the zygomatico-orbital complex. Restoring cheek projection matters, but so does the relationship with the orbital rim and neighbouring midface structures. A small rotational error can become noticeable later, once the swelling disappears. So the final position is judged as part of the whole facial framework rather than as one isolated piece of bone.
After reduction, the fragments must remain where they have been placed. If the fracture is unstable, internal fixation may be used. Small titanium plates and fixation screws hold the reconstructed bone while healing takes place. The number of fixation points varies.
One injury may be stable after limited fixation. Another can involve several junctions of the zygomatic bone and need support in more than one area. The hardware has a straightforward role: maintain the restored facial geometry during bone healing.
This is where two related procedures are often confused. A zygomatico-orbital complex fracture can include an orbital floor fracture, but that does not automatically mean orbital reconstruction is required.
The surgeon looks at the size of the defect, eye movement, diplopia and the position of the globe. If the orbital wall needs reconstruction, that becomes an additional part of treatment rather than simply another fixation plate on the cheekbone.
This distinction matters because zygomatic fracture fixation and orbital floor reconstruction solve different problems.
The first days are dominated by swelling. Cheek numbness can persist for longer, especially when the fracture passes near the infraorbital nerve. Eye movement and diplopia are also followed when the orbit has been involved.
At follow-up, the surgeon looks at facial symmetry, the position of the cheek, wound healing and neurological symptoms. The final contour is easier to judge once the postoperative swelling has settled.
At UKRMED, treatment planning starts with the actual pattern of the facial fracture.Has the zygomatic bone moved backwards? Is the orbital rim involved? Is there diplopia? Has the cheek become numb? These details, together with the CT findings, determine whether fracture reduction alone is sufficient or whether internal fixation and orbital reconstruction should be considered.
Persistent double vision, cheek numbness, facial asymmetry or a visibly displaced cheek after trauma are reasons for a maxillofacial assessment rather than simply waiting for bruising to disappear.
It is a fracture involving the zygomatic bone and neighbouring structures that form part of the cheek and orbit.
The displaced bone is returned to an anatomical position, with attention to cheek projection, the orbital rim and the overall symmetry of the midface.
They keep the repositioned fragments stable while the facial bones heal.
The infraorbital nerve passes through this region. A nearby fracture can temporarily or, less commonly, persistently alter sensation.
No. The decision depends on the defect, eye movement, diplopia, globe position and CT findings.
Double vision, cheek numbness, visible asymmetry or a change in eye position after facial trauma should be assessed.
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