- Reference Number: HEY-139/2020
- Departments: Maxillofacial Department
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This leaflet has been produced to give you general information about your treatment. Most of your questions should have been answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.
What are fractures of the cheekbone?
Your cheekbone has been broken. 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 (figure 1) . The doctor who examined you has already established the number of fractures, where they have occurred and whether they need treatment to help them heal. There are occasions when no treatment is required and the doctor will advise you if this is the case.
Why do I need treatment?
There can be a number of reasons why the fracture requires treatment; the most common is to overcome flattening of the side of the face or to give a better chance of return of feeling to the cheek, nose and upper lip.
The treatment that is about to take place involves a general anaesthetic, i.e. you will be asleep during the operation.
Can there be any complications or risks?
Bleeding in and around the eye socket very rarely occurs (about one in a thousand) but when it does it can cause a problem with eyesight, which may lead to blindness following surgery. You will be closely monitored in the first few hours after your operation to make sure that if this happens it will be recognised and treated quickly. If you experience worsening vision or pain in and around your eye when you get home you should return to hospital immediately.
There is a nerve that runs through the cheekbone that supplies feeling to the cheek, the side of your nose, your upper lip, gum and teeth. This nerve may have been bruised at the time of the fracture and as a result you might already feel some tingling or numbness over your face. This tingling may also be caused or made worse by surgery if the nerve is stretched or bruised as the bone is moved. For most people once the fracture has been treated the numbness gets better on its own, although it may take months or even a year to do so. Some patients are left with numbness, or other feelings such as burning.
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 you get home this can usually be stopped by applying pressure over the site for at least 10 minutes with a rolled up handkerchief or gauze swab.
If a cut is made in the skin of the lower eyelid the outside 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 your 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. Sometimes they can be felt through the skin if they are close to the surface, in which case they sometimes give rise to an ache in cold weather.
How do I prepare for the operation?
Please read the information leaflet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this operation.
Once you are 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. It may be necessary to shave a small area of hair. Sometimes a straight-forward lift of the bone is all that is required, but if the surgeon does not feel that your 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, or insert a metal pin through the bone and inside of the nose.
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 teeth.
- A cut made in the skin crease just below the lower eyelashes, or in a crease below the eyelid, or on the inside of the lower eyelid.
- A cut in the cheek.
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.
What will happen?
You will be given a letter detailing where you should attend, starving instructions and the time to report to the ward. Staff on the ward will greet you and show you round. You will be seen by the Doctor and possibly the anaesthetist. The type of anaesthetic you will be having is called a general anaesthetic. You will be prescribed pain relief to manage any pain you may suffer following the operation.
What happens afterwards?
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 your eye socket to support the eyeball. If this is known in advance the graft material that is going to be used will be discussed with you before you sign any consent form for your operation, but thin sheets of plastic, metal mesh, or bone grafts from other areas of your body may be used.
It is likely to be sore and regular pain relief medication will be arranged for you. 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 give you antibiotics, particularly if a “graft” has been used. Initially it may be necessary to give you antibiotics through a vein in your arm whilst you are in hospital. You will be sent home with pain relief medication 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 the first day after the surgery and have very much reduced by the end of the second week. Swelling and bruising can be improved by using cold compresses.
The usual stay in hospital is for one night following the surgery. If there is uncertainty about the position of the bone the following day it may be checked with X-rays before you are allowed home. If the bone is not in a satisfactory position it may be necessary to re-operate.
Even if the position of the fractured bone has been held with plates and screws it still takes about six weeks for your cheekbone to heal completely. During this time you need to be careful to avoid an injury to this side of your face, since it may well push the cheekbone back out of position again. You should also avoid blowing your nose for two weeks following surgery because otherwise this can produce swelling in and around the eye.
Before you leave hospital an appointment will be arranged for you to be seen in the outpatient department to take out any stitches and for review. It is important to keep any stitches or dressings dry until they are removed. If you have any incisions inside your mouth it may be difficult to clean your teeth around stitches because it is sore. It is best to keep the area free from food debris by gently rinsing your mouth with a mouthwash of hot salt water (dissolve a flat teaspoon of kitchen salt in a cup of hot water) commencing on the day after surgery after meals.
Depending on the nature of your work it may be necessary to take a fortnight or so off, and to avoid strenuous exercise for this time. Some sports with a high risk of facial injury should not be performed for up to three months.
It is important to remember that you will not be able to drive or operate machinery for 48 hours after your general anaesthetic.
Some of information included in this leaflet has been provided by the https://www.baoms.org.uk/patients/procedures/
Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Maxillofacial Unit (01482) 463218
General Advice and Consent
Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.
Consent to treatment
Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.
The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:
- you must be able to give your consent
- you must be given enough information to enable you to make a decision
- you must be acting under your own free will and not under the strong influence of another person
Information about you
We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.
We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.
Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.
If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.