This webpage has been designed to improve understanding of Fractured Cheekbones and contains answers to the most commonly asked questions about this treatment. If you have any other questions that the website does not answer or would like further explanation please ask a member of our medical staff.

The problem
The cheekbone forms part of the eye socket, both protecting the eyeball and supporting it from below. It is also linked to the side of the nose and the upper jaw. The doctor who examined the broken cheekbone has already established the number of fractures, where they have occurred and whether they need treatment to help them heal. The treatment that is about to take place involves a general anaesthetic (i.e.: the patient is going to be put to sleep completely).

What does the operation involve?
Once the patient is asleep the cheekbone will be put back in the right place. This usually involves a small cut about an inch long through the hair in the temple. Sometimes this is all that is required but if the surgeon does not feel that the cheekbone will stay in the correct position on its own it may be necessary to hold it in place with small metal plates and screws. Putting these plates and screws into the cheekbone may require one or more alternative incisions:

		A cut made close to the outside end of the eyebrow
		A cut made on the inside of the mouth through the gum above the back teeth
		A cut made in the skin crease just below the lower eyelashes or on the inside of the lower eyelid

These incisions are put back together again at the end of the operation with stitches. Stitches on the skin need to be removed after a week but any stitches inside the mouth are usually dissolvable although they can take a fortnight or even longer to fall out.

Will any further treatment be performed when the patient is asleep?
Some fractures of the cheekbone produce a break in the floor of the eye socket that needs attention. In such cases a cut on the inside / outside of the lower eyelid is necessary as described above. Occasionally the bones in the floor of the eye socket are shattered and do not support the eyeball properly even if they are put back in the right position. In these circumstances it may be necessary to “graft” the floor of the eye socket to support the eyeball. The graft material that is going to be used will be discussed with the patient before they sign any consent form for the operation but can involve thin sheets of plastic or bone grafted from other areas of the body.

What can be expected after the operation?
It is likely to be sore and regular painkillers will be arranged. The discomfort is usually worse for the first few days although it may take a couple of weeks to completely disappear. Cheekbone fractures usually heal without infection but it may be necessary to take antibiotics, particularly if a “graft” has been used. Initially it may be necessary to give the patient antibiotics through a vein in their arm whilst they are in hospital. Patients will be sent home with painkillers and a course of antibiotics if necessary.

There is a variable amount of swelling and bruising in the skin around the eyelids. Occasionally the whites of the eyes may become bruised giving them a red appearance. All these changes are most noticeable in the first 24 hours after surgery and have very much reduced by the end of the second week. Swelling and bruising can be improved by using cold compresses and sleeping propped upright for the first few days after surgery.

Patients usually stay in hospital for one night following the surgery. The following day the position of their cheekbone may be checked with X-rays before they are allowed home.

Even if the fracture has been held in the right place with plates and screws it still takes around six weeks for the cheekbone to heal completely. During this time patients need to be careful to avoid an injury to this side of their face since it may well push the cheekbone back out of position again. Patients should also avoid blowing their nose on the side of the fracture for a month following surgery because otherwise this can produce swelling in and around the eye.

Before patients leave hospital an appointment will be arranged to take out any stitches and review them in the outpatient department. It is important to keep any stitches or dressings dry until they are removed. If the patient has any incisions inside the mouth it may be difficult to clean their teeth around stitches because it is sore. It is best to keep the area free from food debris by gentling rinsing the mouth with a mouthwash or warm salt water (dissolve a flat teaspoon of kitchen salt in a cup of warm water) commencing on the day after surgery.

Does this procedure require any time off work?
This varies enormously from person to person and depends on what kind of work they do. We recommend that most people have around a week off work if they are having just a genioplasty carried out. It is important to remember that patients will not be able to drive or operate machinery for 48 hours after general anaesthetic.

What are the possible problems?

		There is a nerve that runs through the cheekbone that supplies feeling to the cheek, side of the nose and upper lip. This nerve may have been bruised at the time of the fracture and as a result patients might already feel some tingling or numbness over their face. This tingling may also be caused or made worse by surgery. In the majority of people the numbness gets better on its own although it may take several months to do so.
		Any cuts made on the face will produce a scar but these should fade with time and after a few months are usually difficult to see.
		Bleeding from the incisions is unlikely to be a problem but should the area bleed when the patient gets home this can usually be stopped by applying pressure over the site for at least 10 minutes with a rolled up handkerchief or swab.
		Bleeding in and around the eye socket can very rarely cause a problem with the eyesight immediately following surgery. Patients will be closely monitored in the first few hours after their operation to make sure that if this happens it will be picked up quickly. If the patients experience worsening vision or pain in and around the eye when they get home they should return to hospital immediately.
		If a cut is made in the skin of the lower eyelid the outside corner of the lid may occasionally be pulled down slightly (an ectropion). This tends to settle on its own but may need further surgery.
		If it has been necessary to put any plates or screws in the cheekbone to hold it in position these are not normally removed because they tend not to cause problems unless they become infected. The metal that is used is titanium, which does not set off metal detectors in airports etc.

Will further appointments be required?
A review appointment will be arranged before the patient leaves hospital. It is usual to keep a close eye on the patient for several months following treatment to make sure that the fracture heals uneventfully.

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