Zygomatic Arch Fracture/Injury

[martinarcher]

Hey all. We were boarding yesterday and I've been nailing my fakie heelside W2W 180's. I was practicing them yesterday and came down funny. I knew it was off, but wasn't too worried about it as I had completed the rotation. I was just a bit too far on my toe edge as a landed in the flats. I had crouched to take up the shock of the landing, but when the toe edge caught I was underwater before I knew it and my knee collided hard with my right cheekbone. I didn't go lights out, just lots of pain and stars as I rolled onto my back. Everyone in the boat was talking about crash style points since they thought it was a cool looking wipeout. They had no idea I was hurt until they pulled up to me holding my face and checking for all my teeth.

We put ice on it as soon as I got back in the boat. I could feel a ridge of what felt like a bone poking up that runs from the corner of my right eye down the edge of the right side of my nose. We all figured I had broke a bone in my face. I was in some pretty wicked pain so my buddy drove the boat back to the dock - first time that has ever happened! I did back the truck in, but let him drive it home as I was close to passing out twice while we dried the boat off and put the boards back in the truck.

Once we got home we were going to head to the ER, but we swung by my buddies uncles place who is a doc and had him look at it. He didn't think the Zygomatic Arch was broken, but could feel the ridge and thought is was just some sort of trauma to the flesh along the nose that had swelled. He didn't think I had a concussion and recommended ice for 24 hours (I still had a pack on my cheek at this point) and to have my wife wake me up every two hours throughout the night.

This morning it felt a little better, but I got a ton of blood out of my nose when I blew it. I went into a local MedExpress clinic and had it X-Ray'ed today. The doc didn't think it was terribly serious, but she said the x-rays were hard to read and that the head is a tough thing to x-ray. I got copies of the x-rays and have trouble seeing much of anything. She is having the Radiologist look at it in the morning and will call if I need a CT scan.

I've had no double or blurred vision, but the one thing that worries me is my top right teeth have all been numb since the accident. Hopefully that will go away with time and that my Zygomatic arch isn't really fractured. The doc seemed to think even if it is it wouldn't be serious enough to require surgery. I might loose some weight as it sure hurts to chew!

Anyone had a similar injury....what kind of recovery time?

Thanks guys.....oh if someone wants to peek at he X-rays they are here.

[Sixball]

I have smashed my head into my knee hard but no lasting injuries. Hope all goes well. The X-Rays are very hard to read but I am no doc. Don't think I have ever seen a whole head X-Ray.

[martinarcher]

Thanks man! I hear ya - I spent about an hour looking at those x-rays and they are sure tough to read with the amount of bones and complexity of the human head. I'm looking forward to hearing what the Radiologist says tomorrow. Hopefully good news!

[G-Mack]

yep... fractured mine in an industrial incident (not accident) as a 19 year old. No surgery required... Every injury is different but my numbness took a while- 3-4 months to overcome. first the trauma needs to settle down and then nerves are a wild card as they can recover after swelling is down or ..they do regenerate just random on how and when....

my own experience anyway... I don't think about the injury much anymore and your post reminded me and I went back to felt the divot in my orbital bone under my eyebrow that also happened.

I am a walking advertisement for the value of safety glasses and the hazard to new workers who don't have the knowledge to mange safety risks.

Good luck on your recovery!

[martinarcher]

yep... fractured mine in an industrial incident (not accident) as a 19 year old. No surgery required... Every injury is different but my numbness took a while- 3-4 months to overcome. first the trauma needs to settle down and then nerves are a wild card as they can recover after swelling is down or ..they do regenerate just random on how and when....

my own experience anyway... I don't think about the injury much anymore and your post reminded me and I went back to felt the divot in my orbital bone under my eyebrow that also happened.

I am a walking advertisement for the value of safety glasses and the hazard to new workers who don't have the knowledge to mange safety risks.

Good luck on your recovery!

Thanks for sharing. I figured it was very accident specific. Glad to hear your feeling returned. Was your cheek numb or you teeth on that side? My cheek has pretty good feeling (aka it hurts. ), but the top right row of teeth are almost totally numb. Feels pretty weird brushing my teeth.

I don't think mine is serious enough to require any surgery. The doc seemed pretty positive about it so that's good.

Enjoying a big ole bowl of soup and some pudding for lunch....chewing is out for at least a few days.

[WakeGirl]

I think that I'd be tempted to follow up with a specialist that knows what to look for in these things. When I did my foot a few years ago, the ER told me that nothing was broken & sent me home with a prescription for Percocet. But when I followed up with a foot ortho a few days later, I had broken just about everything possible in the foot, spent 2 surgeries & the next 4 months on crutches. Mine isn't the first story that I've heard like that either. I say that not so much to scare you, but to drive the point home. Those ER docs don't know what to look for in specific cases.

[martinarcher]

I think that I'd be tempted to follow up with a specialist that knows what to look for in these things. When I did my foot a few years ago, the ER told me that nothing was broken & sent me home with a prescription for Percocet. But when I followed up with a foot ortho a few days later, I had broken just about everything possible in the foot, spent 2 surgeries & the next 4 months on crutches. Mine isn't the first story that I've heard like that either. I say that not so much to scare you, but to drive the point home. Those ER docs don't know what to look for in specific cases.

Wow - I remember seeing pics of your foot! I can't believe they gave you pain killers and just sent you home!

I guess this injury would fall under an ear nose and throat doc or oral surgeon? I guess a facial fracture would fall in one of the two categories. At this point I'm more worried about my teeth than anything. I can't wait until the numbness goes away....just scared of loosing them due to root damage - I hate the dentist!

[WakeGirl]

Wow - I remember seeing pics of your foot! I can't believe they gave you pain killers and just sent you home!

I guess this injury would fall under an ear nose and throat doc or oral surgeon? I guess a facial fracture would fall in one of the two categories. At this point I'm more worried about my teeth than anything. I can't wait until the numbness goes away....just scared of loosing them due to root damage - I hate the dentist!

I'm not sure what the specialist would be, but your primary care doc would know where to send you. Probably best to check in with them & figure out how to proceed.

Here's hoping that it's something that will heal up on its own.

[RTS]

I guess this injury would fall under an ear nose and throat doc or oral surgeon? I guess a facial fracture would fall in one of the two categories.

I lost a softball that was thrown to me (hard) in the sun and it hit me in the side of the face. My arch was fractured as was my orbital socket. I now have a stainless plate just below my eye for the orbital. But the arch healed fine on its own. Left side of my face is still numb some 15 years later. I am used to i t now. I was told feeling may come back or may not. Mine did not.

But the ER Doc sent me to a reconstructive plastic surgeon, who went in to do the surgery on the line that my eyelashes follow, so you can not see the scar. If you need surgery, I would seek out the same.

Plus, you get to look at the nice before and after pictures of the 'augmentation' of the ladies in the waiting room in the doctors 'brag book'

Hope you heal up well and don't require surgery.

Edited August 2, 2011 by RTS

[martinarcher]

Thanks all.

RTS - it sure sounds like you had it a lot worse than I do right now. Sorry to hear about your accident!

I'm pretty sure my face will heal on it's own without any surgery. I'm not in any major pain so I'm going to let it roll for a week or so and see how it heals. Aesthetically, you cannot tell I had any facial injury except for some broken blood vessels in my right eye. The ridge along my nose is the only detectable "bone" injury. I'll just keep good tabs on my tooth numbness. I've been reading a lot and it seems like tooth numbness is common when trauma occurs to the tissue around the teeth. After the tissue begins to recover we'll see what happens.

[NorCaliBu]

Not many people can see they broke their face.

Couldn't resist.

[martinarcher]

Not many people can see they broke their face.

Couldn't resist.

I can!

[RTS]

I can!

Me, too.

My claim to fame is that I finished out the inning. I was totally out of it and seeing stars, feeling NO pain, probably in shock. Then, when it was time to take the field the next inning, I was yelling at my buddy to find my glove....which was on my hand. Thats when they decided I should maybe be taken to ER.

Martin. it doesn't take too much to bust the blood vessels in your eye, and if you are not in much pain a day later, you are probably healing up OK.

[BREZ]

Go to the doctor or a specialist. I know a guy who was in a car accident and they thought he just had a concussion after goimg to the ER. He was gone in a week. Not trying to scare you but there are only so many of us left in the square windshield club!

[martinarcher]

Me, too.

My claim to fame is that I finished out the inning. I was totally out of it and seeing stars, feeling NO pain, probably in shock. Then, when it was time to take the field the next inning, I was yelling at my buddy to find my glove....which was on my hand. Thats when they decided I should maybe be taken to ER.

Martin. it doesn't take too much to bust the blood vessels in your eye, and if you are not in much pain a day later, you are probably healing up OK.

Oh man - that is a riot. I'm feeling decent today. Not too much pain in my face except for when I try to chew. My teeth are still pretty numb (most feeling since the accident), but man if I put pressure on the teeth - ouch!

I actually had the dentist call today to remind me that tomorrow morning is my 6 month appointment.....good timing! Hopefully my roots are OK and the pain is just temporary. That's my biggest fear now - I hate the dentist. Novocain shots and I don't get along!

[martinarcher]

Go to the doctor or a specialist. I know a guy who was in a car accident and they thought he just had a concussion after goimg to the ER. He was gone in a week. Not trying to scare you but there are only so many of us left in the square windshield club!

I don't think I had any concussion at all with this accident as most of the damage and pain is in my cheek/teeth, but I really appreciate your concern. So far I've seen two docs, had a radiologist look at full head xrays (she didn't think it was broken after talking with her today), and tomorrow is the dentist. I should be good to go...I'm not leaving the square windshield club any time soon if I can help it!

[martinarcher]

Well check the specialist off the list....

I went to the dentist this morning at 8AM for a routine cleaning and he immediately sent me to his oral/facial surgeon/specialist after feeling the ridge on my nose and seeing my bloody eye. I have two teeth not responding to cold and have a re-visit appointment in 2 weeks to see if they recover. The dentist too a close up xray of the teeth and none are fractured. He also took a panoramic shot.

Got to the surgeons office around 9:30. He took another couple panoramic xrays. After feeling my face he told me he was positive I had a right tripod floor fracture. He began to talk about the surgery required to correct the fracture. I asked the risks of not doing the surgery. He said they were mostly cosmetic, but his concern for my was if the bone was disjointed enough to affect my orbital socket and the eye itself. I told him if the eye is not affected - no surgery for me. I can't tell any difference between the two sides of my face so the cosmetic reason is out. His assistant thought my right cheek was a bit lower than the left, but I can not tell and neither can my wife.

I hit the hospital at 11:00 for the CT Scan. I asked the tech how the images looked and she told me it looks like a surgery required fracture. She said my cheek is full of blood, but that should dissipate on it's own. I waited 20 minutes to get my images on a CD and she called my back in for another CT scan as the original did not come out well. I told her I would stop by tomorrow for the images as I needed to get to work.

On the way to work the specialist called my cell after reviewing the CT scan and he confirmed the fracture in the zygoma (tripod floor fracture) and said I also have a nasal bridge fracture. He said neither are disjointed enough to affect my eye or require surgery. What an answered prayer! I've been praying like crazy about this and the Great Physician answered my prayer! I had been so bummed since leaving the dentist. What great news!

He said soft food only for 4-6 weeks and no impact activities (surfing is cool right. ). He continued asking about my eye to verify I hadn't had any blurry or double vision or any dizziness/fainting. I confirmed I had had none of these symptoms. He told me I was very lucky and not the normal case as we hung up.

[LouDoc]

Glad to hear things are looking up for you! I was interested in your story being that I am an ENT (Otolaryngologist/Head and Neck Surgeon) that both performs and teaches surgery for injuries just like yours! If your fractures are non-displaced then I would actually say that surfing would be ok. (As long as you're accomplished enough not to be face planting onto the platform!) I wouldn't wakeboard or slalom if I were you but I haven't seen a surf fall that had the kind of impact needed to displace a zygoma fracture. A good way to look at the cosmetic defect that may occur is to sit in a recliner and have your wife look from above your head. When you view from above an asymmetry becomes more apparent, especially when focusing on the cheekbone projection just below the eyes. Sometimes, soft tissue swelling will cause things to look symmetric only to have the cheek flatten over time as the swelling resolves. If you'd like, I could review your CT scan and give you a second opinion- just PM me.

[Bill_AirJunky]

Congrats Matt. Sounds like you scored big. Better go buy a lottery ticket tonite!

[aldawg1234]

I had a friend who tore her meniscus landing wrong. took her three surgeries to fix it and she can't go wake to wake any more. she was on crutches for a year, and was unable to do any sports with her legs for three years. talk about stupid doctors.

[Scotty's Sporty]

Damn Matt, what are you doin over there in PA? You better tell DeShlong to keep a better eye on you and quit shopping for speedo's! Until next years WOW of course, when him and I will both be rockin speedo's ridin double!

[martinarcher]

Glad to hear things are looking up for you! I was interested in your story being that I am an ENT (Otolaryngologist/Head and Neck Surgeon) that both performs and teaches surgery for injuries just like yours! If your fractures are non-displaced then I would actually say that surfing would be ok. (As long as you're accomplished enough not to be face planting onto the platform!) I wouldn't wakeboard or slalom if I were you but I haven't seen a surf fall that had the kind of impact needed to displace a zygoma fracture. A good way to look at the cosmetic defect that may occur is to sit in a recliner and have your wife look from above your head. When you view from above an asymmetry becomes more apparent, especially when focusing on the cheekbone projection just below the eyes. Sometimes, soft tissue swelling will cause things to look symmetric only to have the cheek flatten over time as the swelling resolves. If you'd like, I could review your CT scan and give you a second opinion- just PM me.

Thanks a lot - I really appreciate your offer. I'll be picking up a CD with the CT scan on it tomorrow and would love to have you take a peek at it. I have a Triple X Slasher surfboard that should be here Thursday so it sounds like I'll get to know it pretty well over the next 4-6 weeks. I agree - I'd be too chicken to ski or board with my fracture as the risk is way too high of displacing the fractured zygoma. I appreciate you following the thread and giving your advice. Your exactly who I wanted to hear from!

PS - I had her do the top down view and she said my right cheek is slightly "smaller" than the left, but she said she'd still keep me. She said there is very little difference in the two, but just enough to notice. We still can't tell from the front.

Congrats Matt. Sounds like you scored big. Better go buy a lottery ticket tonite!

I know it! Certainly good news!

I had a friend who tore her meniscus landing wrong. took her three surgeries to fix it and she can't go wake to wake any more. she was on crutches for a year, and was unable to do any sports with her legs for three years. talk about stupid doctors.

Bummer man. That really sucks. Is she recovering better now that she's off crutches. A year without exercising your legs would be a big set back for your muscles. I can't imagine.

I'm a weenie when it comes to surgery and very happy I made out OK. I'm a diabetic and inject myself with needles all the time, but still get light headed when having blood drawn. Got pretty white in the chair today as the doc explained the "pop the cheek bone" procedure to me. If it were him talking about anyone's face but mine I'd be fine. I just turn white get light headed and sometime....lights out.

[martinarcher]

Damn Matt, what are you doin over there in PA? You better tell DeShlong to keep a better eye on you and quit shopping for speedo's! Until next years WOW of course, when him and I will both be rockin speedo's ridin double!

I guess I was shredding too hard without you guys to watch me. The funny thing is he wasn't even int he boat when it happened! His bro was driving and my wife and his were talking. His bro is the only one that saw the whole crash.

I'll have the camera ready!

[WakeGirl]

If you don't have to have surgery, that's a good thing. But I am relieved that you got checked out by a specialist & had the CT, I've been a bit worried about you. Nothing against ER docs & gen practitioners, but they don't have the training to see this stuff. Knowing for sure what you're up against is worth the little bit of time & trouble that it took to get checked out. I'm very happy that the worry was for nothing.

[martinarcher]

If you don't have to have surgery, that's a good thing. But I am relieved that you got checked out by a specialist & had the CT, I've been a bit worried about you. Nothing against ER docs & gen practitioners, but they don't have the training to see this stuff. Knowing for sure what you're up against is worth the little bit of time & trouble that it took to get checked out. I'm very happy that the worry was for nothing.

Thanks WG - I really appreciate the concern. Sorry to make you worry! I certainly didn't mean that! Gotta love the Bu crew - this place is like family!

You are certainly right. Being examined by the facial surgeon was a whole different ball game. He knew exactly what was wrong with me by just examining my face. Very different examination than the ER doc. You are right, they just simply don't have the specific knowledge for those special cases.

Edited August 4, 2011 by martinarcher