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Dr. Barry Eppley

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‘Unwrapping’ Cheekbone (ZMC) Fractures


Facial fractures are a common injury and occur to the most prominent portions of the face in the vast majority of cases. These include the nose, cheeks, and jaw as frequent sites of facial fractures.. Blunt trauma is the most common cause with fists, falls, sporting activities and automobile accidents being the most common causes.

Cheek bone fractures, technically known as zygomatico-maxillary complex (ZMC) fractures, happen frequently. The cheek bone is less prominent than the centrally positioned nose but it is the most protruding structure on the side of the face and there are two of them.  The cheek bones are a unique facial bone because, although it is a sturdy stock of bone, it is attached to the eye superiorly, the upper jaw inferiorly and the temple posteriorly by relatively thin legs of bone. This is why it is often called a tripod fracture when it becomes broken. (even though technically there are four legs or attachments) Once impacted by enough force, the thinner legs break causing the body of the cheek bone to be pushed inward and usually downward as well. This flattens the cheek bone and causes a tremendous amount swelling and bruising, particularly around the eye area.

This appears to be the exact injury suffered recently by Food Network TV host, Marc Summers, in Philadelphia. This story drew my attention not only because of the recognizeable facial injury pattern but because I have always liked his well known show, ‘Unwrapped’. So to ‘unwrap’ his facial injury, the mechanism as he described the events of his injury is a classic example of what can cause a ZMC fracture. Rapid deceleration with his face planted right up against the glass partition of a cab in a rainstorm is how the accident happened.

Because it is a natural reaction to turn one’s head even in the split-second of the event, the side of the face where the cheekbone is prominent slams into an immoveable object. The legs of the cheekbone fracture, pushing it inward and down into the maxillary sinus. This was described as ‘wiping out half of my face’ which is somewhat accurate. Fortunately this is a blunt injury where the bone is fractured but no soft tissue is lost. Despite the magnitude of this facial fracture, it can be successfully repaired through an incision inside the mouth with or without an external lower eyelid incision. It requires the cheek bone to be repositioned and then held there to heal with small titanium plates and screws.

Many ZMC fractures can be very successfully repaired and patients can have a complete recovery with no long-term sequelae or facial deformity. It will takes about six weeks for the cheek and eye area to resolve all of its swelling and up to three months for all feeling to return to the skin and teeth. May we wish March Summers a speedy and full recovery and look forward to seeing him again on the show later this year.

Dr. Barry Eppley

Indianapolis, Indiana

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Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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