How to Diagnose a Fractured Cheekbone

The cheekbone is more formally known as the zygomatic bone and forms an important part of the aesthetic appearance of the facial skeleton. It provides the contour of the cheek and separates the orbit maxillary sinus and temporal fossa. A fracture of the cheekbone is a common type of facial fracture, second only to nasal fractures.

Difficulty: Moderate

Instructions

1. Take Computed Tomography (CT) scans as the standard imaging tool for making an accurate preoperative diagnosis of cheekbone fractures. The images may be continued through the facial bones if there is a high suspicion of a facial fracture.

2. Use modern a helical CT scanner to take 1 to 1.5 mm axial images. High resolution coronal and sagittal cuts will allow the patient to avoid neck extension and flexion.

3. Refer the patient for an ophthalmologic evaluation to test visual acuity if there is a significant disruption of the bony orbit.

4. Perform a forced-duction test to detect any mechanical restriction of the eyes. This test should be performed on each eye with a comparison made between them. General anesthesia is usually required for accurate testing.

5. Use surgical exploration if needed for patients with significant orbital disruption. A transmaxillary endoscopy is a newer technique used to evaluate the integrity of the orbital floor. If this procedure is not available, a lid or rim incision may be needed at the time of surgery to determine the extent of the disruption.

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