Repositioning, miss zygomatic-orbital complex

The zygomatico-orbital complex is the cheekbone, the zygomatic arch and the walls of the orbit, which support the cheek and form the "floor" beneath the eye. A zygomatic bone fracture changes the facial contour, and an orbital fracture can affect eye position and vision. At UKRMED Maxillofacial Surgery, these injuries are treated by maxillofacial surgeon Anna Kravchenko: reduction and plate fixation restore facial symmetry and function.

Signs of a zygomaticomaxillary complex fracture

• a flattened cheek and facial asymmetry;
• swelling and bruising around the eye, bleeding into the white of the eye;
• numbness of the cheek, upper lip, side of the nose and upper teeth;
• double vision, limited eye movement or a "sunken" eye;
• pain and difficulty opening the mouth with a zygomatic arch fracture;
• a "step" below the lower eyelid.

Numbness comes from injury to the infraorbital nerve, which runs through the cheekbone. A 2025 meta-analysis of more than 1,300 patients found this nerve injury in about every second patient with a zygomaticomaxillary complex fracture, and early surgical decompression — within two weeks of the injury — gave better sensory recovery than waiting.

Diagnosis

A thin-slice CT scan is essential: it shows every fracture line, displacement, the orbital walls and the maxillary sinus. With double vision or worsening sight, an ophthalmologist is consulted.

When surgery is needed

Undisplaced fractures are often treated conservatively. Orbital fracture surgery or cheekbone fixation is indicated when:

• the face is visibly deformed and the cheekbone is flattened;
• there is double vision, restricted eye movement or enophthalmos;
• fragments block mouth opening;
• the orbital floor defect is large.

A 2025 systematic review of isolated orbital floor fractures found that both conservative and surgical treatment can give good results, with the choice depending on symptoms, defect size and the surgeon's experience. After surgery, enophthalmos was corrected in 85% of cases and double vision in 75%.

The operation

1. General anaesthesia.
2. Access through inconspicuous incisions — inside the mouth, at the eyebrow edge, below the lower eyelid.
3. Reduction of the cheekbone and arch.
4. Fixation with titanium miniplates at several points.
5. If needed, orbital floor reconstruction with a plate or mesh (orbital reconstruction).

Recovery

Swelling and bruising last one to two weeks. Do not blow your nose hard, do not lie on the injured side, and avoid exertion and flying until allowed. Cheek sensation returns gradually, sometimes over several months.

Possible complications

• Numbness of the cheek, side of the nose and upper lip — due to injury of the nerve that exits below the eye. It usually resolves gradually.
• Double vision — in the first weeks due to swelling; if it persists, the orbit is reassessed and an ophthalmologist is involved.
• Sunken eye — possible with a large orbital floor defect, which is why the floor is repaired during surgery.
• Cheekbone asymmetry — with imprecise reduction or late treatment; this is why surgery is best done within the first one to two weeks.
• Limited mouth opening — if a fragment of the zygomatic arch presses on the jaw; it resolves after reduction.
• Infection — rare.

Prices at UKRMED

The surgeon gives the cost after the CT scan, depending on the extent of surgery.

Sources

1. Mehta U. B., Londhe U., Bhate K. et al. Evaluating infra-orbital nerve injury in zygomaticomaxillary complex fractures: a systematic review and meta-analysis. Front Oral Health, 2025. https://doi.org/10.3389/froh.2025.1726808
2. Miran B., Toneatti D. J., Schaller B., Kalaitsidou I. Management Strategies for Isolated Orbital Floor Fractures: A Systematic Review of Clinical Outcomes and Surgical Approaches. Diagnostics (Basel), 2025. https://doi.org/10.3390/diagnostics15233024
3. AO Foundation. AO Surgery Reference: CMF trauma. https://surgeryreference.aofoundation.org/cmf/trauma